| Obstructive sleep apnea hypopnea syndrom(OSAHS),a dangerous and potentially fatal disease with high prevalence, refers to apnea and insufficient ventilation caused by the upper airway repeated collapse and blocking during sleep. As clinical researches have confirmed the high prevalence, multiple complications, and serious threats of OSAHS, Major progresses have made in the understanding and treatment of the disease. Although there are many methods of treatment of OSAHS, however, they have not been sufficient enough. Continuous positive airway pressure(CPAP) and oral rectification device cannot eliminate airway stenosis or obstruction of the pathogeny on the organizational structure, therefore it is necessary to wear the device for a long time, which some patients can’t tolerate. Surgery can cause large trauma some complications with grave consequences and high postoperative recurrence rate.With the development of laser technology, laser, with its painless, noninvasive, no carbide,no vibration, no polluted layer and prompt wound healing,was widely used in the medical field. As a new technology,fractional Er: YAG laser has been recognized in the oral field, and widely used in oral medicine, prosthodontics, surgery, orthodontic, periodontal disease. Recently, domestic and foreign scholars start to use fractional Er: YAG laser to treat the snoring and OSAHS with some clinical effects, yet solid experimental theoretical basis needs to be found. With reference to existing findings, Our research team used both animal experiments and clinical trials to test clinical curative effect after fractional Er: YAG laser irradiation in. Our clinical work seeks to provide theoretical support to better treat the snoring and OSAHS.Experiment One focuses on the histological changes of rabbit oral mucosa after fractional Er:YAG laser irradiation. The research team selected 12 healthy rabbits of 5 months old with 2 ~ 3 kg weight,3 for the control group, 9 for the experimental group. The buccal mucosa was irradiated in the control group. We observe mucosa damage and healing after irradiation by the general observation and HE staining. We cut out the soft palate and the back of the tongue mucosa as control,conventional fixation, dehydration, embedding. Because the clinical laser therapy irradiates pharyngeal around,the soft palate and the back of the tongue mucosa was irradiated three times(0d, 7d, 15d) in the Experimental group. We executed three rabbits respectively in 1, 2, 4 weeks after irradiation, and took irradiation area mucosa to conventional fixation, dehydration, embedding, HE and Masson, elastic fiber dyeing. Yellowish-white dot was observed on the irradiation area through general observation. Scabby fall off completely, most mucosal was healed after three days. The mucosal was healed completely after seven days without leaving a scar and pigment. The mucosal damage zone is only found within the mucosal epithelium by HE staining observation,epithelial basal parts were almost complete,and the mucosa lamina propria was not damaged. The mucosal epithelium was healed completely in 3~7 days. Compared with the control the thickness of the mucosal epithelium was increased. Mucosa lamina propria of collagen fiber, elastic fiber two-dimensional area ratio was significantly increased than the control group. Although mucosa epithelial thickening, differential mean of was about 120 microns, but the pharyngeal cavity ventilation was little influence.Experiment two was the preliminary clinical study of Er:YAG laser in the treatment of snoring and OSAHS. Patients with snoring and OSAHS were recruited,excluding central, narrow nasal cavity and tonsil hypertrophy, small micromaxillary deformity, mandibular retraction caused by sleep apnea. We demonstrated and explained the new laser therapy to the patients, and clarified the benefits and potential risks of the treatment. All the patients signed the informed consent form(Appendix 1). Pre- and post-treatment polysomnography were carried out and the patients were classified in accordance with the Malan Patty classification method(I- IV). Efficacy of the treatment was evaluated with the Sleep apnea syndrome questionnaire(Appendix 2), assessing the severity of snoring(the first question) and other problems associated with sleep-disordered breathing(SDB)(questions 2-10). Answers were graded on 11-point scales(0-10). Assessments with the questionnaire were processed before the first treatment and during follow-ups at 14 and 45 days respectively after the treatment. There are four divisions for the treatment of satisfaction(dissatisfaction, comparative satisfaction, quite satisfaction, great satisfaction). Appendix 3 was the treatment method. 7 patients with simple snoring were recruited and efficacy of the treatment was evaluated after the treatment, 2 of them being comparatively satisfied, 4 being just satisfied and 1 being very satisfied.Conclusion:After Fractional Er:YAG laser irradiation, the rabbit has a small oral mucosa lesion and which healed faster, without leaving a scar and pigment. The cauterization and thermal effect of laser can cause mucosal epithelium to remodel, and cause the degeneration contraction of mucosa lamina propria collagen, as well as cause hyperplasia and recombinant of collagen fiber and elastic fiber, which makes the mucosal tighten and the mucous membrane elasticity increase. It is concluded that Er:YAG laser treatment is an effective, minimally invasive and safe method of treating patients with snoring and OSAHS. |
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