Denise Manica1, Cláudia Schweiger2, Leo Sekine3, Simone Chaves Fagondes4, Marisa Gasparin5, Deborah Salle Levy6, Gabriel Kuhl7, Marcus Vinicius Collares8, Paulo José Cauduro Marostica9. 1. Otolaryngology and Head and Neck Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Programa de Pós Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. Electronic address: denisemanica@gmail.com. 2. Otolaryngology and Head and Neck Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Programa de Pós Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. 3. Programa de Pós Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. 4. Pneumology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil. 5. Programa de Pós Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. 6. Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. 7. Otolaryngology and Head and Neck Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. 8. Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil. 9. Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Pediatric Pneumology Department, Hospital de Clínicas de Porto Alegre, Brazil.
Abstract
OBJECTIVE: To evaluate the performance of two glossoptosis airway obstruction classifications in predicting symptom severity and laryngeal exposure difficulty in Robin Sequence (RS) patients. SETTING: Public tertiary hospital otolaryngology section (Hospital de Clínicas de Porto Alegre - HCPA). PATIENTS: All RS patients diagnosed at HCPA from October 2012 to February 2015 were enrolled, a total of 58 individuals. They were classified in isolated RS, RS-Plus and syndromic RS. INTERVENTION: Patients were submitted to sleep endoscopy and a score was attributed according to Yellon and de Sousa by a blinded researcher. Symptom severity evaluation was performed as defined by Cole classification. MAIN OUTCOME MEASURE: Association between endoscopic findings and clinical symptoms severity and laryngeal exposure difficulty. RESULTS: Twenty four patients were identified as isolated RS (41.4%), 19 patients presented as RS-Plus (32.7%) and 15 patients had well defined diagnosed syndromes (25.9%). Concomitant airway anomalies were found in 18 patients (31%). Specifically 17.4% in isolated RS, 55.6% in RS- Plus and 28.6% in the syndromic group had such anomalies (P = 0,03). Probability of presenting severe clinical symptoms as graded by Cole was higher in grade 3 Yellon classification (68.4%, P = 0.012) and in moderate and severe de Sousa classification (61.5% and 62.5%, respectively, P = 0.015) than in milder grades of obstruction. This findings were considered significant even after controlling for patient age. Laryngeal exposure difficulty was correlated with de Sousa and Yellon (Rho = 0,41 and Rho = 0,43, respectively; P < 0,05). CONCLUSION: Patients with higher degrees of obstruction in sleep endoscopy had a higher probability of presenting a more severe clinical manifestation and a more difficult laryngeal exposure. Since the number of patients included in this study was small for subgroup analyses, it is not clear if this association is restricted to a specific group of RS.
OBJECTIVE: To evaluate the performance of two glossoptosis airway obstruction classifications in predicting symptom severity and laryngeal exposure difficulty in Robin Sequence (RS) patients. SETTING: Public tertiary hospital otolaryngology section (Hospital de Clínicas de Porto Alegre - HCPA). PATIENTS: All RS patients diagnosed at HCPA from October 2012 to February 2015 were enrolled, a total of 58 individuals. They were classified in isolated RS, RS-Plus and syndromic RS. INTERVENTION: Patients were submitted to sleep endoscopy and a score was attributed according to Yellon and de Sousa by a blinded researcher. Symptom severity evaluation was performed as defined by Cole classification. MAIN OUTCOME MEASURE: Association between endoscopic findings and clinical symptoms severity and laryngeal exposure difficulty. RESULTS: Twenty four patients were identified as isolated RS (41.4%), 19 patients presented as RS-Plus (32.7%) and 15 patients had well defined diagnosed syndromes (25.9%). Concomitant airway anomalies were found in 18 patients (31%). Specifically 17.4% in isolated RS, 55.6% in RS- Plus and 28.6% in the syndromic group had such anomalies (P = 0,03). Probability of presenting severe clinical symptoms as graded by Cole was higher in grade 3 Yellon classification (68.4%, P = 0.012) and in moderate and severe de Sousa classification (61.5% and 62.5%, respectively, P = 0.015) than in milder grades of obstruction. This findings were considered significant even after controlling for patient age. Laryngeal exposure difficulty was correlated with de Sousa and Yellon (Rho = 0,41 and Rho = 0,43, respectively; P < 0,05). CONCLUSION:Patients with higher degrees of obstruction in sleep endoscopy had a higher probability of presenting a more severe clinical manifestation and a more difficult laryngeal exposure. Since the number of patients included in this study was small for subgroup analyses, it is not clear if this association is restricted to a specific group of RS.