1
|
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.
Collapse
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
| |
Collapse
|
2
|
Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
Collapse
Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
3
|
Moffa A, Giorgi L, Cassano M, Lugo R, Baptista P, Casale M. Complications and side effects after barbed pharyngoplasty: a systematic review. Sleep Breath 2023; 27:31-38. [PMID: 35217931 DOI: 10.1007/s11325-022-02585-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recently, the use of barbed pharyngoplasty (BP) has become widespread in snoring and obstructive sleep apnoea (OSA) palatal surgery, but there are no studies regarding the short- and long-term complications resulting from these different techniques. This systematic review aimed to report the complications and side effects of different BP techniques. METHODS An electronic search was performed on PubMed/MEDLINE, Google Scholar, and Ovid databases. The PRISMA statement was followed. Databases were searched from inception through September 2, 2021. RESULTS We included 14 prospective clinical studies consisting of 769 patients aged 23 to 81 years. The associated intra-operative complications of BP were as follows: partial thread extrusion (2.9%), self-limited bleeding (2.9%), broken needle (1.0%), and suture rupture (1.0%). Short-term complications were as follows: thread/knot extrusion (12.4%), dysphagia (5.6%), bleeding (1.5%), velopharyngeal insufficiency (1.5%), anterior pharyngoplasty dehiscence (1.2%), tonsillar haemorrhage (1.0%), excessive postnasal discharge (1.0%), barbed suture failure (0.5%), acute infection (0.2%), mucosal granulomas (0.2%), chipped tooth caused by mouth gag displacement (0.2%), and fibrous scar (0.2%). Long-term complications were as follows: foreign body sensation (7.8%), sticky mucus in throat (5.9%), dysphagia (3.6%), rhinolalia (3.1%), throat phlegm (1.1%), nose regurgitation (0.8%), dry throat (0.6%), and throat lump (0.3%). CONCLUSION BP is a safe technique free of significant side effects and major complications. However, in this review, patients undergoing BP were very heterogeneous in terms of characteristics of patients chosen and severity of diseases, surgical technique used (myoresective vs non-myoresective), time of follow-up, and mono level vs multilevel surgery. More studies on a larger scale with long-term follow-up are needed to confirm these promising results.
Collapse
Affiliation(s)
- Antonio Moffa
- School of Medicine, Unit of Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy.
| | - Lucrezia Giorgi
- School of Medicine, Unit of Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Michele Cassano
- Unit of Otolaryngology, University of Foggia, Viale Luigi Pinto 1, 71122, Foggia, Italy
| | - Rodolfo Lugo
- Department of Otorhinolaryngology, Grupo Medico San Pedro, Monterrey, Mexico
| | - Peter Baptista
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Manuele Casale
- School of Medicine, Unit of Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy
| |
Collapse
|
4
|
Rinaldi V, Mancini G, de Apodaca PMR, Vicini C, Carrasco M. "Pharyngolab": a new surgical simulator for pharyngoplasties. Eur Arch Otorhinolaryngol 2023; 280:1339-1342. [PMID: 36169723 DOI: 10.1007/s00405-022-07667-2] [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: 07/26/2022] [Accepted: 09/16/2022] [Indexed: 02/07/2023]
Abstract
Pharyngoplasty represents one of the most widely performed surgical procedures for the treatment of obstructive sleep apnea (OSA) in the presence of palate-oropharyngeal collapse. The learning curve for pharyngoplasties is steep and success is conditional on the correct use of the sutures and the careful application of the surgical steps in a narrow surgical field. The use of synthetic models may be conveniently and safely employed for hands-on surgical practice in pharyngoplasties, especially when fresh frozen cadaveric specimens are not available. We present the "Pharyngolab", a new simulator for pharyngoplasties.
Collapse
Affiliation(s)
- Vittorio Rinaldi
- ORL Roma, Department of Otolaryngology and Head and Neck Surgery, Tiberia Hospital, GVM Care and Research, Rome, Italy.
| | - Giovanni Mancini
- ORL Roma, Department of Otolaryngology and Head and Neck Surgery, Tiberia Hospital, GVM Care and Research, Rome, Italy
| | | | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Marina Carrasco
- Department of Otorhinolaryngology, Doctor Peset University Hospital, Valencia, Spain
| |
Collapse
|
5
|
Casale M, Moffa A, Pierri M, Baptista P, Giorgi L. High-Definition 3D Exoscope-Assisted Barbed Pharyngoplasty for OSAS and Snoring: Better Than Live. Healthcare (Basel) 2023; 11:healthcare11040596. [PMID: 36833130 PMCID: PMC9956328 DOI: 10.3390/healthcare11040596] [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: 10/11/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
Recently, a high-definition 3D exoscope (VITOM), a new magnification system that provides a 3D image of the surgical field, has been introduced. This study aims to describe the first use of VITOM 3D technology in Barbed Pharyngoplasty (BP) for Obstructive Sleep Apnea (OSA). VITOM 3D technology is used to support visualization during BP in a male patient affected by severe OSA with a circular palatal collapse pattern at drug-induced sleep endoscopy. During the surgical procedure, this approach markedly improves the visualization of the surgical field through anatomic details of the oral cavity, facilitating surgical dissection and enhancing the teaching environment. It allows for a better involvement and more interactions during the surgery, as scrubbed and assistant nurses can see the surgical field and anticipate the surgeon's choice of instrument. VITOM 3D technology, by combining a telescope with a standard endoscope, has been successfully used in various surgical disciplines and could be very useful, especially in teaching hospitals. VITOM 3D can guarantee "a real immersive" surgical experience for all participants in the operating room. Economic and efficacy studies would be conducted to support the use of a VITOM-3D exoscope in common clinical practice.
Collapse
Affiliation(s)
- Manuele Casale
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- School of Medicine, Campus Bio-Medico University, 00128 Rome, Italy
| | - Antonio Moffa
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- School of Medicine, Campus Bio-Medico University, 00128 Rome, Italy
- Correspondence:
| | - Michelangelo Pierri
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Peter Baptista
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, 31007 Pamplona, Spain
- ENT Department, Al Zahra Private Hospital Dubai, Dubai 23614, United Arab Emirates
| | - Lucrezia Giorgi
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| |
Collapse
|
6
|
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.
Collapse
|
7
|
Martinovic D, Tokic D, Puizina-Mladinic E, Kadic S, Lesin A, Lupi-Ferandin S, Kumric M, Bozic J. Oromaxillofacial Surgery: Both a Treatment and a Possible Cause of Obstructive Sleep Apnea-A Narrative Review. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010142. [PMID: 36676088 PMCID: PMC9866782 DOI: 10.3390/life13010142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023]
Abstract
Obstructive sleep apnea (OSA) is a chronic, sleep-related breathing disorder. It is characterized by a nocturnal periodic decrease or complete stop in airflow due to partial or total collapse of the oropharyngeal tract. Surgical treatment of OSA is constantly evolving and improving, especially with the implementation of new technologies, and this is needed because of the very heterogeneous reasons for OSA due to the multiple sites of potential airway obstruction. Moreover, all of these surgical methods have advantages and disadvantages; hence, patients should be approached individually, and surgical therapies should be chosen carefully. Furthermore, while it is well-established that oromaxillofacial surgery (OMFS) provides various surgical modalities for treating OSA both in adults and children, a new aspect is emerging regarding the possibility that some of the surgeries from the OMFS domain are also causing OSA. The latest studies are suggesting that surgical treatment in the head and neck region for causes other than OSA could possibly have a major impact on the emergence of newly developed OSA, and this issue is still very scarcely mentioned in the literature. Both oncology, traumatology, and orthognathic surgeries could be potential risk factors for developing OSA. This is an important subject, and this review will focus on both the possibilities of OMFS treatments for OSA and on the OMFS treatments for other causes that could possibly be triggering OSA.
Collapse
Affiliation(s)
- Dinko Martinovic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Daria Tokic
- Department of Anesthesiology and Intensive Care, University Hospital of Split, 21000 Split, Croatia
| | - Ema Puizina-Mladinic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Sanja Kadic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Antonella Lesin
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Slaven Lupi-Ferandin
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
- Correspondence: ; Tel.: +385-21-557-871
| |
Collapse
|
8
|
Garaycochea O, Baptista P, Calvo-Imirizaldu M, Terrasa D, Moffa A, Casale M, Alcalde J, O'Connor-Reina C, Plaza G, Fernández S. Surgical anatomy of the lingual nerve for palate surgery: where is located and how to avoid it. Eur Arch Otorhinolaryngol 2022; 279:5347-5353. [PMID: 35771281 PMCID: PMC9519696 DOI: 10.1007/s00405-022-07432-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/30/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe the anatomic relationship of the lingual nerve with the lateral oropharyngeal structures. METHODS An anatomic dissection of the lateral oropharyngeal wall was conducted in eight sides from four fresh-frozen cadaveric heads. Small titanium clips were placed along the lingual nerve and the most anterior and medial border of the medial pterygoid muscle. Radiological reconstructions were employed for optimal visualization; the coronal view was preferred to resemble the surgical position. The distance between the lingual nerve and the medial pterygoid muscle at its upper and lower portion was measured radiologically. The trajectory angle of the lingual nerve with respect to the pterygomandibular raphe was obtained from the intersection between the vector generated between the clips connecting the upper and lower portion of the medial pterygoid muscle with the vector generated from the lingual nerve clips. RESULTS The mean distance from the upper portion of the medial pterygoid muscle and superior lingual nerve clips was 10.16 ± 2.18 mm (mean ± standard deviation), and the lower area of the medial pterygoid muscle to the lingual nerve was separated 5.05 ± 1.49 mm. The trajectory angle of the lingual nerve concerning to the vector that describes the upper portion of the most anterior and medial border of the medial pterygoid muscle with its lower part was 43.73º ± 11.29. CONCLUSIONS The lingual nerve runs lateral to the lateral oropharyngeal wall, from superiorly-inferiorly and laterally-medially, and it is closer to it at its lower third.
Collapse
Affiliation(s)
- Octavio Garaycochea
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain. .,Otorhinolaryngology Department, Hospital Clínic de Barcelona, c/ Paris 146-3º-2ª, 08036, Barcelona, Spain.
| | - Peter Baptista
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Marta Calvo-Imirizaldu
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - David Terrasa
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Antonio Moffa
- School of Medicine, Campus Bio-Medico University, Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Manuele Casale
- School of Medicine, Campus Bio-Medico University, Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Juan Alcalde
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | | | - Guillermo Plaza
- Otorhinolaryngology Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
| | - Secundino Fernández
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| |
Collapse
|
9
|
Saenwandee P, Neruntarat C, Saengthong P, Wiriyaamornchai P, Khuancharee K, Sirisomboonwech S, Chuoykwamdee N. Barbed pharyngoplasty for obstructive sleep apnea: A meta-analysis. Am J Otolaryngol 2022; 43:103306. [PMID: 34906825 DOI: 10.1016/j.amjoto.2021.103306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/02/2021] [Accepted: 11/28/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to perform a meta-analysis of barbed pharyngoplasty (BP) in the treatment of obstructive sleep apnea (OSA). METHODS Databases included PubMed, Ovid MEDLINE, Cochrane Library, Web of Science and Scopus, and reference lists. Relevant articles were searched through August 2021, following the PRISMA guidelines. RESULTS Twenty articles with 762 participants were included. The mean success in BP as a single-level surgery was 85.2% (MD, 95% CI 77.6%, 92.7%). There was a significant reduction of oxygen desaturation index (ODI) of -11.7 (MD 95% CI -16, -7.4). The lowest oxygen saturation (LSAT) improved 8.9% (MD, 95% CI 1.3%, 16.7%). Epworth Sleepiness Scale (ESS) and snoring score significantly decreased -6.8 (MD 95% CI -8.3, -5.2) and -5.3 (MD 95% -7.9, -2.7), respectively. The apnea-hypopnea index (AHI) significantly decreased -23.9 events/h (MD, 95% CI -25.5, -22.9) with a 69% reduction. The mean surgical time was 23 min. A significant improvement of AHI, ODI, ESS, and LSAT was also revealed in BP as a multilevel surgery. Complications included suture extrusion (18%), dysphagia (20%), velopharyngeal insufficiency (15%), and dysgeusia (3%) without serious consequences. The median follow-up period was 6 months, ranged 1 to 26 months. CONCLUSION Barbed pharyngoplasty as a single-level or multilevel surgery is a safe and effective procedure with significant objective and subjective outcomes for OSA patients with palatal obstruction. However, randomized clinical controlled trials with multicenter cooperation and long-term study are necessary.
Collapse
Affiliation(s)
- Piroonya Saenwandee
- Department of Otolaryngology, Faculty of Medicine, Srinakharinwirot University, Sukhumvit 23, Watana, Bangkok, Thailand
| | - Chairat Neruntarat
- Department of Otolaryngology, Faculty of Medicine, Srinakharinwirot University, Sukhumvit 23, Watana, Bangkok, Thailand.
| | - Petcharat Saengthong
- Department of Otorhinolaryngology Head and Neck Surgery, Police General Hospital, 492/1 Rama 1 Road, Patumwan, Bangkok, Thailand
| | - Pannipa Wiriyaamornchai
- Department of Otolaryngology, Faculty of Medicine, Srinakharinwirot University, Sukhumvit 23, Watana, Bangkok, Thailand
| | - Kitsarawut Khuancharee
- Department of Preventive and Social Medicine, Faculty of Medicine, Srinakharinwirot University, Sukhumvit 23, Watana, Bangkok, Thailand.
| | | | - Nuttaphum Chuoykwamdee
- Faculty of Medicine, Srinakharinwirot University, Sukhumvit 23, Watana, Bangkok, Thailand.
| |
Collapse
|
10
|
No-cutting remodelling intra-pharyngeal surgery can avoid CPAP in selected OSA patients: myth or reality? Eur Arch Otorhinolaryngol 2022; 279:5039-5045. [DOI: 10.1007/s00405-022-07261-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/05/2022] [Indexed: 12/20/2022]
|
11
|
Is there a relationship between tonsil volume and the success of pharyngeal surgery among adult patients with obstructive sleep apnea? Braz J Otorhinolaryngol 2022; 88 Suppl 5:S156-S161. [PMID: 35184978 PMCID: PMC9801021 DOI: 10.1016/j.bjorl.2021.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/07/2021] [Accepted: 12/14/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Hypertrophic palatine tonsils play a role in the blockage of the upper airway, one of the known causes of Obstructive Sleep Apnea (OSA). Therefore, it is possible that there is an association between tonsil size and the success of pharyngeal surgery during OSA treatment. The main objective of this study was to evaluate the relationship between tonsil grade and volume, as well as to establish whether a relationship exists between tonsil size and the success rate of pharyngeal surgery (tonsillectomy and pharyngoplasty with barbed sutures). METHODS This retrospective study includes forty-four adult patients who underwent tonsillectomy and pharyngeal surgery with barbed sutures for the treatment of simple snoring and OSA between January 2016 and September 2019. Patients who had been previously tonsillectomized or those for whom tonsil volume measurement was lacking were excluded. All patients underwent a pre-operative physical exploration at the clinic exam room and a sleep study. Prior to surgery a Drug Induced Sleep Endoscopy (DISE) was performed. Tonsil volume was measured intraoperatively using the water displacement method. The same sleep study was repeated six months following surgery. RESULTS A significant correlation was found between tonsil grade and volume and between such measurements and the blockage observed at the level of the oropharynx during the DISE. Moreover, an association was observed between tonsil volume, but not tonsil grade, and the success of tonsillectomy and pharyngoplasty with barbed sutures. A tonsil volume greater than 6.5 cm3 was linked to success during pharyngeal surgery. CONCLUSION A correlation exists between tonsil grade and tonsil volume. A bigger tonsil volume is associated with a greater success rate of oropharyngeal surgery during treatment of OSA. LEVEL OF EVIDENCE Level 3, non-randomized cohort study.
Collapse
|
12
|
|
13
|
Palatopharyngeus muscle in pharyngoplasty surgery for OSAS: cut or not to cut? Eur Arch Otorhinolaryngol 2021; 278:2657-2658. [PMID: 33839915 DOI: 10.1007/s00405-021-06761-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
|
14
|
Gasparini G, Saponaro G, Todaro M, Ciasca G, Cigni L, Doneddu P, Azzuni C, Foresta E, De Angelis P, Barbera G, Parcianello RG, Hreniuc HV, Moro A. Functional Upper Airway Space Endoscopy: A Prognostic Indicator in Obstructive Sleep Apnea Treatment with Mandibular Advancement Devices. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052393. [PMID: 33804517 PMCID: PMC7967765 DOI: 10.3390/ijerph18052393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 02/06/2023]
Abstract
Purpose: The use of a mandibular advancement device (MAD) in the treatment of obstructive sleep apnea (OSA) is a consolidated therapy. This study aimed to evaluate the predictive value of awake upper airways (UA) functional endoscopy in identifying the outcome of MAD therapy. Methods: This observational prospective study included 30 adult OSA patients, all patients underwent pre-treatment awake UA functional endoscopy, during the exam subjects were instructed to advance their mandible maximally, and they were divided into three different groups according to the response of the soft tissue, group A (expansion), group B (stretch), group C (unchanged). The results of this test were used in combination with other noninvasive indexes to predict the treatment outcome in terms of apnea-hypopnea index (AHI) reduction. Results: We found that a substantial AHI reduction occurred in group A and group B while e slight AHI reduction was measured in group C. Conclusion: Based on our experience the awake UA endoscopy is a valid prognostic exam for discriminating responder and non-responder patients; in addition our results indicate the possibility of predicting a range of post-treatment AHI index values.
Collapse
Affiliation(s)
- Giulio Gasparini
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Gianmarco Saponaro
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Mattia Todaro
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
- Correspondence:
| | - Gabriele Ciasca
- Dipartimento di Neuroscienze, Sezione di Fisica, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy;
| | - Lorenzo Cigni
- Department of Odonto-Stomatology, Azienda Ospedaliera Valtellina e Valchiavenna, 23100 Sondrio, Italy;
| | - Piero Doneddu
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Camillo Azzuni
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Enrico Foresta
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Paolo De Angelis
- Departement of Head, Division of Oral Surgery and Implantology, Neck and Sensory Organs, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy;
| | - Giorgio Barbera
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Roberta Gaia Parcianello
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Horia Vasile Hreniuc
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy;
| | - Alessandro Moro
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| |
Collapse
|
15
|
Mantovani M, Rinaldi V, Moffa A, Casale M, Pignataro L. The palato-oropharyngeal musculo-aponeurotic system (POMAS): this must be the place-an integrated new vision of the palatal and oropharyngeal surgical anatomy. Eur Arch Otorhinolaryngol 2021; 278:1297-1298. [PMID: 33595700 DOI: 10.1007/s00405-021-06699-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Mario Mantovani
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Vittorio Rinaldi
- Integrated Sleep Surgery Team UCBM - Unit of Otolaryngology - Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Via Álvaro del Portillo, 21, 00128, Rome, Italy.
| | - Antonio Moffa
- Integrated Sleep Surgery Team UCBM - Unit of Otolaryngology - Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Manuele Casale
- Integrated Sleep Surgery Team UCBM - Unit of Otolaryngology - Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Lorenzo Pignataro
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| |
Collapse
|
16
|
Casale M, Moffa A, Cassano M, Mantovani M, Pignataro L, Rinaldi V. Barbed Suture Needle Rescue Procedure. CURRENT SLEEP MEDICINE REPORTS 2020. [DOI: 10.1007/s40675-020-00196-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
17
|
Waxman JA, Shenouda KG, Lin HS. Assessment and Management of Postoperative Pain Associated with Sleep Apnea Surgery. Otolaryngol Clin North Am 2020; 53:765-777. [PMID: 32564947 DOI: 10.1016/j.otc.2020.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A literature review was conducted regarding the assessment and treatment of postoperative pain following surgery for obstructive sleep apnea (OSA). Given the risks of opioid use by patients with OSA, special attention to opioid risk reduction and avoidance is warranted in this population. The results of this review demonstrate the existence of a body of evidence that supports the use of nonopioid analgesics and nonpharmacologic approaches pain management. Strategies for managing postoperative pain should emphasize the use of local anesthetic infiltration, nonsteroidal antiinflammatory drugs, acetaminophen, topical analgesics, surgical wound cooling, and when necessary, safer opioid medications, such as tramadol and intranasal butorphanol.
Collapse
Affiliation(s)
- Jonathan A Waxman
- Department of Otolaryngology, Head and Neck Surgery, Wayne State University, 4201 St. Antoine, 5E-UHC, Detroit, MI 48201, USA.
| | - Kerolos G Shenouda
- Department of Otolaryngology, Head and Neck Surgery, Wayne State University, 4201 St. Antoine, 5E-UHC, Detroit, MI 48201, USA
| | - Ho-Sheng Lin
- Department of Otolaryngology, Head and Neck Surgery, Wayne State University, 4201 St. Antoine, 5E-UHC, Detroit, MI 48201, USA
| |
Collapse
|
18
|
Moffa A, Rinaldi V, Mantovani M, Pierri M, Fiore V, Costantino A, Pignataro L, Baptista P, Cassano M, Casale M. Different barbed pharyngoplasty techniques for retropalatal collapse in obstructive sleep apnea patients: a systematic review. Sleep Breath 2020; 24:1115-1127. [PMID: 32350702 DOI: 10.1007/s11325-020-02088-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/05/2020] [Accepted: 04/14/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The use of barbed sutures (BS) for the treatment of retropalatal collapse and vibration in patients suffering from snoring and obstructive sleep apnea (OSA) has significantly increased in the last few years. Many surgeons have discovered the advantages and unique properties of the BS and allowed the popular surgical pharyngoplasty techniques to be updated and improved. METHODS A systematic review was performed to identify all the clinical studies concerning the different barbed pharyngoplasty (BP) techniques used for the treatment of palatal collapse in snoring and OSA patients. A qualitative analysis of data extracted was conducted. RESULTS We included 12 studies of which 10 are prospective and 2 retrospective: 9 single-arm studies on the efficacy of a specific BP technique, 1 randomized clinical trial on the comparison between BP and control groups, and 2 studies on the correlation between two different BP techniques. To date, in the literature, 5 different types of BP techniques have been described: barbed snore surgery, barbed reposition pharyngoplasty, barbed expansion sphincter pharyngoplasty, barbed suture suspension, and barbed soft palate posterior webbing flap pharyngoplasty. All the studies showed an overall improvement in the primary efficacy parameters investigated (apnea-hypopnea index, oxygen desaturation index, and Epworth sleepiness scale) in each of the surgical techniques performed without any major complications. CONCLUSIONS Given the extreme heterogeneity of the studies analyzed, it is necessary to perform more randomized and control studies on large samples aimed to define the best BP technique based on its effectiveness, surgical success rate, patient's compliance, and complications.
Collapse
Affiliation(s)
- Antonio Moffa
- Department of Otolaryngology, University of Foggia, Foggia, Italy.
| | - Vittorio Rinaldi
- Integrated Sleep Surgery Team UCBM, Unit of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
- Department of Otolaryngology, Department of Clinical Sciences and Community Health, Fondazione I.R.C.C.S. Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Mario Mantovani
- Department of Otolaryngology, Department of Clinical Sciences and Community Health, Fondazione I.R.C.C.S. Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Michelangelo Pierri
- Integrated Sleep Surgery Team UCBM, Unit of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - Valeria Fiore
- Department of Otolaryngology, University of Foggia, Foggia, Italy
| | - Andrea Costantino
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Lorenzo Pignataro
- Department of Otolaryngology, Department of Clinical Sciences and Community Health, Fondazione I.R.C.C.S. Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Peter Baptista
- Unit of Otolaryngology, Clinica Universitaria de Navarra, Pamplona, Spain
| | - Michele Cassano
- Department of Otolaryngology, University of Foggia, Foggia, Italy
| | - Manuele Casale
- Integrated Sleep Surgery Team UCBM, Unit of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| |
Collapse
|
19
|
Kastoer C, Op de Beeck S, Dom M, Neirinckx T, Verbraecken J, Braem MJ, Van de Heyning PH, Nadjmi N, Vanderveken OM. Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement. Laryngoscope 2020; 130:E268-E274. [DOI: 10.1002/lary.28022] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/28/2019] [Accepted: 04/03/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Chloé Kastoer
- Department of Otorhinolaryngology–Head and Neck SurgeryAntwerp University Hospital Edegem, Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Wilrijk, Antwerp Belgium
| | - Sara Op de Beeck
- Department of Otorhinolaryngology–Head and Neck SurgeryAntwerp University Hospital Edegem, Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Wilrijk, Antwerp Belgium
| | - Marc Dom
- Department of Special Care DentistryAntwerp University Hospital Edegem, Antwerp Belgium
| | - Thérèse Neirinckx
- Department of Special Care DentistryAntwerp University Hospital Edegem, Antwerp Belgium
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders CentreAntwerp University Hospital Edegem, Antwerp Belgium
- Department of PulmonologyAntwerp University Hospital Edegem, Antwerp Belgium
| | - Marc J. Braem
- Department of Special Care DentistryAntwerp University Hospital Edegem, Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Wilrijk, Antwerp Belgium
| | - Paul H. Van de Heyning
- Department of Otorhinolaryngology–Head and Neck SurgeryAntwerp University Hospital Edegem, Antwerp Belgium
- Multidisciplinary Sleep Disorders CentreAntwerp University Hospital Edegem, Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Wilrijk, Antwerp Belgium
| | - Nasser Nadjmi
- Department of Oral and Cranio‐Maxillofacial SurgeryAntwerp University Hospital Edegem, Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Wilrijk, Antwerp Belgium
| | - Olivier M. Vanderveken
- Department of Otorhinolaryngology–Head and Neck SurgeryAntwerp University Hospital Edegem, Antwerp Belgium
- Multidisciplinary Sleep Disorders CentreAntwerp University Hospital Edegem, Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Wilrijk, Antwerp Belgium
| |
Collapse
|
20
|
State-of-the Art in Reconstructive Palatal Surgery Techniques for Obstructive Sleep Apnea. CURRENT SLEEP MEDICINE REPORTS 2020. [DOI: 10.1007/s40675-020-00168-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
21
|
Postoperative Pain and Wound Healing After Coblation-Assisted Barbed Anterior Pharyngoplasty (CABAPh): An Observational Study. Indian J Otolaryngol Head Neck Surg 2019; 71:1157-1162. [PMID: 31750142 DOI: 10.1007/s12070-018-01577-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 12/24/2018] [Indexed: 10/27/2022] Open
Abstract
Despite the numerous progresses in the palatal surgery, one of the critical aspect of snoring and OSA surgery is the postoperative pain. Over the last decades several surgical palatal procedures have been proposed. Our aim was to evaluate the tolerability of the coblation-assisted barbed anterior pharyngoplasty (CABAPh) in terms of postoperative pain and wound healing, compared with bipolar assisted barbed anterior pharyngoplasty (BAPh). An observational study on 20 patients with simple snoring was conducted. The outcomes measured to assessing pain were a 10 cm visual analog scale (VAS) and the dose of paracetamol + codeine administrated postoperatively. The wound healing was evaluated using a 3-point scale. The other parameters indicative of both pain and surgical repair were food intake and weight loss postoperatively. The mean overall pain (VAS scale) was significantly less in the CABAPh group (M 3.7; CI 3.34-4.06) compared with the BAPh (M 4.73; CI 4.28-5.19) with a P = 0.003. The mean wound healing after 4 weeks was significantly less in CABAPh group (M 2.7; CI 3.12-2.28) compared with the BAPh (M 2.1; CI 2.45-1.75) with a P = 0.02. There were no statistically significant difference with regard to food intake (P = 0.09) and weight loss (P = 0.94). The CABAPh was able to achieve a greater pain reduction and a faster wound healing compared with bipolar forceps.
Collapse
|
22
|
Rinaldi V, Costantino A, Moffa A, Casale M. Ex-vivo surgical model for “Barbed Snore Surgery”: a feasibility study. Eur Arch Otorhinolaryngol 2019; 276:3539-3542. [DOI: 10.1007/s00405-019-05660-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/16/2019] [Indexed: 12/23/2022]
|
23
|
Carrasco-Llatas M, Matarredona-Quiles S, De Vito A, Chong KB, Vicini C. Drug-Induced Sleep Endoscopy: Technique, Indications, Tips and Pitfalls. Healthcare (Basel) 2019; 7:healthcare7030093. [PMID: 31344900 PMCID: PMC6787696 DOI: 10.3390/healthcare7030093] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/09/2019] [Accepted: 07/21/2019] [Indexed: 11/16/2022] Open
Abstract
Drug-induced sleep endoscopy (DISE) is a diagnostic tool to assess the upper airway of snorers and obstructive sleep apnea patients in conditions that mimic natural sleep. Although DISE appears simple and similar to awake endoscopy, there are many aspects that need to be standardized in order to obtain reliable and reproducible information. In this article, we will recommend how to reliably perform DISE, its indications, and how to obtain and interpret the information of the upper airway.
Collapse
Affiliation(s)
| | | | - Andrea De Vito
- Department of Otolaryngology; Ospedale Morgagni Pierantoni, 47121 Forli, Italy
| | - Khai Beng Chong
- Department of Otolaryngology; Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Claudio Vicini
- Department of Otolaryngology; Ospedale Morgagni Pierantoni, 47121 Forli, Italy
| |
Collapse
|
24
|
Rinaldi V, Costantino A, Moffa A, Baptista P, Sabatino L, Casale M. “Barbed snore surgery” simulator: a low-cost surgical model. Eur Arch Otorhinolaryngol 2019; 276:2345-2348. [DOI: 10.1007/s00405-019-05497-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
|
25
|
Adult sleep apnea and tonsil hypertrophy: should pharyngoplasty be associated with tonsillectomy? Sleep Breath 2019; 23:917-923. [PMID: 31115738 DOI: 10.1007/s11325-019-01864-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 04/16/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Velopharyngoplasty and palatine tonsillectomy are at the very heart of the surgical treatment of obstructive sleep apnea syndrome (OSAS) care. In cases of major tonsil hypertrophy, we evaluated the relevance of associating soft palate surgery with palatine tonsillectomy, independent of the soft palate length. METHODS We conducted a retrospective single-center study in OSAS patients with grade III or IV tonsils treated with tonsillectomy. Preoperative assessment included an upper airway examination performed while the patient was awake, a polysomnography and a drug-induced sedation endoscopy (DISE). Surgical efficacy was assessed on postoperative polysomnography. Success was considered when the postoperative apnea-hypopnea index (AHI) was less than 20 events/h with a 50% reduction. We compared palatine tonsillectomy efficacy alone (group A) and associated with soft palate surgery (group B). RESULTS We analyzed 33 patients who had undergone surgery between December 2006 and May 2018. Their preoperative mean BMI and mean AHI were 27.3 ± 7.5 kg/m2 and 38.6 ± 21.4 events/h, respectively. The two groups (A, n = 18 and B, n = 15) were clinically comparable. The success rate was 72.2% in group A and 60% in group B. There was no statistically significant difference between the two groups (p > 0.1). CONCLUSIONS According to this study, in our institution, in cases of major tonsillar hypertrophy, simultaneous soft palate surgery had no significant impact on the success rate, regardless of soft palate length. Associating soft palate surgery with palatine tonsillectomy does not seem mandatory to increase the success rate. LEVEL OF EVIDENCE III. Retrospective comparative study.
Collapse
|
26
|
Carrasco-Llatas M, Martínez-Ruiz de Apodaca P, Vaz de Castro J, Matarredona-Quiles S, Dalmau-Galofre J. Drug-Induced Sleep Endoscopy as a Tool for Surgical Planning. CURRENT OTORHINOLARYNGOLOGY REPORTS 2019. [DOI: 10.1007/s40136-019-00220-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
27
|
Pang KP, Plaza G, Baptista J PM, O'Connor Reina C, Chan YH, Pang KA, Pang EB, Wang CMZ, Rotenberg B. Palate surgery for obstructive sleep apnea: a 17-year meta-analysis. Eur Arch Otorhinolaryngol 2018; 275:1697-1707. [PMID: 29802464 DOI: 10.1007/s00405-018-5015-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/23/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Systematic review of palate surgery for the treatment of OSA. METHODS Independent searches to identify publications relevant to OSA treatment and upper airway palate surgery. All relevant studies published between January 2001 and February 2018 were included. Inclusion criteria were adult patients, documented airway evaluation methods and absent hypopharyngeal collapse. Outcomes included success rates of treatment, AHI, Epworth scale, QOL and snoring VAS. RESULTS Fifty-nine papers with a total of 2715 patients, UPPP accounted for 16.7% of all the procedures. Evident differentiation progressing from 2001 to 2018, from 2001 to 2010, the percentage of UPPP procedures were 25.67%, from 2011 to 2018, there were only 12.6% of UPPP procedures. The average follow up was 8.18 months. Meta-analysis on the AHI change for all procedures, showed the fixed effect AHI per follow-up (FU) month change was 1.45 (95% CI 1.33, 1.8), p < 0.001; while for ESS, the fixed effect AHI per FU month change was 0.61 (95% CI 0.56, 0.66), p < 0.001. The mean decrease in AHI was from 35.66 to 13.91 (p < 0.001). The mean decrease in ESS was from 11.65 to 5.08 (p < 0.001). The mean AHI change was 19.9 (p < 0.001). The mean ESS change was 5.8 (p < 0.001). The overall pooled success rate was 67.5%. Meta-analysis of the procedures, showed that the respective mean AHI reduction was 24.7 for the anterior palatoplasty (p = 0.015), 19.8 for the lateral/expansion pharyngoplasty (p = 0.046), and 17.2 for the uvulopalatopharyngoplasty (p = 0.360). CONCLUSIONS Better understanding of the upper airway and objective airway evaluation diagnostic techniques and innovative palate surgeries have improved success rates of OSA surgery.
Collapse
Affiliation(s)
- Kenny Peter Pang
- Asia Sleep Centre, Paragon, 290 Orchard Road, Unit 18-04, Singapore, 238859, Singapore.
| | - Guillermo Plaza
- Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
| | | | | | - Yiong Huak Chan
- Biostatistics Unit, School of Medicine, National University Singapore, Singapore, Singapore
| | - Kathleen A Pang
- Asia Sleep Centre, Paragon, 290 Orchard Road, Unit 18-04, Singapore, 238859, Singapore
| | - Edward B Pang
- Asia Sleep Centre, Paragon, 290 Orchard Road, Unit 18-04, Singapore, 238859, Singapore
| | - Cybil Mei Zhi Wang
- Asia Sleep Centre, Paragon, 290 Orchard Road, Unit 18-04, Singapore, 238859, Singapore.,Western University, London, ON, Canada
| | - Brian Rotenberg
- Asia Sleep Centre, Paragon, 290 Orchard Road, Unit 18-04, Singapore, 238859, Singapore.,Western University, London, ON, Canada
| |
Collapse
|
28
|
Barbed Hyoglossomandibulopexia: A Preclinical Study on Human Anatomic Models. J Craniofac Surg 2018; 29:2334-2336. [PMID: 29771831 DOI: 10.1097/scs.0000000000004606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The retrobasilingual space is the one of the most frequent sites of obstruction in patients with severe obstructive sleep apnea hypopnea syndrome, and several multilevel surgical procedures have been developed. The authors tested by means a preclinical study the feasibility of a new experimental surgical procedure called barbed hyoglossomandibulopexia (B.Hy.G.M.P.) which aims at advancing the tongue base with the hyoid bone (hyo-glossopexia) by multiple plicatures at the oral floor muscles.B.Hy.G.M.P. was performed during cadaveric dissection on 12 human models. Retrobasilingual space enlargement was assessed by means of nasopharyngeal fiberendoscopy.A 25% to 50% enlargement in the retrobasilingual space was documented by means of nasopharyngeal fiberendoscopy in all the patients.The authors' preclinical study documents the feasibility of the B.Hy.G.M.P. procedure on human models, and suggests the possible usefulness of this approach in obstructive sleep apnea hypopnea syndrome patients with retrobasilingual collapse. Dedicated clinical studies on living subjects are needed to assess the effectiveness and safety of this technique.
Collapse
|