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The endemic spread of obesity and unhealthy behaviors of modern society led to revisiting the real prevalence related to obstructive sleep apnea. Recent data support a paradigm shift towards individually tailored treatments which include functional surgery of the upper airways. This paper presents the results of a randomized interventional, prospective study on 68 patients referred by the general practitioner for obstructive sleep apnea. The eligible cohort consisted of 28 patients who were offered functional surgery for definitive relief of obstructive symptoms. After topographic diagnosis of the obstruction site and grading of the severity of the obstructive sleep apnea, the eligible lot was randomized for either nasal surgery or pharyngeal surgery. Subjective and objective measurements were carried out at presentation and three months after surgery. Results showed a significant reduction in AHI (more than 50%) after functional surgery, with marginal benefit for those treated with nasal surgery. Functional improvement is unequivocal for both surgical methods, but the superior results reported in the nasal surgery group could be related to the relatively small size of the study group. The involvement of a larger cohort in subsequent studies with a similar design could confirm these results.

Introduction. Juvenile nasopharyngeal angiofibroma is a rare type of benign vascular tumour that affects only young males, especially those between the ages of 9 and 19. Therapeutic management depends on the extent of the lesion, being conditioned by the complexity of the anatomy of the skull base and the risk of massive bleeding due to the abundant vascular supply. The purpose of this article is to describe the modern approach to juvenile nasopharyngeal angiofibroma, starting from the general knowledge on this topic and presenting the experience of our clinic. Materials and Methods. A retrospective study was conducted on 10 male patients with juvenile angiofibroma, with clinical and imaging diagnoses, confirmed by post-ablative histopathological examination. From the 10 juvenile angiofibroma case treated in our clinic, 4 of them were less extensive, 2 with invasion to the pterygopalatine fossa, 3 involving the infratemporal fossa and 1 with minimal intracranial extension. Results. Combined approach (endoscopic trans-nasal approach and Caldwell Luc approach) was necessary in the treatment of a IIC case. Follow-up after surgery was done using MRI scans every 6 months. Recurrence was encountered in one case (9 months from the first surgery), and needed reintervention to remove the residual tumour. Conclusions. Even if it is a rare condition, the development of specific materials and techniques (endoscopic, embolization) has been considerable, allowing the reduction of intraoperative bleeding and residual tumour tissue, in conditions of minimal interference with the facial anatomy of such young patients.