[Surgical treatment of severe sleep apnea syndrome by maxillomandibular advancing or mental tranposition].

Surgery of the facial skeleton or the tongue may be envisaged in case of failure of continuous positive pressure ventilation for severe sleep apnea syndrome defined by a apnea-hyponea index greater than 30/h. We present here our results in patients treated by maxillo-mandibular advancing and mental transposition. We define the surgical indications.

[Hypoglossal nerve in its intralingual trajectory: anatomy and clinical implications].

There is little literature on the intralingual trajectory of the hypoglosal nerve. We performed an anatomical dissection on 6 cadavers and completed our study with histological examinations. The 12th cranial nerve enters the lower part of the tongue laterally, reaching the anterior border of the hypoglossal muscle where it follows the ascending lingual artery medially to terminate anteriorly to the lingual V.

Tongue base reduction with hyoepiglottoplasty: a treatment for severe obstructive sleep apnea.

Objective: To describe a surgical procedure for the treatment of severe obstructive sleep apnea syndrome (OSAS), the procedure's indications, and its results.

Study Design: A retrospective study of 10 male patients with OSAS treated by tongue base reduction with hyoepiglottoplasty (TBRHE) at the Foch Hospital (Suresnes, France) between 1994 and 1997. Patients had a mean body mass index (BMI) of 32 kg/m2, a mean respiratory disturbance index (RDI) of 70 events/h, and a mean minimal oxygen saturation of 78%.

[Tongue base reduction with hyoid-epiglottoplasty. A surgical alternative in severe sleep apnea syndromes].

We present preliminary results and indications of tongue base reduction with hyo-epiglottoplasty for the treatment of severe obstructive sleep apnea syndrome (OSAS) due to isolated hyolingual abnormalities. The procedure consists in a subtotal resection of the tongue base after identification and derouting of the lingual neurovascular bundle. Hypopharyngeal enlargement, epiglottis verticalization, floor of the mouth tension and hyoid bone repositioning are also performed during the procedure.

[Long-term results of surgical pharyngectomy (uvulo-palato-pharyngoplasty) versus office CO2 laser (L.A.U.P.) for the treatment of uncomplicated snoring].

Two treatments are habitually proposed for snoring without obstructive sleep apnea syndrome: the surgical pharyngotomy, and the treatment by laser done in the office. Our study analyses retrospectively, by telephone questionnaire, a group of 168 snorers, without obstructive sleep apnea syndrome, treated by pharyngotomy (n = 71) or CO2 laser (n = 97) between 1989 and 1993. Results after a mean follow-up of 5 years, with a minimal of 3 years, show for the two procedures the same efficacity, and an equivalent prevalence of side effects.

[Frontal mucoceles of orbital or cerebral extension: therapeutic strategy].

The aim of this study was to investigate ten patients who underwent surgery for mucoceles of the frontal sinus. Bicoronal direct access was required by the localization of the mucocele limited to the frontal sinuses, its extension to the orbit and/or the brain and because of the anatomy of the frontal sinuses (large size, lateral horn..

[Treatment of velopharyngeal stenosis after pharyngotomy for chronic snoring. Apropos of 13 cases].

Velopharyngeal stenosis is a rare complication of pharyngotomy (UPPP) for chronic snoring. Its treatment is hard because of its recidivant feature. The aim of this study was to determine a therapeutic strategy accorded to each stenosis from clinical and anatomical features of 13 velopharyngeal stenosis.

[A new technique of gene transposition in the surgical treatment of sleep apnea syndrome].

Pharyngotomy appears to be insufficient for the treatment of severe sleep apnea. For patients who refuse or abandon mechanical ventilatory assistance, surgery can be used to widen the retrobasilingual space adapting it to the cephalometric profile defined by cineradiography and MRI in combination with velopharyngeal plasty. For patients with no maxillomandibular or lingual malformation, the pharyngotomy can be combined with an anterior transposition of the genial insertions of the tongue without rotation.

[Analysis of results of pharyngotomy in the surgical treatment of sleep apnea syndrome. Apropos of 150 cases].

The indications and limitations of simple veloamygdalotomy as surgical cure for sleep apnoea were analyzed on the basis of results obtained in the first 150 cases treated prospectively by pharyngotomy. Clinical and polysomnographic results were analyzed as possible factors predicting success or failure. With a success rate of 80%, pharyngotomy is a simple and effective treatment for patients with minor forms of sleep apnoea (initial apnoea/hypopnoea index < 20) and no severe obesity.

[Treatment of simple snoring. Surgical pharyngoplasty vs. laser CO2 pharyngotomy].

CO2 laser pharyngotomy is a newly described technique used in treatment bronchopathy without sleep apnea syndrome. Retrospective results of 70 CO2 laser pharyngotomies and 63 surgical pharyngoplasties are studied and compared. All patients were SAS free snoring patients.