Obstructive sleep apnea syndrome of unusual cause - Clinical case
DOI:
https://doi.org/10.34631/sporl.80Keywords:
Obstructive apnea, sleep, morphology, imagingAbstract
Introduction: The authors describe a clinic case of mild ostructive sleep apnea syndrome, whose study has revealed a right parapharyngeal neoformation at the level of the styloid apophysis, adjacent to the skull base.
Material and Methods: 58 year old female patient with with a mild obstructive sleep apnea syndrome diagnosis. The patient had been submitted to uvulopalatoplasty in 2008 without clinical resolution. Structurally the patient presented a classe I modified Friedman’s anatomic classification for Obstructive Sleep Apnea Syndrome, with a type 1 Angle’s class and body mass index of 24. The endoscopic study of the upper airway has not revealed morphological aspects to point out. Sequential diagnostic exams were requested to evaluate possible anomalies of the upper airways.
Results: Imaging studies revealed the existence of a expansive lesion centered to the right parapharyngeal area, with oval configuration, and an estimated volume of 20 cm3, conditioning medial deviation of the oropharynx. Elective surgery was performed. The histology was compatible with pleomorphic adenoma of a minor salivary gland.
Conclusion: The obstructive sleep apnea syndrome results from structural changes of the upper airway. The determination of the obstructive level is corner stone for decision about treatment planning of this entity. This case represents an unusual and rare etiology that nonetheless fulfils the required criteria for obstructive sleep apnea syndrome to occur, simply because of its location.
References
Friedman M, Ibrahim H, Bass L. Clinical Staging for sleep-disordered breathing. Otolaryngology-Head and Neck Surgery 2002; 127: 13-21
Li HY,Wang PC, Lee LA, Chen NH et al. Prediction of Uvulopalatopharyngoplasty Outcome: Anatomy-Based Staging System
Versus Severity-Based Staging System. SLEEP 2006;29(12):1537-1541
Balbani APS, Formigoni GGS. Ronco e síndrome da apnéia obstrutiva do sono. Rev Ass Med Brasil 1999; 45(3): 273-8
Colin WB. Comprehensive reconstructive surgery for obstructive sleep apnea KWA 2004 Apr; 12:154-162
Filho VAP, Jeremias F, Tedeschi L, Souza RF. Avaliação cefalométrica do espaço aéreo posterior em pacientes com oclusão Classe II submetidos à cirurgia ortognática. R Dental Press Ortodon Ortop Facial.2007; 12 (5):119-125
Schellenberg JB, Maislin G, Schwab RJ. Physical Findings and the Risk for Obstructive Sleep Apnea - The Importance of Oropharyngeal Structures. Am J Respir Crit Care Med 2000;162:740–748
Togeiro SM, ChavesJr. CM, Palombini L, Tufik S e tal.Evaluation of the upper airway in obstructive sleep apnoea. Indian J Med Res 131, 2010 Feb, pp 230-235
Núñez-Fernández D, García-Osornio M, Vokurka J, Upper Airway Evaluation in Snoring and Obstructive Sleep Apnea http://emedicine.medscape.com/article/868925-overview
Gregório M, Jacomelli M, Figueiredo A, Cahali M et al. Evaluation of airway obstruction by Nasopharyngoscopy: comparison of the Müller maneuver versus induced sleep. Rev Bras Otorrinolaringol 2007;73(5):618-22
Kilinç AS, Arslan SG, Kama JD, Ozer T et al. Effects on the sagittal pharyngeal dimensions of protraction and rapid palatal expansion in Class III malocclusion subjects. European Journal of Orthodontics 2008; 30: 61–66
Sakakibara H, Tong M, Matsushita K, Hirata M et al. Cephalometric abnormalities in non-obese and obese patients with obstructive sleep apnoea. Eur Respir J 1999; 13: 403-410