Background: This paper aims to examine published articles between January 2008 and January 2019 on the different palatal surgeries performed on OSA patients and the treatment outcomes, which in turn will be used to determine the effectiveness of various palatal surgical techniques in treating OSAS and the most effective of the palatal surgical techniques in treating OSAS. Patients and Methods: The current review followed the guidelines of preferred reporting items for systematic reviews and meta-analysis statement 2009 (PRISMA). The quality of relevant studies was assessed using NIH quality assessment tool for observational cohort and cross-sectional studies as well as NIH tool for quality assessment for case series studies. Results: Meta-analyses of relevant studies showed that the surgical technique that achieved the best reduction on AHI (Apnea/Hypopnea Index) was the lateral pharyngoplasty followed by the Anterior Palatoplasty, with a significant mean reduction of [(SMD = −0.848, 95% CI (−1.209 -−0.487), p-value < 0.001) and (SMD = −0.864, 95% CI (−1.234 -−0.494), p-value < 0.001), respectively]. The technique responsible for the best improvement in Epworth Sleepiness Score (ESS) was the Relocation Pharyngoplasty, with a significant mean reduction of [SMD = −0.998, 95% CI (−1.253 -−0.743), p-value < 0.001]. Minimal O 2 saturation level improved most with the Expansion Sphincter Pharyngoplasty, with a significant mean reduction of [SMD = 1.011, 95% CI (0.581 -1.440), p-value < 0.001]. The surgical procedure that results in the best post-operative Visual Analogue Scale (VAS) was Z-Palatoplasty, with a significant mean reduction of [SMD = −1.551, 95% CI (−2.049 -−1.052), p-value < 0.001]. Soft palate length changes with a significant mean reduction of [SMD = −2.219, 95% CI (−2.730 -−1.708), p-value < 0.001]. Finally, meta-analyses of relevant studies showed that expansion sphincter pharyngoplasty achieved the overall highest success rate

No abstract

Background The first description of a patient with obstructive sleep apnea was in ‘The Posthumous Papers of the Pickwick Club’ published by English writer Charles Dickens in 18361. The first introduction of the terms ‘sleep apnea syndrome’ and ‘obstructive sleep apnea syndrome’ was by Guilleminault et al in 1967. Subsequently, Guilleminault coined the term ‘upper airway resistance syndrome’ in 19932. Objectives This paper aims to examine published articles between January 2008 and January 2019 on the different palatal surgeries performed on OSA patients and the treatment outcomes, which in turn will be used to determine two things. The first being the effectiveness of various palatal surgical techniques in treating OSAS and the second (if applicable) the most effective of the palatal surgical techniques in treating OSAS. Patients and Methods The current review followed the guidelines of preferred reporting items for systematic reviews and meta-analysis statement 2009 (PRISMA)5. The detailed steps of methods were described elsewhere as well as PRISMA checklist. The quality of relevant studies was assessed using NIH quality assessment tool for observational cohort and cross -sectional studies as well as NIH tool for quality assessment for case series studies. Results Meta-analyses of relevant studies showed that the surgical technique that achieved the best reduction on AHI was the lateral pharyngoplasty followed by the Anterior Palatoplasty, with a significant mean reduction of [(SMD= -0.848, 95% CI (-1.209 – -0.487), p-value&lt;0.001) and (SMD= -0.864, 95% CI (-1.234 – -0.494), p-value&lt;0.001), respectively]. The technique responsible for the best improvement in ESS was the Relocation Pharyngoplasty, with a significant mean reduction of [SMD= -0.998, 95% CI (-1.253 – -0.743), p-value&lt;0.001]. Minimal O2 saturation level improved most with the Expansion Sphincter Pharyngoplasty, with a significant mean reduction of [SMD= 1.011, 95% CI (0.581 – 1.440), p-value&lt;0.001]. The surgical procedure that result in the best post-operative VAS was Z-Palatoplasty, with a significant mean reduction of [SMD= -1. 551, 95% CI (-2.049 – -1.052), p-value&lt;0.001]. soft palate length change with a significant mean reduction of [SMD= -2.219, 95% CI (-2.730 – 1.708), p-value&lt;0.001]. Finally, meta-analyses of relevant studies showed that expansion sphincter pharyngoplasty achieved the overall highest success rate [Event rate= 77%, 95% CI (65.4%– 85.5%), p-value&lt;0.001] Conclusion The best procedure for treating OSA varies from patient to patient and there is no universal cure-all. Careful patient selection and pre-operative evaluation are mandatory.

Background The first case of fungal sinusitis was reported in 1885. This fungal disease occurred rarely until the past decade, when a worldwide increase in its incidence occurred. Till one decade back bacteria was implicated as pathogen in most form of chronic rhinosinusitis (CRS). Fungi were thought to be responsible for few specific forms, sine 1999, when ponikau and associates claimed that fungi were responsible for nearly all cases of CRS. Their study demonstrated the presence of fungi & eosinophils from nose & paranasal sinuses from ∼96 % cases of CRS. Aim of the Work The aim of the work was to detect the presence of fungal biofilm, in patients with fungal sinusitis trying to find its role in recurrence of fungal sinus infection, resistance to medical treatment and occurrence of intra orbital and intracranial complications. Patients and Methods The study consisted of 20 different cases of fungal sinusitis controlled by 10 cases of non fungal sinusitis. Control cases were divided into 5 cases of chronic sinusitis with nasal polyposis and 5 cases of deviated septum with no evidence of sinusitis undergoing nasal surgery. Results Using statistical analysis, there was evidence of pressure of fungal biofilm in different cases of fungal sinusitis whether primary or recurrent, also whether invasive or non invasive. Comparing cases with controls, There was statistically significant difference between them as regard Biofilm (p-value: &lt; 0.001) with incidence reaching (70 %) in cases while (0%) in controls. By applying risk analysis for biofilm, we used relative risk (p value = 0.0001) which is statistically significant indicating higher risk of positive biofilm in cases of fungal sinusitis, also by Using odds ratio (p value= 0.0002) which is statistically significant indicating higher risk of positive biofilm in cases of fungal sinusitis. Conclusion The study showed the presence of fungal biofilm in different cases of fungal siunsitis whether primary or recurrent, also whether invasive or non invasive.