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Descrizione della relazione tra classificazione NOHL definita durante la drug-induced sleep endoscopy e AHI iniziale in pazienti con OSAS da moderato a grave, e valutazione dei risultati ottenuti con dispositivi orali.La drug-induced sleep endoscopy (DISE) è ampiamente riconosciuta come un valido strumento per la diagnosi e la pianificazione del trattamento della sindrome delle apnee ostruttive (OSAS), in quanto consente una visualizzazione diretta dei siti e pattern di collasso delle vie aeree superiori (VAS). In letteratura sono state proposte molteplici classificazioni per descrivere gli eventi osservati duranti la DISE, fra cui la NOHL (Nasopharynx cavity and walls, Oropharynx, Hypopharynx, Larynx) classification (Vicini 2012). Lo studio si prefigge gli obiettivi di identificare quali strutture anatomiche, definite secondo la classificazione NOHL, sono più rappresentate nel collasso delle VAS in pazienti con OSAS da moderato (15 ≤ AHI ≤ 30) a grave (AHI30), e valutare il risultato del trattamento con dispositivi orali (OA), in termini di riduzione dell’AHI. Il gruppo studio è composto da 35 pazienti (29 M, 6 F, età media 50,6, BMI medio 26) con diagnosi polisonnografica di OSAS da moderato a severo, sottoposti a DISE e classificati secondo la classificazione NOHL per individuare le sedi anatomiche e i pattern di collasso più frequentemente riportati. I pazienti sono stati successivamente indirizzati a terapia con Mandibular Advancing Devices (MAD), ed è stato valutato il risultato del trattamento in termini di riduzione dell’AHI. Nel campione esaminato, le strutture anatomiche più frequentemente coinvolte nel collasso delle VAS risultano essere il nasofaringe (N) e la base lingua (H), con indice di correlazione 0,35 (p0,04), mentre non è stata evidenziata significatività per l’area retropalatale (O) e la laringe (L). L’analisi descrittiva ha evidenziato inoltre un collasso multisede in tutti i pazienti, con coinvolgimento di più strutture nella meccanica ostruttiva. In tutti i pazienti è stata osservata una riduzione dell’AHI dopo terapia con MAD (p0,00), sebbene in alcuni casi non completamente risolutiva della patologia.Nowadays, drug-induced sleep endoscopy is widely recognised as a valid tool for diagnosis and treatment planning of obstructive sleep apnoea syndrome (OSAS), as it allows a direct visualisation of sites and patterns of collapse of the upper airways (UA). Various classifications have been proposed in the literature to describe the events observed during DISE, including the NOHL (Nasopharynx cavity and walls, Oropharynx, Hypopharynx, Larynx) classification. This study was aimed at assessing which anatomical structures, according to the NOHL Classification, were most frequently involved in UA collapse in patients with moderate to severe OSAS, and evaluating treatment results with oral appliances (OA), in terms of AHI reduction. The study group consisted of 35 patients (29 M, 6 F, mean age 50.6, average BMI 26) with polysomnographic diagnosis of moderate to severe OSAS, subjected to DISE and classified according to the NOHL classification to identify the anatomical sites and patterns of UA collapse most frequently reported. Patients were subsequently addressed to mandibular advancing device (MAD) therapy and treatment results in terms of AHI reduction were evaluated. In the sample examined, the anatomical structures most frequently involved in the collapse of the UA were the nasopharynx cavity and walls and tongue base, with a correlation index of 0.35 (p0.04), while no significance was found for the retro-palatal area or larynx. Descriptive analysis revealed multilevel collapse in all patients, involving multiple anatomical structures in obstructive mechanics. In all patients, AHI reduction was observed after treatment with MAD (p0.00).

Learning Objectives After completing this course, the reader will be able to: Discuss the importance of treating patients with bone metastases using a multidisciplinary approach.Explain why bisphosphonates are a fundamental part of bone metastasis treatment.Evaluate the main features of ONJ and, in particular, its high risk factor.Describe the importance of ONJ prevention during bisphosphonate treatment.Emphasize the importance of interaction among the patient's dentist, surgeon, and oncologist for the management of ONJ. CME Access and take the CME test online and receive 1 AMA PRA Category 1 Credit™ at CME.TheOncologist.com Objective. Bone metastases are a major cause of morbidity in cancer patients. Treatment includes bisphosphonates, which are also associated with avascular osteonecrosis of the jaw (ONJ). Our aim was to evaluate the correlation between bisphosphonates and ONJ. Patients and Methods. Of the 539 patients with bone metastases treated in our department from June 2002 to December 2006 with i.v. bisphosphonates, eight (1.5%) developed ONJ. Results. The eight patients with ONJ had all been given zoledronic acid, and two had also been treated with pamidronic acid. In four of the patients, ONJ was diagnosed during treatment, while in the remaining four it was diagnosed several months after therapy with bisphosphonates had ended. Six of these patients received local noninvasive treatment, of whom five progressed. Two showed apparent autolimitation of the disease. The remaining two patients underwent surgical resection and currently show no signs of relapse. All eight ONJ patients presented with various concomitant risk factors such as paradontopathy, dental extraction, or spontaneous avulsion. Conclusions. Our results show that ONJ can appear months after interruption of treatment and that a surgical approach can be used in suitable cases. Closer cooperation is needed among specialists to define guidelines for the prevention of ONJ in patients with bone metastases.

Background and purpose Management of severe obstructive sleep apnea-hypopnea syndrome (OSAHS) is challenging and needs multidisciplinary cooperation. Ventilation is considered the gold standard of treatment in severe OSAHS. The aim of the study was to compare the therapeutical efficacy of a type of surgery (maxillomandibular advancement [MMA]) vs a ventilatory treatment modality (autotitrating positive airway pressure [APAP]). Materials and methods At the ENT Department of Forli Hospital (University of Pavia), in strict cooperation with the Sleep Lab of the University of Bologna, a prospective randomized controlled trial was designed and performed. After fully informing them, 50 consecutive patients who have severe OSAHS were enrolled and randomized into a conservative (APAP) or surgical (MMA) section. Demographic, biometric, polysomnogram (PSG) and Epworth Sleepiness Scale profiles of the 2 groups were statistically not significantly different. Results One year after surgery or continuous APAP treatment, both groups showed a remarkable improvement of mean Apnea-Hypopnea Index (AHI) and Epworth Sleepiness Scale levels; the degree of improvement was not statistically different. Conclusions Given the relatively small sample of subjects studied and the relatively brief follow-up, MMA proved to be a valuable alternative therapeutical tool in our adult and severe OSAHS patient group, with a success rate not inferior to APAP.