Soft palate reconstruction after radionecrosis: Combined anterolateral thigh adipofascial and nasoseptal flaps.
Auris Nasus Larynx. 2017 Nov 13;:
Authors: Zenga J, Sharon JD, Gross J, Gantz J, Pipkorn P
Although radiation-based treatment for nasopharyngeal cancer may achieve excellent long term oncologic results, late effects of therapy may lead to soft tissue radionecrosis and velopharyngeal insufficiency (VPI). Repair of these oro- and nasopharyngeal defects presents a complex reconstructive challenge. We present a case of a long-term survivor treated with chemoradiotherapy for nasopharyngeal cancer who developed progressive dysphagia, velopharyngeal insufficiency, and radionecrosis of the nasopharynx and soft palate, leading to tracheostomy and gastrostomy tube dependence. A staged reconstruction was performed, initially with a tubed nasoseptal flap for a creation of a mucosal-lined nasopharyngeal port. An adipofascial anterolateral thigh free flap was subsequently performed for soft palate reconstruction. Within 2 months, the oropharyngeal reconstruction had remucosalized and she was decannulated, taking an oral diet. Her speech was intelligible and she had good nasal breathing without symptoms of velopharyngeal insufficiency.
PMID: 29146179 [PubMed - as supplied by publisher]
High Flow Nasal Cannula Oxygen in Adults: An Evidence-Based Assessment.
Ann Am Thorac Soc. 2017 Nov 16;:
Authors: Drake MG
High flow nasal cannula oxygenation has distinct advantages over other oxygen devices due to its unique effects on respiratory physiology. In particular, adjustable oxygen delivery and flow-dependent carbon dioxide clearance from the upper airway reduce work of breathing and can better match inspiratory demand during respiratory distress. Historically, few studies had evaluated whether the physiologic effects of these devices translated into clinical benefit. However, recent publications have begun to address this knowledge gap. High flow nasal cannula oxygenation has been shown to have similar, and in some cases superior, clinical efficacy compared to conventional low flow oxygen supplementation and non-invasive positive pressure ventilation in acute hypoxemic respiratory failure. High flow nasal cannula oxygenation also prevents reintubations in medical and post-operative surgical populations, and has been used to provide pre-oxygenation for laryngoscopy and to support oxygenation during bronchoscopy. This review evaluates recent evidence for high flow nasal cannula oxygenation in adults, including its physiological effects and clinical indications. Since many clinical indications have not been studied, clinicians and physiologists must have a thorough understanding of device titration to tailor therapy for specific clinical scenarios.
PMID: 29144160 [PubMed - as supplied by publisher]
Association between allergic and nonallergic rhinitis and obstructive sleep apnea.
Curr Opin Allergy Clin Immunol. 2017 Nov 14;:
Authors: Zheng M, Wang X, Zhang L
PURPOSE OF REVIEW: Allergic rhinitis and nonallergic rhinitis (NAR) are common disorders, which have been considered as potential risk factors for obstructive sleep apnea (OSA). This review summarizes the proposed underlying pathophysiological mechanisms to provide a better understanding of the relationship between these conditions.
RECENT FINDINGS: In adults, allergic rhinitis and NAR may be considered as symptoms potentiating, rather than risk potentiating factors in the pathophysiology of OSA, whereas in children, these are considered to be independent predictors for sleep-disordered breathing (SDB) and failure of adeno-tonsillectomy, the recommended first-line therapy for children with OSA. Current advances suggest IL-6 may be important in regulating the sleep-wake cycle, and serum soluble IL-6 receptor (sIL-6R) levels may reflect the severity of OSA. Elevated Th17/Treg ratio correlates positively with apnea-hypopnea index of OSA patients, and Th17 and Treg imbalances caused by allergic rhinitis and OSA, respectively, may possibly promote each other, leading to further imbalance. Moreover, obesity is a strong risk factor for OSA, and leptin plays an important role in ventilatory function and upper airway obstruction. The variant trigeminocardiac reflex and nasotrigeminal reflex may also be involved in the association between rhinitis and OSA.
SUMMARY: Allergic rhinitis/NAR and OSA are closely associated, and each condition can be detrimental to the other. Thus, clinicians should pay attention to the potential presence of allergic rhinitis/NAR in OSA patients and vice versa.
PMID: 29135515 [PubMed - as supplied by publisher]