Li Lieber P H, Lee Shan S, Chuang Ann Y C, Niddam David M, Tung Tao H, Chen Joshua K C
Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan.
Lasers Surg Med. 2011 Nov;43(9):887-91. doi: 10.1002/lsm.21122.
Kenalog application onto surgical wounds has been used to control dynamic pain following Laser-Assisted-Uvulo-Palatoplasty (LAUP) with good results in our department. When the effect was sub-optimal, insufficient ointment over the superior-lateral corner of wounds were always noted. Fulfilling the coating led to optimal results, and preliminary trials showed a good outcome of dynamic pain control as well by treating the corners only. The corners were thus named "sweet spots." This study aimed to verify the efficacy of applying Kenalog on "sweet spots" instead of whole surgical wounds to mitigate dynamic pain due to LAUP.
STUDY DESIGN/MATERIALS AND METHODS: This is an outcomes research. Fifty-five subjects with primary snoring treated with LAUP were studied. By using Kenalog, local treatments were applied to sweet spots during the first postoperative week. A visual analogous scale was used to evaluate dynamic pain on the 1st, 2nd, 3rd, and 7th days after LAUP.
Once sweet spots were treated, there was instant alleviation of dynamic pain; the average improvement level was ≥80% (P < 0.001, power = 100%). The area of sweet spots, in contrast to the significant relief in dynamic pain, occupied only about 30% of denuded mucosa.
Dynamic pain after LAUP could immediately be mitigated by local treatments upon sweet spots using topical regimens. The large-scale relief of dynamic pain in contrast to the small area of sweet spots implies a congregation of free nerve endings there. Our finding invites further studies to correlate the neuroanatomy of the soft palate and dynamic pain caused by LAUP.
在我们科室，将曲安奈德应用于手术伤口已被用于控制激光辅助悬雍垂腭成形术（LAUP）后的动态疼痛，效果良好。当效果欠佳时，总是会注意到伤口上外侧角的软膏用量不足。涂满该区域可取得最佳效果，初步试验表明仅治疗这些角对动态疼痛的控制效果也很好。因此，这些角被称为“甜蜜点”。本研究旨在验证将曲安奈德应用于“甜蜜点”而非整个手术伤口以减轻LAUP引起的动态疼痛的疗效。
研究设计/材料与方法：这是一项结果研究。对55例接受LAUP治疗的原发性打鼾患者进行了研究。术后第一周，使用曲安奈德对甜蜜点进行局部治疗。采用视觉模拟评分法评估LAUP后第1、2、3和7天的动态疼痛。
一旦治疗了甜蜜点，动态疼痛立即得到缓解；平均改善水平≥80%（P < 0.001，检验效能=100%）。与动态疼痛的显著缓解形成对比的是，甜蜜点的面积仅占裸露黏膜的约30%。
使用局部用药方案对甜蜜点进行局部治疗可立即减轻LAUP后的动态疼痛。与甜蜜点小面积形成对比的动态疼痛的大幅缓解意味着那里有大量游离神经末梢聚集。我们的发现促使进一步研究软腭的神经解剖结构与LAUP引起的动态疼痛之间的关联。
