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Moffa A, Giorgi L, Nardelli D, Iafrati F, Iannella G, Lugo R, Baptista PM, Casale M. Supine or non-supine sleep apnea events: which can be treated better with Barbed Pharyngoplasty? Sleep Breath 2024:10.1007/s11325-024-03127-9. [PMID: 39096429 DOI: 10.1007/s11325-024-03127-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 08/05/2024]
Abstract
PURPOSE Among the treatment options for Obstructive Sleep Apnea (OSA), intrapharyngeal surgery has undergone significant changes and received solid scientific support. However, it is crucial to identify the best candidate. This study aims to present the results of the modified Alianza technique in our clinic to show the differences in the impact of surgery on supine and non-supine apnea levels in moderate-severe OSA patients. METHODS Adult patients affected by moderate-severe OSA (Apnea-Hypopnea Index (AHI) > 15), having circular palatal collapse, and candidates for modified Alianza Tecnique were retrospectively enrolled. Each subject performed polysomnography pre- and post-operatively, and the follow-up check was performed after at least six months. RESULTS This study enrolled 24 patients who underwent the Modified Alianza technique for sleep apnea. We found significant reductions in both supine and non-supine AH) after surgery. Non-supine AHI showed a greater reduction (from 20.89 to 11.64 episodes/hour, p = 0.0001) than supine AHI (from 42.51 to 25.93, p = 0.0003). We subsequently divided the patients into two groups based on whether they were affected by positional OSA before surgery. There was a lower percentage decrease in non-supine AHI compared to supine AHI after surgery in patients who were positional before surgery, but this difference was not statistically significant. Conversely, in the non-positional patient group, there was a higher decrease in non-supine AHI compared to supine AHI, although this was not statistically significant. CONCLUSION The Modified Alianza Tecnique leads to notable enhancement in AHI among patients with OSA. Non-supine apneas exhibit a more favorable response to the surgery than supine apneas.
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Affiliation(s)
- Antonio Moffa
- School of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio- Medico, Rome, Italy.
| | - Lucrezia Giorgi
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio- Medico, Rome, Italy
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Domiziana Nardelli
- School of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio- Medico, Rome, Italy
| | - Francesco Iafrati
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio- Medico, Rome, Italy
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Giannicola Iannella
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, Rome, 00185, Italy
| | - Rodolfo Lugo
- Grupo Medico San Pedro, Department of Otorhinolaryngology, Monterrey, 64660, Mexico
| | - Peter M Baptista
- ENT Department, Al Zahra Private Hospital Dubai, Dubai, 23614, United Arab Emirates
| | - Manuele Casale
- School of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio- Medico, Rome, Italy
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Giorgi L, Moffa A, Pericone G, Galantai D, De Benedetto L, Jacobowitz O, Vicini C, Lugo R, Baptista PM, Casale M. Barbed Pharyngoplasty simulation using a 3D-printed model: design and validation study. Sleep Breath 2024:10.1007/s11325-024-03067-4. [PMID: 38806978 DOI: 10.1007/s11325-024-03067-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/22/2024] [Accepted: 05/20/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE Learning how to use barbed sutures and perform Barbed Pharyngoplasty (BP) is challenging due to limited surgical training opportunities. This work aims to design, develop, and validate a new 3D surgical simulator to train ENT residents and specialists in performing BP. METHODS The Barbed Pharyngoplasty Simulator (BPS) was designed using diagnostic images of the facial mass and testing different materials to replicate the mucosal and bony tissues. ENT specialists with experience in BP and ENT residents were included in the validation study and were asked to perform the Alianza BP. After the simulation, they compiled the Face and Content Validity Questionnaires. RESULTS The BPS consists of a reusable cranial structure that contains the disposable palatopharyngeal structure, replicating the palatal structures and the tongue. Fifteen experienced ENT specialists and nine residents were included in the study. Findings demonstrated that the BPS faithfully replicated the muscular and fibrous-bony palatopharyngeal structures, with only 11% of residents having a negative opinion of the mucosal tissue. All the participants positively rated the sensation of using surgical instruments on the simulator. Also, ENT residents rated all aspects of the content validity test from normal to excellent, while specialists rated the BPS as a general training tool from normal to excellent; for lateral pharyngoplasty, BP, and Alianza, only 6.7% of participants disagreed with its usefulness, and 13.3% disagreed with it for anterior pharyngoplasty. CONCLUSION The BPS proposed in this preliminary study can potentially be a valuable tool in BP surgical training for residents and young otolaryngologists.
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Affiliation(s)
- Lucrezia Giorgi
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico Di Roma, Rome, Italy
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Antonio Moffa
- School of Medicine, Università Campus Bio-Medico Di Roma, Rome, Italy.
| | - Giovanni Pericone
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- School of Medicine, Università Campus Bio-Medico Di Roma, Rome, Italy
| | - Dorina Galantai
- Bajcsy-Zsilinszky Kórház És Rendelőintézet, Fül-Orr-Gégészeti És Fej-Nyaksebészeti Osztály Budapest, Maglódi Út 89-91, 1106, Maglódi Út, Hungary
| | - Luigi De Benedetto
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | | | - Claudio Vicini
- Department of Head-Neck Surgery, Oral Surgery Unit, Morgagni Pierantoni Hospital, Head-Neck, OtolaryngologyForli, Italy
- Department ENT & Audiology, University of Ferrara, Ferrara, Italy
| | - Rodolfo Lugo
- Department of Otolaryngology Head and Neck Surgery, Hospital San José, 64718, Monterrey, Mexico
| | - Peter M Baptista
- ENT Department, Al Zahra Private Hospital Dubai, 23614, Dubai, United Arab Emirates
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Manuele Casale
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- School of Medicine, Università Campus Bio-Medico Di Roma, Rome, Italy
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Luca C, Pasquale C, Caterina T, Antonio M, Federico L, Annalisa P, Riccardo A, Giuditta M, Gennaro R, Giovanni C. Barbed palatal surgery: single stage or multilevel setting-a systematic review by the Young Otolaryngologists of the Italian Society of Otolaryngology. Eur Arch Otorhinolaryngol 2023; 280:3905-3913. [PMID: 37227471 DOI: 10.1007/s00405-023-08018-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE This systematic review aims to compare the efficacy and safety of multilevel and single level surgery, including barbed pharyngoplasties, in the treatment of obstructive sleep apnea (OSA). METHODS The study followed PRISMA guidelines and searched PubMed/MEDLINE, Google Scholar, and Ovid databases for studies evaluating the effect of barbed pharyngoplasties on adults with OSA. Prospective and retrospective cohort studies were included with pre- and post-treatment comparisons of sleep tests and self-reported clinical outcomes. Exclusion criteria were non-English studies, case reports, reviews, conference abstracts, letters, and pediatric studies. Successful surgery was classified using Sher's criteria. RESULTS The study selected a total of 1014 patients from 26 studies, 24 of which were longitudinal studies with 10 retrospective trials and 14 prospective studies. The average age of the patients was 46.9 years, with an average Body Mass Index (BMI) of 25.6 kg/m2. Most of the patients were male (84.6%). The study included only palatal surgical techniques with barbed sutures, and patients who underwent cardio-respiratory monitoring and Drug Induced Sleep Endoscopy (DISE) before surgery. Mean Apnea Hypopnea Index (AHI) preoperative was 32.9/h, AHI postoperative was 11.9/h, and mean reduction of AHI was 62.3%. The most commonly adopted palatoplasty was Barbed Repositioning Pharyngoplasty (BRP) in 16 out of 26 studies, followed by its subsequent modifications in 3 studies. CONCLUSIONS Barbed pharyngoplasties appear to be effective both on objective measurement and subjective scores. DISE represents a fundamental tool to assess uni-level or multilevel obstruction. When retro-palatal collapse is present, barbed pharyngoplasty appears to be effective. Barbed pharyngoplasties maintain their good results both in single level or multilevel surgery. Randomized clinical controlled trials with multi-center cooperation and long-term study are necessary.
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Affiliation(s)
- Cerritelli Luca
- Ent Department, University of Ferrara, via A. Moro 8, loc. Cona, 4412, Ferrara, Italy.
- Young Otolaryngologists of the Italian Society of Otolaryngology (GOS-SIO), Ferrara, Italy.
| | - Capasso Pasquale
- Young Otolaryngologists of the Italian Society of Otolaryngology (GOS-SIO), Ferrara, Italy
- Otolaryngology Head and Neck Surgery Unit of "Azienda Ospedaliera di Rilievo Nazionale dei Colli, Ospedale Monaldi", Napoli, Italy
| | - Tripodi Caterina
- Young Otolaryngologists of the Italian Society of Otolaryngology (GOS-SIO), Ferrara, Italy
- Department of Otolaryngology Head and Neck Surgery, F. Spaziani Hospital, ASL Frosinone, Frosinone, Italy
| | - Moffa Antonio
- Young Otolaryngologists of the Italian Society of Otolaryngology (GOS-SIO), Ferrara, Italy
- Integrated Therapies in Otolaryngology, Campus Bio-Medico University Hospital Foundation, 00128, Rome, Italy
| | - Leone Federico
- Young Otolaryngologists of the Italian Society of Otolaryngology (GOS-SIO), Ferrara, Italy
- Otorhinolaryngology-Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milano, Italy
| | - Pace Annalisa
- Young Otolaryngologists of the Italian Society of Otolaryngology (GOS-SIO), Ferrara, Italy
- Department of Sense Organs, 9311Sapienza University of Rome, Roma, Italy
| | - Albertini Riccardo
- Young Otolaryngologists of the Italian Society of Otolaryngology (GOS-SIO), Ferrara, Italy
- Department of Otolaryngology, Ospedale Maggiore "C.A. Pizzardi", 2, Largo Nigrisoli, 40100, Bologna, Italy
| | - Mannelli Giuditta
- Young Otolaryngologists of the Italian Society of Otolaryngology (GOS-SIO), Ferrara, Italy
- Head and Neck Oncology and Robotic Surgery, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Russo Gennaro
- Young Otolaryngologists of the Italian Society of Otolaryngology (GOS-SIO), Ferrara, Italy
- Otolaryngology Head and Neck Surgery Unit of "Azienda Ospedaliera di Rilievo Nazionale dei Colli, Ospedale Monaldi", Napoli, Italy
| | - Cammaroto Giovanni
- Young Otolaryngologists of the Italian Society of Otolaryngology (GOS-SIO), Ferrara, Italy
- Department of Otolaryngology-Head and Neck Surgery, Morgagni Pierantoni Hospital, 47121, Forli, Italy
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Sabatino L, Moffa A, Iafrati F, Di Giovanni S, De Benedetto L, Giorgi L, Baptista P, Vicini C, De Vito A, Casale M. A New Lighting System for Surgical Vision Optimization in Barbed Pharyngoplasty for OSA. J Pers Med 2023; 13:1320. [PMID: 37763089 PMCID: PMC10532610 DOI: 10.3390/jpm13091320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Obstructive sleep apnea (OSA) surgery is now a viable solution in selected patients and the "remodeling" palatopharyngeal surgery is the most common one. Recently, it has become less invasive with the introduction of barbed sutures (BS). An optimization of surgical techniques is represented by barbed pharyngoplasty (BP), which requires surgical precision and needs efficient and precise oropharyngeal visualization. Consequently, the lighting system is of pivotal importance in BP. The aim of this work is to describe the first experience on the use of a new lighting system, called KLAROTM in BP for OSA. We evaluated the KLARO™ system in 15 consecutives BP for OSA in comparison with conventional headlamp illumination. The visualization of palatopharyngeal muscle in the bottom of the tonsillar fossa, entry and exit needle, such as needle tip, were statistically better with KLAROTM than headlamp illumination for both the surgeon and resident (p < 0.05). No significant differences for the visualization of the posterior pharyngeal wall and uvula were reported. The KLAROTM lighting system allows a satisfied illumination of oral cavity and oropharynx in the majority of cases. We encourage the use of KLAROTM not only in BP for OSA, but in all oral and pharyngeal surgeries, including tonsillectomy and oncological surgery.
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Affiliation(s)
- Lorenzo Sabatino
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Antonio Moffa
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- School of Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Francesco Iafrati
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- School of Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Simone Di Giovanni
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- School of Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Luigi De Benedetto
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Lucrezia Giorgi
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Peter Baptista
- ENT Department, Al Zahra Private Hospital Dubai, Dubai 23614, United Arab Emirates
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, 31008 Pamplona, Spain
| | - Claudio Vicini
- ENT Department, Morgagni Pierantoni Hospital, 47121 Forli, Italy
- ENT Department, University of Ferrara, 44121 Ferrara, Italy
| | - Andrea De Vito
- Otolaryngology and Head-Neck Surgery Unit, Department of Surgery, Ravenna & Lugo Hospitals, Health Local Agency of Romagna, 48121 Ravenna, Italy
| | - Manuele Casale
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- School of Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
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Morato M, Cardona-Sosa MP, Bosco G, Pérez-Martín N, Marte-Bonilla MM, Marco A, O’Connor-Reina C, Lugo R, Plaza G. Palatopharyngeal Arch Staging System (PASS): Consensus about Oropharyngeal Evaluation. Life (Basel) 2023; 13:life13030709. [PMID: 36983863 PMCID: PMC10056556 DOI: 10.3390/life13030709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/20/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
Intraoral examinations are essential in the evaluation of the upper airway in patients with obstructive sleep apnea (OSA). The morphology of the anatomic structures of the soft palate, the tonsillar fossae, and the palatoglossus and palatopharyngeal muscles is an important determinant of the size and collapsibility of the velum and oropharynx. The Palatopharyngeal Arch Staging System (PASS) is a systematic way to explore the oropharynx and report anatomic variations in the visible part of the palatopharyngeal muscle. In this prospective study, 30 sleep surgeons evaluated the reliability of the PASS using a selection of 23 videos of oropharyngeal examinations of healthy patients. The corresponding score on the PASS scale was graded for each examination. For internal structure and internal agreement, the Cronbach and Krippendorff alpha values were 0.96 and 0.46, which corresponded to a nearly perfect interrelationship and a moderate agreement, respectively. These findings suggest that the PASS is a valuable tool for evaluating the position of the palatopharyngeus muscle during oropharyngeal examinations and may be useful for creating a common language for sleep surgeons when evaluating the palatopharyngeal muscle.
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Affiliation(s)
- Marta Morato
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28942 Madrid, Spain
- Department of Otolaryngology, Hospital Quirónsalud Madrid, 28223 Madrid, Spain
| | - Maribel P. Cardona-Sosa
- Ronquido Monterrey, Centro de Diagnóstico y Tratamiento, Monterrey 64660, Mexico
- Department of Otolaryngology, Clínica Hospital Constitución, ISSSTE, Monterrey 64530, Mexico
| | - Gabriela Bosco
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28942 Madrid, Spain
- Department of Otolaryngology, Hospital Universitario Sanitas La Zarzuela, 28942 Madrid, Spain
| | - Nuria Pérez-Martín
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28942 Madrid, Spain
- Department of Otolaryngology, Hospital Universitario Sanitas La Zarzuela, 28942 Madrid, Spain
| | - Mayerin M. Marte-Bonilla
- Ronquido Monterrey, Centro de Diagnóstico y Tratamiento, Monterrey 64660, Mexico
- Department of Otolaryngology, Clínica Hospital Constitución, ISSSTE, Monterrey 64530, Mexico
| | - Alfonso Marco
- Department of Otolaryngology, Hospital Universitario Reina Sofía, 30003 Murcia, Spain
| | | | - Rodolfo Lugo
- Ronquido Monterrey, Centro de Diagnóstico y Tratamiento, Monterrey 64660, Mexico
- Department of Otolaryngology, Clínica Hospital Constitución, ISSSTE, Monterrey 64530, Mexico
| | - Guillermo Plaza
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28942 Madrid, Spain
- Department of Otolaryngology, Hospital Universitario Sanitas La Zarzuela, 28942 Madrid, Spain
- Correspondence:
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Barbed Pharyngoplasty for Snoring: Does It Meet the Expectations? A Systematic Review. Healthcare (Basel) 2023; 11:healthcare11030435. [PMID: 36767010 PMCID: PMC9914261 DOI: 10.3390/healthcare11030435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/23/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
To date, the use of barbed sutures for the surgical management of patients suffering from obstructive sleep apnea and snoring with retropalatal collapse and vibration has significantly increased. A systematic review was carried out, which included clinical studies that used barbed sutures for the treatment of snoring. A qualitative analysis, including six clinical studies, was conducted. Of these, five were studies on barbed pharyngoplasties, and one study involved a minimally invasive surgical procedure. The population consisted of 176 patients, aged 26 to 58 years old. Overall, the included studies showed a mean gain in the snoring Visual Analog Scale of 5.67 ± 1.88, with a mean preoperative value of 8.35 ± 1.17 and a postoperative value of 2.68 ± 1.27. No major complications were described. Given the lack and heterogeneity of this evidence, the conclusion calls for being cautious. In carefully selected snorers and obstructive sleep apnea patients, the use of barbed sutures could represent a valid therapeutic strategy for snoring, ensuring a statistically significant improvement in the subjective parameters. Further studies on a larger scale that assess the role of barbed pharyngoplasties in snoring surgery and more extended follow-up studies are needed in order to confirm these promising results.
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New diagnostic tools to screen and assess a still too underestimated disease: the role of the wrist-worn peripheral arterial tonometry device—a systematic review. Sleep Breath 2022; 27:817-828. [DOI: 10.1007/s11325-022-02700-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 10/15/2022]
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