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Maniaci A, Ronsivalle S, Lentini M, Lechien JR. In Reference to Barbed Stayed Bridge Pharyngoplasty (BSBP). Laryngoscope 2024. [PMID: 38855847 DOI: 10.1002/lary.31560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 04/30/2024] [Indexed: 06/11/2024]
Affiliation(s)
- Antonino Maniaci
- Department of Medicine and Surgery, School of Medicine, University of Enna "Kore", 94100, Enna, Italy
- Research Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
| | - Salvatore Ronsivalle
- ENT Department, Gravina Hospital Caltagirone, ASP Catania, 95041, Caltagirone, Italy
| | - Mario Lentini
- ASP Ragusa-Hospital Giovanni Paolo II, 97100, Ragusa, Italy
| | - Jerome R Lechien
- Research Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
- Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, 7000, Mons, Belgium
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Emara TA, Elmonem MSAA, Khaled AM, Genedy HAH, Youssef RS. Anterolateral advancement pharyngoplasty versus barbed reposition pharyngoplasty in patients with obstructive sleep apnea. Eur Arch Otorhinolaryngol 2024; 281:1991-2000. [PMID: 38170209 PMCID: PMC10943148 DOI: 10.1007/s00405-023-08402-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES To compare functional outcomes and complication rates of anterolateral advancement pharyngoplasty (ALA) versus barbed reposition pharyngoplasty (BRP) in the treatment of obstructive sleep apnea patients with palatal and lateral pharyngeal wall collapse. STUDY DESIGN Prospective study. SETTING University hospitals. SUBJECTS AND METHODS Forty-six patients were included in this study. Patients were divided into two groups randomly, group 1 (23 cases) underwent anterolateral advancement pharyngoplasty and group 2 (23 cases) underwent barbed relocation pharyngoplasty. According to the following criteria: both sex, age between 18 and 65 years, body mass index ≤ 32 kg/m2, Friedman stage II or III, type I Fujita, nocturnal polysomnography study diagnostic for OSA, retropalatal and lateral pharyngeal wall collapse, diagnosis with flexible nasoendoscopy during a Muller's maneuver based on a 5-point scale and drug-induced sleep endoscopy. Patients who suffered from retroglossal airway collapse were rolled out. RESULTS Apnea-hypopnea index decreased from 27.50 ± 11.56 to 11.22 ± 7.63 (P ≤ .001) in group 1 and from 33.18 ± 10.94 to 12.38 ± 6.77 (P ≤ .001) in group 2. Retropalatal posterior airway space increased from 9.84 ± 1.29 mm to 21.48 ± 2.8 mm (P ≤ .001) in group 1 and increased from 10.26 ± 1.2 mm to 22.86 ± 2.62 mm (P ≤ .001) in group 2. Retropalatal space volume increased from 1.9 ± 0.68 cm3 to 2.75 ± 0.7 cm3 (P ≤ .001) in group 1 and increased from 1.96 ± 0.88 cm3 to 2.82 ± 0.83 cm3 (P ≤ .001) in group 2. Surgical success was 86.95% in group 1 compared to 82.6% in group 2. CONCLUSIONS Both techniques appear to be effective with a high surgical success rate in the treatment of OSA patients with retropalatal and lateral pharyngeal wall collapse.
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Affiliation(s)
| | | | | | - Hisham Ahmed Hasan Genedy
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
- Faculty of Medicine, ENT Department, Beni-Suef University, Beni Suef, Egypt
| | - Rabie Sayed Youssef
- Faculty of Medicine, ENT Department, Beni-Suef University, Beni Suef, Egypt.
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Kattimani V, Panneerselvam E, Tiwari R, Panga GSK, Sreeram RR. An Overview of Systematic Reviews on the Surgical Management of Obstructive Sleep Apnoea. J Maxillofac Oral Surg 2023; 22:781-793. [PMID: 38105854 PMCID: PMC10719205 DOI: 10.1007/s12663-023-02051-x] [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: 08/24/2023] [Accepted: 10/21/2023] [Indexed: 12/19/2023] Open
Abstract
Background Obstructive Sleep Apnoea (OSA) is a common sleep disorder marked by partial or total obstruction of the upper airway while a person is asleep leading to breathing difficulty, reduced oxygenation and frequent awakenings. This condition affects the general health significantly compromising quality of life. The objective of this overview is to thoroughly assess the systematic reviews on current surgical therapies for the management of OSA in terms of patient outcomes. Methods A thorough literature search was performed from inception till 31st December 2022 using PubMed, and Cochrane databases. Studies evaluating the effectiveness and safety of different surgical techniques for the management of OSA were considered. The quality of articles was assessed using AMSTAR (A MeaSurement Tool to Assess systematic Reviews) and Glenny et al. checklist. Results Out of eighteen studies, only seven studies met the inclusion and exclusion criteria. Results showed that the majority of studies were in the pediatric age group except one systematic review which assessed the adult age group. Conclusion None of the published articles had compared all surgical procedures based on the standard evaluating procedure nor followed all reporting guidelines in the primary studies. For better implementation, further multi center studies are warranted with unique reporting criteria and guidelines about pre- as well as post-operative phases. Future research should concentrate on contrasting strategies, combination therapies, and evaluating long-term effects. Supplementary Information The online version contains supplementary material available at 10.1007/s12663-023-02051-x.
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Affiliation(s)
- Vivekanand Kattimani
- SIBAR Institute of Dental Sciences, Takkellapadu, Guntur, Andhra Pradesh 522509 India
| | | | - Rahul Tiwari
- Narsinhbhai Patel Dental College and Hospital, Sankalchand Patel University, Visnagar, Gujarat India
| | | | - Roopa Rani Sreeram
- SIBAR Institute of Dental Sciences, Takkellapadu, Guntur, Andhra Pradesh 522509 India
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Larsen MHH, Kehlet H, von Buchwald C. Transoral robotic surgery - time for consensus on pain assessment. A review. Acta Otolaryngol 2023; 143:902-911. [PMID: 37991140 DOI: 10.1080/00016489.2023.2282149] [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: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND In Head and Neck surgery Transoral Robotic Surgery (TORS) is evolving as a key treatment option for benign and malignant lesions in the oropharynx. Even so, postoperative pain is one of the primary early complaints following TORS. Well established evidence-based procedure specific pain treatment guidelines are available for a variety of other surgical specialties. However, there are no guidelines for TORS. AIM This review describes the available data of early pain intensity following TORS during rest and procedure related activity. METHODS Literature concerning pain in the immediate postoperative phase following TORS were obtained from two literature databases. RESULTS Most data on pain intensity following TORS are based upon a numeric rating scale, e.g. the Visual Analogue Scale and/or analgesic demands. Only one randomized clinical trial is available reflecting that the literature is mainly based on retrospective and a few prospective studies. Only one study analyzed pain during relevant functionality, i.e. swallowing. Overall, the studies suffer from a non-standardized approach and there is a need for transparent information concerning the timing of pain ratings and methodology. CONCLUSIONS The evidence for optimal pain control is limited, particularly during surgical relevant activity. Postoperative pain rating during activity is a fundamental element in pain trials in order to enhance recovery thereby calling for future consensus on assessment methodology.
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Affiliation(s)
- Mikkel Hjordt Holm Larsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Kehlet
- Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
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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: 62] [Impact Index Per Article: 62.0] [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.
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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
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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.
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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
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The Effects of Barbed Repositioning Pharyngoplasty in Positional and Non-Positional OSA Patients: A Retrospective Analysis. J Clin Med 2022; 11:jcm11226749. [PMID: 36431226 PMCID: PMC9697864 DOI: 10.3390/jcm11226749] [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: 08/27/2022] [Revised: 11/05/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of our retrospective study is evaluating the effectiveness of barbed repositioning pharyngoplasty (BRP) in a consecutive cohort of patients and assessing its impact on positional indexes in order to potentially identify specific obstructive sleep apnea (OSA) phenotypes for patients who might benefit more significantly from this intervention. METHODS A single-center retrospective study with baseline and follow-up type III sleep tests evaluating the Apnea Hypopnea Index (AHI), supine AHI, non-supine AHI, oxygen desaturation index (ODI), mean SaO2, percentage of time spent at SaO2 below 90% (CT90), and lowest oxygen saturation (LOS) were performed. The patients were then divided into groups according to Sher's criteria and Amsterdam Positional OSA Classification (APOC). Parametric and non-parametric tests and univariate and multivariate analyses were conducted. RESULTS The study finally included 47 patients. The statistical analysis showed significant improvement in AHI, supine AHI, non-supine AHI, and ODI after surgery. The linear regression showed that high values of baseline AHI, AHI supine, and AHI non supine predict more significant postoperative reductions in AHI, AHI supine, and AHI non supine, respectively. Therapeutic success was achieved in 22 patients out of 47. The logistic regression did not find any independent risk factors for success. The most significant reduction in AHI, supine AHI, and non-supine AHI was observed in the APOC 3 group while the APOC 1 patients experience a substantially lower improvement. CONCLUSIONS BRP appears to be an effective surgical procedure for the treatment of OSA. The non-positional patients might benefit more from BRP in comparison with positional patients. Moreover, OSA severity should not be considered an absolute contra-indication for this surgical procedure.
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Lateral pharyngoplasty: polysomnographic results and phenotype-based analysis of OSA. Sleep Breath 2022; 27:1125-1134. [DOI: 10.1007/s11325-022-02706-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/01/2022] [Accepted: 09/08/2022] [Indexed: 10/14/2022]
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9
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Iannella G, Magliulo G, Lo Iacono CAM, Visconti IC, Lechien JR, Perrone T, Cammaroto G, Meccariello G, Maniaci A, Cocuzza S, Di Luca M, De Vito A, Martone C, Polimeni A, Greco A, de Vincentiis M, Ralli M, Pace A, Gulotta G, Pelucchi S, Eplite A, Vicini C. Quality of Life and Excessive Daytime Sleepiness in Adults with Obstructive Sleep Apnea Who Are Treated with Multilevel Surgery or Adherent to Continuous Positive Airway Pressure. J Clin Med 2022; 11:2375. [PMID: 35566499 PMCID: PMC9103957 DOI: 10.3390/jcm11092375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 12/15/2022] Open
Abstract
Obstructive Sleep Apnea (OSA) syndrome is a respiratory sleep disorder characterized by a reduction (hypopnea) in or a complete cessation (apnea) of airflow in the upper airways at night, in the presence of breathing effort. The gold standard treatment for OSA is ventilation through continuous positive airway pressure (CPAP), although this often shows poor patient compliance. In recent years, transoral robotic surgery (TORS) has been proposed as a valid surgical treatment for patients suffering from OSA in a multilevel surgical setting. The aim of this study is to analyze the effects on QoL and daytime sleepiness of multilevel surgery for OSA (barbed pharyngoplasty + transoral robotic surgery). Furthermore, we compared the impact on QoL and daytime sleepiness of two different treatments for patients with moderate to severe OSA, such as CPAP and TORS. Sixty-seven OSA patients who underwent multilevel robotic surgery and sixty-seven OSA patients treated with CPAP were enrolled, defined as Group 1 and Group 2, respectively. The Glasgow Benefit Inventory (GBI) questionnaire was administrated to evaluate the changes in the QoL. Respiratory outcomes were evaluated and compared. Group 1 showed a GBI total average value of +30.4, whereas Group 2, a value of +33.2 (p = 0.4). General benefit score showed no difference between groups (p = 0.1). Better values of social status benefit (p = 0.0006) emerged in the CPAP Group, whereas greater physical status benefit (p = 0.04) was shown in the TORS Group. Delta-AHI (-23.7 ± 14.3 vs. -31.7 ± 15.6; p = 0.001) and Delta-ODI (-24.5 ± 9.5 vs. -29.4 ± 10.5; p = 0.001) showed better values in the CPAP group. Therapeutic success rate of the Multilevel TORS Group was 73.1% and 91% in the CPAP group (p = 0.01), respectively. Multilevel TORS and CPAP have a positive effect on the quality of life of OSA patients. Greater social support has been reported in the CPAP group and better physical health status in the TORS group. No statistical difference emerged in the reduction in daytime sleepiness between both groups.
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Affiliation(s)
- Giannicola Iannella
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy; (G.I.); (G.M.); (C.V.)
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (I.C.V.); (A.P.); (A.G.); (M.d.V.); (M.R.); (A.P.); (G.G.)
| | - Giuseppe Magliulo
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (I.C.V.); (A.P.); (A.G.); (M.d.V.); (M.R.); (A.P.); (G.G.)
| | - Cristina Anna Maria Lo Iacono
- Department of Cardiovascular, Respiratory, Nephrologic, Anaesthesiologic and Geriatric Sciences, Sapienza University, Viale dell’Università, 33, 00185 Rome, Italy;
| | - Irene Claudia Visconti
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (I.C.V.); (A.P.); (A.G.); (M.d.V.); (M.R.); (A.P.); (G.G.)
| | - Jerome R. Lechien
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, University of Mons (UMONS), Avenue du Champ de Mars, 6, B7000 Mons, Belgium; (J.R.L.); (S.P.)
| | - Tiziano Perrone
- Department ENT & Audiology, University of Ferrara, Via Savonarola, 9, 44121 Ferrara, Italy;
| | - Giovanni Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy; (G.I.); (G.M.); (C.V.)
| | - Giuseppe Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy; (G.I.); (G.M.); (C.V.)
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Via S. Sofia, 78, 95125 Catania, Italy; (A.M.); (S.C.); (M.D.L.)
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Via S. Sofia, 78, 95125 Catania, Italy; (A.M.); (S.C.); (M.D.L.)
| | - Milena Di Luca
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Via S. Sofia, 78, 95125 Catania, Italy; (A.M.); (S.C.); (M.D.L.)
| | - Andrea De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Ospedale “Santa Maria delle Croci”, Viale Vincenzo Randi, 5, 48121 Ravenna, Italy; (A.D.V.); (C.M.)
| | - Chiara Martone
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Ospedale “Santa Maria delle Croci”, Viale Vincenzo Randi, 5, 48121 Ravenna, Italy; (A.D.V.); (C.M.)
| | - Antonella Polimeni
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (I.C.V.); (A.P.); (A.G.); (M.d.V.); (M.R.); (A.P.); (G.G.)
| | - Antonio Greco
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (I.C.V.); (A.P.); (A.G.); (M.d.V.); (M.R.); (A.P.); (G.G.)
| | - Marco de Vincentiis
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (I.C.V.); (A.P.); (A.G.); (M.d.V.); (M.R.); (A.P.); (G.G.)
| | - Massimo Ralli
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (I.C.V.); (A.P.); (A.G.); (M.d.V.); (M.R.); (A.P.); (G.G.)
| | - Annalisa Pace
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (I.C.V.); (A.P.); (A.G.); (M.d.V.); (M.R.); (A.P.); (G.G.)
| | - Giampiero Gulotta
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (I.C.V.); (A.P.); (A.G.); (M.d.V.); (M.R.); (A.P.); (G.G.)
| | - Stefano Pelucchi
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, University of Mons (UMONS), Avenue du Champ de Mars, 6, B7000 Mons, Belgium; (J.R.L.); (S.P.)
| | - Angelo Eplite
- ENT Department, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy;
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy; (G.I.); (G.M.); (C.V.)
- Department ENT & Audiology, University of Ferrara, Via Savonarola, 9, 44121 Ferrara, Italy;
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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.
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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.
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11
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Lateral pharyngoplasty vs. traditional uvulopalatopharyngoplasty for patients with OSA: systematic review and meta-analysis. Sleep Breath 2022; 26:1539-1550. [PMID: 34978022 DOI: 10.1007/s11325-021-02520-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 09/19/2021] [Accepted: 10/27/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To compare the efficacy and success rates of lateral pharyngoplasty techniques (LP) vs. uvulopalatopharyngoplasty (UPPP) among adult patients surgically treated for obstructive sleep apnea. METHODS A systematic literature review of the last 20 years' papers was conducted using PubMed/Medline, Embase, Web of Science, Scholar, and the Cochrane Library until April 2021. Only full-text English articles comparing LP and UPPP outcomes in adult patients with objective outcomes were included in the study. RESULTS We included 9 articles for a total of 312 surgically treated patients with OSA. LP techniques for obstructive sleep apnea were used on 186 (60%) subjects, while 126 patients (40%) were treated with UPPP. Both surgical procedures resulted in significant improvements in apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS) score, and lowest oxygen saturation (LOS) (p < 0.001 in all cases). Although better outcomes were reported with lateral pharyngoplasty, the differences were not significant compared to UPPP post-operative results (p > 0.05 in all cases). CONCLUSIONS UPPP and LP are both effective surgical procedures in treating OSA in adults. Although not significant, LPs demonstrated improved post-operative outcomes. However, further evidence comparing the surgical effect on patients with OSA is needed to discriminate post-operative outcomes.
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12
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Iannella G, Lechien JR, Perrone T, Meccariello G, Cammaroto G, Cannavicci A, Burgio L, Maniaci A, Cocuzza S, Di Luca M, Stilo G, De Vito A, Magliulo G, Greco A, de Vincentiis M, Ralli M, Pelucchi S, Ciorba A, Vicini C. Barbed reposition pharyngoplasty (BRP) in obstructive sleep apnea treatment: State of the art. Am J Otolaryngol 2022; 43:103197. [PMID: 34492427 DOI: 10.1016/j.amjoto.2021.103197] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/15/2021] [Accepted: 08/26/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE In this paper, we perform a systematic review that discusses the state of the art and evolution on the barbed reposition pharyngoplasty (BRP) in the velo-pharyngeal surgery. Clinical evidence and published outcomes of this surgical technique are reported and discussed. MATERIALS AND METHODS We performed a systematic review of the current literature through the analysis of the last 10 years of literature on barbed palate surgery. Study design, number of patients enrolled, inclusion criteria, pre- and posttreatment outcomes (AHI, ODI), surgical success rate, follow-up time and complication has been collected and reported. RESULTS 15 studies for a total of 1531 patients, out of which 1061 underwent barbed reposition pharyngoplasty. Five trials were uncontrolled prospective studies (215 patients, 14% of total), nine were retrospective studies (1266 patients, 82,6% of total), and one randomized prospective clinical trial (RCT) (50 patients, 3,32% of total). All analyzed studies reported good outcomes after BRP surgery. Average preoperative values of AHI and ODI reduced in all studies considered with a significative statistical difference between preoperative and postoperative values (p < 0.05 in all cases). The postoperative surgical success rate ranged between 65.4 and 93% of cases. There were no significant intra-operative or post-operative complications in all studies considered in this systematic review. CONCLUSIONS Barbed reposition pharyngoplasty has proven to be an easy to learn, quick, safe and effective new palatopharyngeal procedure, that can be used in a single level surgery or as a part of multilevel procedures.
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Affiliation(s)
- Giannicola Iannella
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy; Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185 Rome, Italy.
| | - Jerome R Lechien
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, University of Mons (UMONS), Avenue du Champ de mars, 6, B7000 Mons, Belgium
| | - Tiziano Perrone
- Department ENT & Audiology, University of Ferrara, Ferrara, Italy
| | - Giuseppe Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Giovanni Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Angelo Cannavicci
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Luca Burgio
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, Catania, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, Catania, Italy
| | - Milena Di Luca
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, Catania, Italy
| | - Giovanna Stilo
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, Catania, Italy
| | - Andrea De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Ospedale "Santa Maria delle Croci", Viale Vincenzo Randi, 5, 48121 Ravenna, Italy
| | - Giuseppe Magliulo
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185 Rome, Italy
| | - Antonio Greco
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185 Rome, Italy
| | - Marco de Vincentiis
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185 Rome, Italy
| | - Massimo Ralli
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185 Rome, Italy
| | - Stefano Pelucchi
- Department ENT & Audiology, University of Ferrara, Ferrara, Italy
| | - Andrea Ciorba
- Department ENT & Audiology, University of Ferrara, Ferrara, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy; Department ENT & Audiology, University of Ferrara, Ferrara, Italy
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Ciğer E, İşlek A. Anterior Palatoplasty With Expansion Sphincter Pharyngoplasty for All Type of Pharyngeal Collapse. Laryngoscope 2021; 132:1313-1319. [PMID: 34936109 DOI: 10.1002/lary.29999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/24/2021] [Accepted: 12/08/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study was aimed to compare the efficiency of the anterior palatoplasty and expansion sphincter pharyngoplasty (APwESP) technique for all patterns of velopharyngeal obstruction (anterior-posterior [APPC], lateral [LPC], or combined circular pharyngeal collapse [CPC]). STUDY DESIGN The study was designed as a randomized prospective trial at Kâtip Çelebi University, Atatürk Training, and Research Hospital. METHODS Patients only with velopharyngeal obstruction were included. Three groups were created according to the obstruction pattern (APPC, LPC, and CPC) for the study. Outcome parameters included patient's demographics, apnea-hypopnea index (AHI), lowest oxygen saturation (LOS), Stanford subjective scale of snoring (SSSS), and Epworth sleepiness scale (ESS). RESULTS Thirty-one (34.1%) patients were in APPC group, while 30 (33.0%) patients were in LPC, and 30 (33.0%) were in CPC group. Preoperatively for all patients, on average, AHI was 33.4 ± 13.6, SSSS was 8.3 ± 1.0, ESS was 16.5 ± 2.6, and LOS was determined as 85.5 ± 3.6. There was a significant postoperative improvement in all parameters for all patients. There was no significant difference in outcome parameters between the groups according to obstruction pattern postoperatively. After APwESP surgery, obstruction pattern was not a significant factor for AHI (P = .234), SSSS (P = .180), and LOS (P = .280) (repeated measure analysis of variance test). The rate of surgical success was detected similarly for both of the study groups (P = .435). The rate of successful surgery for severe obstructive sleep apnea in the APPC group was 72.2%, 88.2% in the LPC group, and 75.0% in the CPC group (P = .472). CONCLUSION A combination of APwESP surgery can manage all types of pharyngeal obstruction confidently. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Ejder Ciğer
- Atatürk Training and Research Hospital, Otolaryngology-Head and Neck Surgery Clinic, Kâtip Çelebi University, Izmir, Turkey
| | - Akif İşlek
- Otolaryngology-Head & Neck Surgery Clinic, Acibadem Eskişehir Hospital, Eskişehir, Turkey
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Kent D, Stanley J, Aurora RN, Levine CG, Gottlieb DJ, Spann MD, Torre CA, Green K, Harrod CG. Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med 2021; 17:2507-2531. [PMID: 34351849 PMCID: PMC8726364 DOI: 10.5664/jcsm.9594] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This systematic review provides supporting evidence for the accompanying clinical practice guideline on the referral of adults with obstructive sleep apnea (OSA) for surgical consultation. METHODS The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of upper airway sleep apnea surgery or bariatric surgery to no treatment as well as studies that reported on patient-important and physiologic outcomes pre- and postoperatively. Statistical analyses were performed to determine the clinical significance of using surgery to treat obstructive sleep apnea in adults. Finally, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process was used to assess the evidence for making recommendations. RESULTS The literature search resulted in 274 studies that provided data suitable for statistical analyses. The analyses demonstrated that surgery as a rescue therapy results in a clinically significant reduction in excessive sleepiness, snoring, blood pressure (BP), apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index (ODI); an increase in lowest oxygen saturation (LSAT) and sleep quality; and an improvement in quality of life in adults with OSA who are intolerant or unaccepting of positive airway pressure (PAP) therapy. The analyses demonstrated that surgery as an adjunctive therapy results in a clinically significant reduction in optimal PAP pressure and improvement in PAP adherence in adults with OSA who are intolerant or unaccepting of PAP due to side effects associated with high pressure requirements. The analyses also demonstrated that surgery as an initial treatment results in a clinically significant reduction in AHI/RDI, sleepiness, snoring, BP, and ODI and an increase in LSAT in adults with OSA and major anatomical obstruction. Analysis of bariatric surgery data showed a clinically significant reduction in BP, AHI/RDI, sleepiness, snoring, optimal PAP level, BMI, and ODI and an increase in LSAT in adults with OSA and obesity. Analyses of very limited evidence suggested that upper airway surgery does not result in a clinically significant increase in risk of serious persistent adverse events and suggested that bariatric surgery may result in a clinically significant risk of iron malabsorption that may be managed with iron supplements. The task force provided a detailed summary of the evidence along with the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations. CITATION Kent D, Stanley J, Aurora RN, et al. Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2021;17(12):2507-2531.
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Affiliation(s)
- David Kent
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - R. Nisha Aurora
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Daniel J. Gottlieb
- VA Boston Healthcare System, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Carlos A. Torre
- University of Miami, Miller School of Medicine, Miami, Florida
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Tsou YA, Hsu CC, Shih LC, Lin TC, Chiu CJ, Tien VHC, Tsai MH, Chang WD. Combined Transoral Robotic Tongue Base Surgery and Palate Surgery in Obstructive Sleep Apnea Syndrome: Modified Uvulopalatopharyngoplasty versus Barbed Reposition Pharyngoplasty. J Clin Med 2021; 10:jcm10143169. [PMID: 34300335 PMCID: PMC8306291 DOI: 10.3390/jcm10143169] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Successful surgery outcomes are limited to moderate to severe obstructive sleep apnea (OSA) syndrome. Multilevel collapse at retropalatal and retroglossal areas is often found during the drug-induced sleep endoscopy (DISE). Therefore, multilevel surgery is considered for these patients. The aim of our study was to survey surgical outcomes by modified uvulopalatoplasty (UPPP) plus transoral robotic surgery tongue base reduction (TORSTBR) versus barbed repositioning pharyngoplasty (BRP) plus TORSTBR. Methods: The retrospective cohort study was performed at a tertiary referral center. We collected moderate to severe OSA patients who were not tolerant to positive pressure assistant PAP from September 2016 to September 2019; pre-operative–operative Muller tests all showed retropalatal and retroglossal collapse; pre-operative Friedman Tongue Position (FTP) > III, with the tonsils grade at grade II minimum, with simultaneous velum (V > 1) and tongue base (T > 1), collapsed by drug-induced sleep endoscopy (DISE) under the VOTE grading system. The UPPP plus TORSTBR (n = 31) and BRP plus TORSTBR (n = 31) techniques were offered. We compare the outcomes using an Epworth sleepiness scale (ESS) questionnaire, and measure the patients’ apnea–hypopnea index (AHI), lowest O2 saturation, cumulative time spent below 90% (CT90), and arousal index (AI) by polysomnography six months after surgery; we also measure their length of hospital stay and complications between these two groups. Results: Comparing BRP plus TORSTBR with UPPP plus TORSTBR, the surgical success rate is 67.74% and 38.71%, respectively. The significantly higher surgical success rate in the BRP plus TORSTBR group was noted. The surgical time is shorter in the BRP plus TORSTBR group. The complication rate is not significant in pain, bleeding, dysgeusia, dysphagia, globus sensation, and prolonged suture stay, even though the BRP plus TORSTBR rendered a higher percentage of globus sensation during swallowing and a more prevalent requirement of suture removal one month after surgery. The length of hospital stay is not significantly different between the two groups. Conclusion: In conclusion, BRP plus TORSTBR is a considerable therapy for moderate to severe OSA patients with DISE showing a multi-level collapse in velum and tongue base area. The BRP technique might offer a better anterior–posterior suspension vector for palate level obstruction.
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Affiliation(s)
- Yung-An Tsou
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung 40402, Taiwan; (Y.-A.T.); (C.-C.H.); (L.-C.S.); (T.-C.L.); (C.-J.C.); (V.H.-C.T.); (M.-H.T.)
- School of Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung 41354, Taiwan
| | - Chun-Chieh Hsu
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung 40402, Taiwan; (Y.-A.T.); (C.-C.H.); (L.-C.S.); (T.-C.L.); (C.-J.C.); (V.H.-C.T.); (M.-H.T.)
| | - Liang-Chun Shih
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung 40402, Taiwan; (Y.-A.T.); (C.-C.H.); (L.-C.S.); (T.-C.L.); (C.-J.C.); (V.H.-C.T.); (M.-H.T.)
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan
| | - Tze-Chieh Lin
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung 40402, Taiwan; (Y.-A.T.); (C.-C.H.); (L.-C.S.); (T.-C.L.); (C.-J.C.); (V.H.-C.T.); (M.-H.T.)
| | - Chien-Jen Chiu
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung 40402, Taiwan; (Y.-A.T.); (C.-C.H.); (L.-C.S.); (T.-C.L.); (C.-J.C.); (V.H.-C.T.); (M.-H.T.)
| | - Vincent Hui-Chi Tien
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung 40402, Taiwan; (Y.-A.T.); (C.-C.H.); (L.-C.S.); (T.-C.L.); (C.-J.C.); (V.H.-C.T.); (M.-H.T.)
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung 41354, Taiwan
| | - Ming-Hsui Tsai
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung 40402, Taiwan; (Y.-A.T.); (C.-C.H.); (L.-C.S.); (T.-C.L.); (C.-J.C.); (V.H.-C.T.); (M.-H.T.)
- School of Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung 41354, Taiwan
| | - Wen-Dien Chang
- Department of Sport Performance, National Taiwan University of Sport, Taichung 404401, Taiwan
- Correspondence: ; Tel.: +886-4-22213108
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17
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Zhou N, Ho JPTF, Huang Z, Spijker R, de Vries N, Aarab G, Lobbezoo F, Ravesloot MJL, de Lange J. Maxillomandibular advancement versus multilevel surgery for treatment of obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med Rev 2021; 57:101471. [PMID: 33831676 DOI: 10.1016/j.smrv.2021.101471] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/03/2021] [Accepted: 02/18/2021] [Indexed: 12/12/2022]
Abstract
Multilevel surgery (MLS) and maxillomandibular advancement surgery (MMA) are two established options in surgical management of obstructive sleep apnea (OSA), which target different levels of airway obstruction. The objective of this review was to comparatively evaluate the clinical efficacy and safety of MMA and MLS in the treatment of OSA. MEDLINE and Embase databases were searched for studies on MMA and/or MLS in OSA patients. Twenty MMA studies and 39 MLS studies were identified. OSA patients who underwent MMA showed significant improvements in AHI, LSAT, ODI, and ESS by -46.2/h, 13.5%, -30.3/h, and -8.5, respectively. The pooled rates of surgical success and cure for MMA were 85.0% and 46.3%, respectively. Patients who underwent MLS showed significant improvements in AHI, LSAT, ODI, and ESS by -24.7/h, 8.7%, -19.1/h, and -5.8, respectively. The pooled surgical success and cure rates for MLS were 65.1% and 28.1%, respectively. The rates of major complication of MMA and MLS were 3.2% and 1.1%, respectively, and the rate of minor complication of MMA was higher than that of MLS. We conclude that both MMA and MLS are effective treatment options for OSA. Compared to MLS, MMA may be more effective in improving OSA. However, the complication rate of MMA is higher.
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Affiliation(s)
- Ning Zhou
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, the Netherlands; Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Jean-Pierre T F Ho
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, the Netherlands
| | - Zhengfei Huang
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Clinical Neurophysiology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, the Netherlands
| | - René Spijker
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nico de Vries
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Madeline J L Ravesloot
- Department of Otorhinolaryngology - Head and Neck Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, the Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, the Netherlands
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Neruntarat C, Khuancharee K, Saengthong P. Barbed Reposition Pharyngoplasty versus Expansion Sphincter Pharyngoplasty: A Meta-Analysis. Laryngoscope 2020; 131:1420-1428. [PMID: 33368308 DOI: 10.1002/lary.29357] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study was to compare barbed reposition pharyngoplasty (BRP) and expansion sphincter pharyngoplasty (ESP) in the treatment of obstructive sleep apnea (OSA). METHODS Relevant 907 articles were searched from various databases until August 2020, including PubMed, MEDLINE, EMBASE, Cochrane Library, Web of Science and Scopus, and reference lists. RESULTS Four studies with a total of 208 participants were included. The mean reduction of apnea-hypopnea index (AHI) in the BRP group was 74.03% and the mean reduction of AHI in the ESP group was 60.17%. The mean success rate in the BRP group and the ESP group was 84.96% and 79.87%, respectively. The mean difference (MD) of the change in AHI between groups was not significantly different (MD = -1.24 event/hr, 95% CI [-11.86, 9.36], P = .82). There was no significant difference in postoperative AHI, postoperative Epworth Sleepiness Scale, pain, hospital stay, time to oral diet, and the change in oxygen desaturation index in both groups whereas the analgesic requirement was lower in the BRP group. Operative time was lower in the BRP group (MD = 21.72 minutes, 95% CI [18.85, 24.60], P < .0001). CONCLUSION The outcomes in both procedures are comparable in the improvement of OSA with palatal collapse. BRP is superior to ESP in term of surgical time. However, randomized clinical controlled trials with multicenter cooperation and long-term follow-up are essential to further demonstrate the efficacy of these procedures. Laryngoscope, 131:1420-1428, 2021.
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Affiliation(s)
- Chairat Neruntarat
- Department of Otolaryngology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Kitsarawut Khuancharee
- Department of Preventive and Social Medicine, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Petcharat Saengthong
- Department of Otorhinolaryngology Head and Neck Surgery, Police General Hospital, Bangkok, Thailand
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Capaccio P, Montevecchi F, Meccariello G, Cammaroto G, Magnuson JS, Pelucchi S, Bresciani L, Vicini C. Transoral robotic submandibular sialadenectomy: how and when. Gland Surg 2020; 9:423-429. [PMID: 32420268 DOI: 10.21037/gs.2020.02.04] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Traditional removal of the submandibular gland is done through a transcervical approach; new proposals have come into the scientific limelight such as endoscopy-assisted transcervical sialadenectomy or (robot-assisted) submandibular sialadenectomy through a postauricular facelift transcervical approach. Transoral submandibular sialadenectomy has been described in the past, but with the advent of transoral robotic surgery, the proposal of removing the submandibular gland from the oral floor is gaining strength. A transoral robotic submandibular sialadenectomy by the Si Da Vinci Surgical Robot was performed in a 68-years-old female patient under general anaesthesia. The transoral robotic procedure was successful with no major postoperative complications. A mild tingling of the tip of the tongue was described by the patient 3 months after. The surgical time took 110 minutes. No residual gland was observed at ultrasonography. The transoral robotic submandibular sialadenectomy seems to be, with selective indication based on clinical and radiological assessment, a viable and safe alternative to traditional management in patients who refuse a cervical scar and the risk of paralysis of the facial nerve.
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Affiliation(s)
- Pasquale Capaccio
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Filippo Montevecchi
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni-L. Pierantoni Hospital of Forlì, Forlì, Italy
| | - Giuseppe Meccariello
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni-L. Pierantoni Hospital of Forlì, Forlì, Italy
| | - Giovanni Cammaroto
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni-L. Pierantoni Hospital of Forlì, Forlì, Italy
| | | | - Stefano Pelucchi
- Otolaryngology Head and Neck Surgery, University Hospital of Ferrara, Ferrara, Italy
| | - Lorenzo Bresciani
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudio Vicini
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni-L. Pierantoni Hospital of Forlì, Forlì, Italy.,Otolaryngology Head and Neck Surgery, University Hospital of Ferrara, Ferrara, Italy
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20
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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.
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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
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Acquired Nasopharyngeal Stenosis Correction Using a Modified Palatal Flaps Technique in Obstructive Sleep Apnea (OSA) Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062048. [PMID: 32204516 PMCID: PMC7142903 DOI: 10.3390/ijerph17062048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 11/21/2022]
Abstract
Background: Acquired nasopharyngeal stenosis is a rare and heterogeneous pathological condition that has different causes, generally resulting as a complication of a pharyngeal surgery, especially in patients affected by obstructive sleep apnea (OSA). Different approaches have been proposed for the treatment of nasopharyngeal stenosis but a unique and standardized management has not yet been presented. The aim of our paper is to evaluate the efficacy of our surgical technique, describing its steps and results with the aim to consider it as a possible solution for the treatment of this condition. Methods: This is a retrospective cohort study. Eight patients (mean age 27.25 years old (yo), range 8–67 yo; Male/Female ratio 4/4; mean body mass index (BMI) 26.1) affected by OSA (mean apnea hypopnea index (AHI) before OSA surgery was 22.1) and acquired nasopharyngeal stenosis as a consequence of different pharyngeal surgeries were treated with our modified approach in the Department of Otolaryngology, Morgagni Pierantoni Hospital, Forlì, Italy. Resolution of stenosis and complication rate were the main outcome measures. Results: Complete resolution of the stenosis was achieved in all cases and no complications were recorded at three weeks, six months, and 2 years follow-up. Conclusions: Our technique appears to be a promising method for the management of nasopharyngeal stenosis in OSA patients. However, further studies comparing different techniques and reporting on larger series and longer follow up time are needed to prove the efficacy of the proposed technique.
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Capaccio P, Montevecchi F, Meccariello G, D’Agostino G, Cammaroto G, Pelucchi S, Vicini C. Transoral robotic surgery for hilo-parenchymal submandibular stones: step-by-step description and reasoned approach. Int J Oral Maxillofac Surg 2019; 48:1520-1524. [DOI: 10.1016/j.ijom.2019.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/20/2019] [Accepted: 07/02/2019] [Indexed: 11/29/2022]
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Cambi J, Chiri ZM, De Santis S, Franci E, Frusoni F, Ciabatti PG, Boccuzzi S. Outcomes in single‐stage multilevel surgery for obstructive sleep apnea: Transoral robotic surgery, expansion sphincter pharyngoplasty and septoplasty. Int J Med Robot 2019; 15:e2034. [DOI: 10.1002/rcs.2034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 08/19/2019] [Accepted: 08/28/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Jacopo Cambi
- Department of ENTOspedale della Misericordia Grosseto Italy
| | - Zaira M. Chiri
- Department of ENTOspedale della Misericordia Grosseto Italy
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Dachuri S, Sachidananda R, Montevecchi F, Rashwan M, Vicini C, Gandla S, Pugazhendi SK, Vasista SR. Barbed Reposition Pharyngoplasty in Indian Population: A New Palatal Surgery for OSAS. Indian J Otolaryngol Head Neck Surg 2019; 71:249-253. [PMID: 31275839 DOI: 10.1007/s12070-018-1320-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 03/24/2018] [Indexed: 10/17/2022] Open
Abstract
Obstructive sleep apnoea (OSA) is a common problem affecting almost 4% of the population. Although continuous positive airway pressure (CPAP) is considered the standard of care, the patient compliance for long term use is poor. Clinicians have explored surgical options for cure with varying success. Uvulopalatopharyngoplasty was considered as a standard of surgical care but long-term results were not satisfactory. Surgical researchers have explored newer techniques to improve outcomes in the past decade with less morbidity and better quality of life outcomes. One of such development is Barbed Reposition Pharyngoplasty (BRP). We would like to discuss the technique of BRP for OSA patients step by step.
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Affiliation(s)
- Sandeep Dachuri
- Integrated ENT, Head and Neck Services, People Tree Hospitals, Goreguntapalya, Bangalore, India
| | - Ravi Sachidananda
- Integrated ENT, Head and Neck Services, People Tree Hospitals, Goreguntapalya, Bangalore, India
| | - Filippo Montevecchi
- 2ENT and Oral Surgery Unit, Head and Neck Department, G.B Morgagni- L. Pierantoni Hospital, Forlì, Italy
| | - Mohamed Rashwan
- 2ENT and Oral Surgery Unit, Head and Neck Department, G.B Morgagni- L. Pierantoni Hospital, Forlì, Italy
| | - Claudio Vicini
- 2ENT and Oral Surgery Unit, Head and Neck Department, G.B Morgagni- L. Pierantoni Hospital, Forlì, Italy
| | - Sowjanya Gandla
- 3Head and Neck Oncology Department, Kidwai Memorial Institute of Oncology, Bangalore, India
| | | | - Srividya Rao Vasista
- Integrated ENT, Head and Neck Services, People Tree Hospitals, Goreguntapalya, Bangalore, India
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Bosco G, Pérez-Martín N, Racionero MA, Plaza G. Expansion Sphincter Pharyngoplasty: Usefulness of DISE. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otoeng.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Babademez MA, Gul F, Teleke YC. Barbed palatoplasty vs. expansion sphincter pharyngoplasty with anterior palatoplasty. Laryngoscope 2019; 130:E275-E279. [PMID: 31188473 DOI: 10.1002/lary.28136] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/09/2019] [Accepted: 05/28/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE/HYPOTHESIS To compare the functional outcomes and complication rates in patients who underwent expansion sphincter pharyngoplasty with anterior palatoplasty (ESPwAP) versus barbed pharyngoplasty (BP). STUDY DESIGN Retrospective cohort study. METHODS A medical database was used to retrieve the records of 129 patients who had an isolated palatoplasty surgery between January 2014 and July 2018. Patients who had mild or moderate obstructive sleep apnea without a history of revision surgery and underwent ESPwAP or BP in addition to traditional tonsillectomy were included in the study. Pre- and postoperative polysomnography and Epworth Sleepiness Scale (ESS) was evaluated in the patients who completed at least a 6-month follow-up period. RESULTS Forty-five and 53 patients met the inclusion, and were comprised of BP and ESPwAP groups, respectively. ESPwAP and BP significantly improved mean apnea hypopnea index (AHI) from 28.5 to 9.1 (P = .000) and 25.9 to 7.4 (P = .000), respectively. No significant statistical difference was found between the mean AHI scores of two groups. Selecting a threshold of a 50% reduction in AHI and AHI less than 20 events/h, success rates were 86.6% in BP group and 84.9% in ESPwAP group. CONCLUSIONS Our study showed that both types of surgeries are effective with comparable results. The BP technique may be preferred when possible to avoid soft tissue excision and seems to be a less invasive procedure with a similar success rate when compared to ESPwAP. LEVEL OF EVIDENCE 4 Laryngoscope, 130:E275-E279, 2020.
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Affiliation(s)
- Mehmet Ali Babademez
- Department of Otorhinolaryngology, Yıldırım Beyazıt University School of Medicine, Head and Neck Surgery, Ankara, Turkey
| | - Fatih Gul
- Department of Otorhinolaryngology, Yıldırım Beyazıt University School of Medicine, Head and Neck Surgery, Ankara, Turkey
| | - Yagmur Canan Teleke
- Department of Otorhinolaryngology, Yıldırım Beyazıt University School of Medicine, Head and Neck Surgery, Ankara, Turkey
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Testani E, De Corso E, Losurdo A, Fiorita A, Vollono C, Marca GD, Scarano E. Treatment-emergent central sleep apnoea after surgery for obstructive sleep apnoea. ACTA ACUST UNITED AC 2019; 38:476-479. [PMID: 30498277 PMCID: PMC6265664 DOI: 10.14639/0392-100x-1476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/19/2018] [Indexed: 11/29/2022]
Abstract
Central sleep apnoea (CSA) is a lack of drive to breathe during sleep, which can occur in physiologic as well as in pathologic conditions. A particular type of CSA, defined treatment-emergent CSA (TECSA), may occur after the treatment of obstructive sleep apnoea syndrome (OSAS), either with CPAP or surgery. TECSA is transitory and seems to be related to the severity of OSAS. We describe a 51-year-old man affected by severe OSAS who developed severe, transient CSA immediately after upper airways surgery. We believe that CSA was triggered by the sudden variation in nocturnal arterial PCO2, which decreased from 52.3 mmHg before surgery to 42.0 mmHg after surgery. It is conceivable that, due to long-lasting severe OSAS, our patient lowered his chemosensitivity to PCO2. Consequently, the resolution of obstructive apnoeas and the restoration of normal nocturnal values of PCO2 may have reduced the nocturnal PCO2 to the point of being inadequate to stimulate ventilation.
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Affiliation(s)
- E Testani
- Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa Collo, Area Neuroscenze, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italia
| | - E De Corso
- UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Otorinolaringoiatria, Università Cattolica del Sacro Cuore, Roma, Italia
| | - A Losurdo
- Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa Collo, Area Neuroscenze, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italia
| | - A Fiorita
- UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Otorinolaringoiatria, Università Cattolica del Sacro Cuore, Roma, Italia
| | - C Vollono
- Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa Collo, Area Neuroscenze, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italia
| | - G Della Marca
- Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa Collo, Area Neuroscenze, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italia
| | - E Scarano
- UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Otorinolaringoiatria, Università Cattolica del Sacro Cuore, Roma, Italia
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Plaza G, Baptista P, O'Connor-Reina C, Bosco G, Pérez-Martín N, Pang KP. Prospective multi-center study on expansion sphincter pharyngoplasty. Acta Otolaryngol 2019; 139:219-222. [PMID: 30794010 DOI: 10.1080/00016489.2018.1533992] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to demonstrate the long-term effectiveness of Expansion Sphincter Pharyngoplasty (ESP) as a standalone surgical treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) patients through a prospective multi-center study. MATERIAL AND METHODS A prospective non-comparative multicenter study of patients suffering from OSHAS selected after drug-induced sleep endoscopy, with ESP as standing alone procedure was performed. Inclusion criteria were lateral collapse on oropharynx and preoperative AHI between 5 and 70. Minimum follow-up was >12 months. Outcome measures were Epworth sleepiness scale (ESS), AHI, success rate and CPAP need after surgery. RESULTS A total of 75 ESP were performed. Mean patient age was 46.7 ± 10.5 years. Mean pre-operative and post-operative AHI was 22.1 ± 12.2 and 8.6 ± 6.7, respectively (p < .001). Mean pre-operative and post-operative ESS score was 11.5 ± 4.7 and 4.6 ± 6.6, respectively (p < .001). AHI <5 was obtained in 25 patients (33.3%), and CPAP was not further needed after surgery in a total of 62 patients (82.6%). CONCLUSIONS AND SIGNIFICANCE In this prospective multi-center study, patients undergoing ESP standing alone for the treatment of OSAHS have a reasonable expectation for success with minimal morbidity.
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Affiliation(s)
- Guillermo Plaza
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | - Peter Baptista
- Department of Otolaryngology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Gabriela Bosco
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | - Nuria Pérez-Martín
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | - Kenny P. Pang
- Department of Otolaryngology, Asia Sleep Centre, Paragon Medical Centre, Singapore
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Crosetti E, Caracciolo A, Arrigoni G, Delmastro E, Succo G. Barbed suture in oral cavity reconstruction: preliminary results. ACTA ACUST UNITED AC 2019; 39:308-315. [PMID: 30745594 PMCID: PMC6843584 DOI: 10.14639/0392-100x-2130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/20/2018] [Indexed: 11/23/2022]
Abstract
The purpose of this study is to evaluate the efficacy and safety of unidirectional barbed suture (V-Loc) compared to a standard monofilament stitch (Vicryl) in suturing of a free flap to local tissue after head and neck surgery for squamous cell carcinoma of the oral cavity. Complication rates, operative closure time, length of hospitalisation and costs were evaluated. The study cohort (group A) of 20 consecutive patients reconstructed using barbed stitches for suturing was prospectively compared to a control cohort (group B) of 20 consecutive patients reconstructed using conventional vicryl stitches. All patients were affected by squamous cell carcinoma of the tongue and underwent different types of glossectomy and reconstruction with free flaps. This analysis demonstrates the efficacy of the barbed suture compared with a standard monofilament stitch in terms of lower complication rate (15% group A, 30% group B), intra-operative closure times (486 minutes group A, 517 minutes group B), and length of hospitalisation (average length of hospitalisation 14.60 days group A, 16.85 days group B). These factors coupled with the use of a lower number of stitches compared with the standard stitches may compensate the increased cost of the barbed suture. In conclusion, this study demonstrates that the use of unidirectional barbed stitches for suturing of a free flap to the recipient site reduces the complication rate, principally in terms of dehiscence and fistula incidence, and reduces intra-operative time and length of hospitalisation. Based on these results and on the literature, the use of unidirectional barbed stitches can be considered as a safe and efficient alternative to conventional stitches for suturing of free flaps to local tissue.
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Affiliation(s)
- E Crosetti
- Head and Neck Oncology Service, Oncology Deparment University of Turin, Candiolo Cancer Institute - FPO, IRCCS, Candiolo (TO), Italy
| | - A Caracciolo
- Head and Neck Oncology Service, Oncology Deparment University of Turin, Candiolo Cancer Institute - FPO, IRCCS, Candiolo (TO), Italy
| | - G Arrigoni
- Head and Neck Oncology Service, Oncology Deparment University of Turin, Candiolo Cancer Institute - FPO, IRCCS, Candiolo (TO), Italy
| | - E Delmastro
- Division of Radiotherapy, Candiolo Cancer Institute - FPO, IRCCS, Candiolo (TO), Italy
| | - G Succo
- Head and Neck Oncology Service, Oncology Deparment University of Turin, Candiolo Cancer Institute - FPO, IRCCS, Candiolo (TO), Italy
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Expansion sphincter pharyngoplasty: Usefulness of DISE. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 70:215-221. [PMID: 30115363 DOI: 10.1016/j.otorri.2018.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The aim of this study was first to present the indications and results using expansion sphincter pharyngoplasty to treat obstructive sleep apnoea-hypopnoea syndrome (OSAHS). And second, to compare the findings of drug-induced sleep endoscopy (DISE) before and after the surgery. MATERIAL AND METHODS The study design was a prospective cohort of patients surgically treated between 2015 and 2016. All patients were diagnosed with mild to severe obstructive sleep apnoea and did not tolerate CPAP. All had pre- and post-surgery DISE and polysomnography. The inclusion criteria were age, between 18 years and 70 years, small tonsils (sizes 1 and 2), Friedman II and III clinical stage, and lateral collapse in preoperative DISE. We performed surgery to the palate only, using expansion sphincter pharyngoplasty. RESULTS Seventeen patients were included, 52.94% had severe OSAHS. Average age was 42 years, average body mass index was 28. The surgical success rate according to Sher criteria was 82.35%. 41.17% had a postoperative apnoea-hypopnoea index of less than 10. Seventy-five percent of the patients had no further need for CPAP. CONCLUSION Expansion sphincter pharyngoplasty is a safe technique for treating OSAHS, in patients with small tonsils, Friedman grade I and II and collapse of lateral walls in DISE, in the absence of multilevel collapse. The postoperative DISE showed improvement of the lateral collapse was achieved with the expansion.
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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.
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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
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Rashwan MS, Montevecchi F, Cammaroto G, Badr el Deen M, Iskander N, El Hennawi D, El Tabbakh M, Meccariello G, Gobbi R, Stomeo F, Vicini C. Evolution of soft palate surgery techniques for obstructive sleep apnea patients: A comparative study for single-level palatal surgeries. Clin Otolaryngol 2017; 43:584-590. [DOI: 10.1111/coa.13027] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Mohamed S. Rashwan
- Faculty of Medicine; Department of Otorhinolaryngology; Suez Canal University Teaching Hospitals; Ismailia Egypt
| | - Filippo Montevecchi
- Head and Neck Department - ENT & Oral Surgery Unit; G.B. Morgagni - L. Pierantoni Hospital; Forlì - ASL of Romagna Italy
| | - Giovanni Cammaroto
- Head and Neck Department - ENT & Oral Surgery Unit; G.B. Morgagni - L. Pierantoni Hospital; Forlì - ASL of Romagna Italy
- Department of Otorhinolaryngology; University of Messina; Messina Italy
| | - Mohamed Badr el Deen
- Faculty of Medicine; Department of Otorhinolaryngology; Suez Canal University Teaching Hospitals; Ismailia Egypt
| | - Nagi Iskander
- Faculty of Medicine; Department of Otorhinolaryngology; Suez Canal University Teaching Hospitals; Ismailia Egypt
| | - Diaa El Hennawi
- Faculty of Medicine; Department of Otorhinolaryngology; Suez Canal University Teaching Hospitals; Ismailia Egypt
| | - Mohammed El Tabbakh
- Faculty of Medicine; Department of Otorhinolaryngology; Suez Canal University Teaching Hospitals; Ismailia Egypt
| | - Giuseppe Meccariello
- Head and Neck Department - ENT & Oral Surgery Unit; G.B. Morgagni - L. Pierantoni Hospital; Forlì - ASL of Romagna Italy
| | - Riccardo Gobbi
- Head and Neck Department - ENT & Oral Surgery Unit; G.B. Morgagni - L. Pierantoni Hospital; Forlì - ASL of Romagna Italy
| | - Francesco Stomeo
- ENT & Audiology Department; University of Ferrara; Ferrara Italy
| | - Claudio Vicini
- Head and Neck Department - ENT & Oral Surgery Unit; G.B. Morgagni - L. Pierantoni Hospital; Forlì - ASL of Romagna Italy
- ENT & Audiology Department; University of Ferrara; Ferrara Italy
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Montevecchi F, Meccariello G, Firinu E, Rashwan MS, Arigliani M, De Benedetto M, Palumbo A, Bahgat Y, Bahgat A, Lugo Saldana R, Marzetti A, Pignataro L, Mantovani M, Rinaldi V, Carrasco M, Freire F, Delgado I, Salamanca F, Bianchi A, Onerci M, Agostini P, Romano L, Benazzo M, Baptista P, Salzano F, Dallan I, Nuzzo S, Vicini C. Prospective multicentre study on barbed reposition pharyngoplasty standing alone or as a part of multilevel surgery for sleep apnoea. Clin Otolaryngol 2017; 43:483-488. [PMID: 28981208 DOI: 10.1111/coa.13001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to demonstrate in a prospective multicentre study that Barbed Reposition Pharyngoplasty (BRP) procedure is safe and effective in management of obstructive sleep apnoea/hypopnea syndrome (OSAHS) patients. DESIGN Prospective study. SETTING Multicentre study. PARTICIPANTS Patients suffering from obstructive sleep apnoea. MAIN OUTCOMES MEASURES Values of postoperative apnoea-hypopnea index (AHI), oxygen desaturation index (ODI), epworth sleepiness scale (ESS). RESULTS 111 Barbed Reposition Pharyngoplasty procedures standing alone or as a part of multilevel surgery for OSAHS, performed between January and September 2016, were analysed in 15 different centres. The average hospitalisation period was 2.5 ± 0.5 days. The mean patient age was 46.3 ± 10.5 years. The average body mass index at the time of the procedure was 27.9 ± 3.2, and the majority of the patients were men (83%). The mean preoperative and postoperative apnoea/hypopnea index was 33.4 ± 19.5 and 13.5 ± 10.3, respectively (P < .001). The mean preoperative and postoperative ESS score was 10.2 ± 4.5 and 6.1 ± 3.6, respectively (P < .001). The mean preoperative and postoperative ODI were 29.6 ± 20.7 and 12.7 ± 10.8, respectively (P < .001). CONCLUSIONS Patients undergoing BRP standing alone or as part of a multilevel approach for the treatment of OSAHS have a reasonable expectation for success with minimal morbidity.
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Affiliation(s)
- F Montevecchi
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni - L. Pierantoni Hospital, Forlì - Infermi Hospital, Faenza - ASL of Romagna, Forli, University of Ferrrara, Italy
| | - G Meccariello
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni - L. Pierantoni Hospital, Forlì - Infermi Hospital, Faenza - ASL of Romagna, Forli, University of Ferrrara, Italy
| | - E Firinu
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni - L. Pierantoni Hospital, Forlì - Infermi Hospital, Faenza - ASL of Romagna, Forli, University of Ferrrara, Italy
| | - M S Rashwan
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni - L. Pierantoni Hospital, Forlì - Infermi Hospital, Faenza - ASL of Romagna, Forli, University of Ferrrara, Italy
| | - M Arigliani
- Department of Otolaryngology Head and Neck Surgery, Fazzi Hospital, Lecce, Italy
| | - M De Benedetto
- Department of Otolaryngology Head and Neck Surgery, Fazzi Hospital, Lecce, Italy
| | - A Palumbo
- Department of Otolaryngology Head and Neck Surgery, Fazzi Hospital, Lecce, Italy
| | - Y Bahgat
- Department of Otorhinolaryngology, Alexandria University, Alexandria, Egypt
| | - A Bahgat
- Department of Otorhinolaryngology, Alexandria University, Alexandria, Egypt
| | - R Lugo Saldana
- Department of Otorhinolaryngology, Grupo Medico San Pedro, Monterrey, Mexico
| | - A Marzetti
- Department of Otolaryngology, Fabrizio Spaziani Hospital, Frosinone, Italy
| | - L 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
| | - M 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
| | - V Rinaldi
- 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
| | - M Carrasco
- Department of Otorhinolaryngology, Doctor Peset University Hospital, Valencia, Spain
| | - F Freire
- Department of Otolaryngology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - I Delgado
- Department of Otolaryngology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - F Salamanca
- Department of Otolaryngology, S. Pio X Hospital, Milan, Italy
| | - A Bianchi
- Department of Otolaryngology, S. Pio X Hospital, Milan, Italy
| | - M Onerci
- Ear Nose Throat-Head and Neck Surgery Department, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - P Agostini
- Department of Otolaryngology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - L Romano
- Department of Otolaryngology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - M Benazzo
- Department of Otolaryngology Head Neck Surgery, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - P Baptista
- Department of Otolaringology, Campus Universitario, University of Navarra, Pamplona, Spain
| | - F Salzano
- Otorhinolaryngologic Unit, San Giovanni di Dio e Ruggi d' Aragona University Hospital, Salerno, Italy
| | - I Dallan
- First Otorhinolaryngologic Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - S Nuzzo
- Biostatistics Unit, G.B. Morgagni - L. Pierantoni Hospital, Forlì - ASL of Romagna, Forli, Italy
| | - C Vicini
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni - L. Pierantoni Hospital, Forlì - Infermi Hospital, Faenza - ASL of Romagna, Forli, University of Ferrrara, Italy
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