We hypothesized that those obstructive sleep apnea (OSA) patients with upper airway collapse during sleep within the transpalatal airway would have a more favorable response to uvulopalatopharyngoplasty (UPP) than those patients with obstruction within the hypopharyngeal airway. We tested this hypothesis in seven OSA patients with transpalatal and seven with hypopharyngeal obstruction undergoing UPP. Preoperatively the apnea/hypopnea index (AHI) was different between palatal and hypopharyngeal obstructors, 37.8 +/- 6.0 (+/- SEM) and 63.9 +/- 6.3, respectively (p less than 0.05), but the apnea-associated arterial oxygen desaturation and the lowest sleep saturation level were not different between the two groups. Postoperatively the AHI was 17.6 +/- 7.2 in the palatal obstructors and 40.3 +/- 15.6 in the hypopharyngeal obstructors (both p less than 0.05 from preoperative AHI). The palatal obstructors had a significant decrease in the percentage of sleep time spent apneic and the hypopharyngeal obstructors had a significant decrease in the hypopnea, but not apnea, time following surgery. The palatal obstructors had a significantly higher postoperative arterial oxygen saturation than the hypopharyngeal obstructors. Two hypopharyngeal obstructors worsened postoperatively. In addition we found that regardless of the site of the obstruction preoperatively, all obstructions occurred at the level of the palate postoperatively. We conclude that patients with preoperative transpalatal obstruction had diminution in obstructive apneas and those with hypopharyngeal obstruction had diminution in hypopneas but not apneas. Oxygenation was better postoperatively in the palatal obstructors, and none worsened postoperatively. These results suggest that identification of the site of upper airway obstruction in OSA may be beneficial.(ABSTRACT TRUNCATED AT 250 WORDS)

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\s=b\A neonate had respiratory distress caused by a parapharyngeal space tumor composed of glial tissue. This entity is rare and may be difficult to diagnose. The origin of glial tissue in the neck is not well understood, since no anatomical extension has been shown. (Arch Otolaryngol 1981;107:638-641) Only ten cases of glial tissue in the parapharyngeal space have been reported in the English literature.This fact makes this condition much rarer than its nasal counterpart (more than 100 published cases). The present report stresses the importance of the early signs of pharyngeal compres¬ sion. Not only can these masses pro¬ duce difficult diagnostic problems, but their origin remains uncertain. REPORT OF A CASEA female infant was the second fraternal twin of a 27-year-old primagravid mother who had an uneventful full-term pregnan¬ cy, except for premature rupture of the membranes 2Vè days before delivery. The infant's birth weight was 1,700 g, and the gestational age was estimated to be 34 weeks. The Apgar score was 7, and although no resuscitation was required, the patient received oxygen because of poor color that subsequently improved. The results of the initial physical examination, including the head, neck, and throat, were considered to be normal.Shortly after birth, severe respiratory distress developed in the patient; this was thought to be caused by bilateral pneumothoraces and required the placement of chest tubes. At the age of 3 weeks, the patient was gradually weaned off contin¬ uous positive airway pressure and oxygen and was starting to gain weight, when spells of bradycardia developed. Chest roentgenograms and ECGs were normal. Two months later, the infant had an upper airway obstruction that was relieved by the placement of an oral airway. Physical examination disclosed a mass measuring 2.5 x 1.5 cm in the left anterior triangle of the neck. The mass was soft, mobile, nontender, and nonpulsating. The overlying skin was mobile and of normal color. There was also a suggestion of a soft mass in the left side of the palate. The jaw was thought to be hypoplastic, and a relative macroglossia was noted. Results of endoscopie exam¬ ination were normal. At the age of 4 months, the infant could breathe adequate¬ ly without an oral tube, gained more weight, and was discharged with a working diagnosis of Pierre Robin syndrome.During the following ten months, there were a series of readmissions for poor feeding, failure to thrive, and occasional cyanotic spells. At the age of 14 months, the infant was irritable and wasted with a weight of 4,000 g, placing her in the third percentile. A general physical examination disclosed noisy respiratory sounds, right ventricular hypertrophy, and hepatosplenomegaly. The ear, nose, and throat exam¬ ination showed a small jaw with a higharched palate, a large tongue, and a devia¬ tion of the uvula toward the right by a mass in the parapharyngeal space. Chest roentgenograms showed pulmonary con¬ gestion, and neck films demonstrated that the pharyngeal air column would not...

A newborn male presented with respiratory distress and laryngeal stridor at the time of birth. Laryngoscopy revealed a circumscribed mass in the right vocal cord which was diagnosed as an undifferentiated malignant neoplasm on frozen section. Further light microscopic studies, special stains and electron microscopy disclosed features consistent with a special subtype of sarcoma adopted by the Intergroup Rhabdomyosarcoma Committee. Several authors have also demonstrated similarities between this type of tumor and soft tissue Ewing sarcomas. Nonepithelial malignancies of the larynx are rare in children and are only anecdotally reported in newborns. Histopathologically, the tumors predominantly include rhabdomyosarcomas among other rarer less well documented sarcomas and lymphomas. Although modern chemotherapy and radiotherapy have improved the otherwise grim prognosis of soft tissue Ewing sarcoma, this young patient was only treated with total laryngectomy at ten days of age and is alive and well two years later.