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Valderrama-Penagos JX, Rodríguez Alcalá L, Plaza G, Baptista P, Garcia Iriarte MT, Correa EJ, O’Connor-Reina C. Ankyloglossia in Children, a Cause of Obstructive Sleep Apnoea: Case Report of Paediatric Ankyloglossia and Sleep Apnoea: DISE Resolves the Mystery. CHILDREN (BASEL, SWITZERLAND) 2024; 11:218. [PMID: 38397330 PMCID: PMC10887148 DOI: 10.3390/children11020218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/21/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
Tongue mobility is an obstructive sleep apnoea (OSA) marker and myofunctional therapy (MFT) target. For this reason, all paediatric patients with sleep-disordered breathing should require a combined functional assessment from an ear, nose, and throat (ENT) specialist and a phonoaudiologist to confirm or rule out the presence of ankyloglossia. To our knowledge, this is the first case of a 13-year-old girl diagnosed with severe OSA and a significant decrease of 94% in her apnoea index (AI), requiring frenotomy with an immediate postoperative change in the tongue position. A drug-induced sleep endoscopy (DISE) was performed before and immediately postfrenotomy, and the anatomical changes provoked by this surgery during sleep were confirmed for the first time.
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Affiliation(s)
| | - Laura Rodríguez Alcalá
- Department of Otorhinolaryngology, Hospital Quiron Salud Marbella, Av. Severo Ochoa 22, 29603 Marbella, Spain
| | - Guillermo Plaza
- Department of Otorhinolaryngology, Hospital Fuenlabrada, Universidad Rey Juan Carlos I, 28032 Madrid, Spain
| | - Peter Baptista
- Department of Otorhinolaryngology, Clinica Universitaria de Navarra, 31008 Pamplona, Spain
| | | | - Eduardo J. Correa
- Department of Otorhinolaryngology, Hospital La Linea, 11300 La Linea de la Concepción, Spain
| | - Carlos O’Connor-Reina
- Department of Otorhinolaryngology, Hospital Quiron Salud Marbella, Av. Severo Ochoa 22, 29603 Marbella, Spain
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Askar SM, Khazbak AO, Mobasher MA, Abd Al Badea AM, Abu Sharkh AA, Awad AM. Role of DISE in the surgical outcome for patients with obstructive sleep apnea. Am J Otolaryngol 2023; 44:103869. [PMID: 37084610 DOI: 10.1016/j.amjoto.2023.103869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 03/22/2023] [Accepted: 03/25/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE To investigate and compare the surgical outcomes of DISE and non-DISE-guided surgery in cases with obstructive sleep apnea. METHODS Sixty-three patients with severe OSA and BMI ≤35 kg/m2 were included in the study. Patients were randomly divided into group A where surgical intervention was performed without DISE, and group B where surgery was planned according to the findings of DISE. RESULTS In group A, the mean AHI, LO2, and Snoring index showed a highly significant improvement (P < 0.0001). Group B had highly significant improvements as regards PSG data (P < 0.0001). High significant differences exist when comparing the operative time of both groups (P < 0.0001). On comparing the success rates in both groups, no statistically significant differences were reported (p = 0.6885). CONCLUSION Preoperative topo-diagnosis with DISE does not significantly affect the surgical outcomes in OSA. Primary OSA cases could benefit from a no-DISE cost-effective surgical protocol that entails multilevel surgical interventions in a reasonable time.
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Affiliation(s)
- Sherif M Askar
- Head and Neck Surgery, Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt
| | - Alaa O Khazbak
- Head and Neck Surgery, Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt.
| | - Mohamed A Mobasher
- Head and Neck Surgery, Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt
| | - Amany M Abd Al Badea
- Head and Neck Surgery, Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt
| | - Ameer A Abu Sharkh
- Head and Neck Surgery, Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt
| | - Ali M Awad
- Head and Neck Surgery, Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt
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Masárová M, Formánek M, Jor O, Novák V, Vrtková A, Matoušek P, Komínek P, Zeleník K. Epiglottopexy Is a Treatment of Choice for Obstructive Sleep Apnea Caused by a Collapsing Epiglottis. Life (Basel) 2022; 12:life12091378. [PMID: 36143414 PMCID: PMC9502758 DOI: 10.3390/life12091378] [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: 08/02/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
Drug-induced sleep endoscopy (DISE) reveals epiglottic collapse to be a frequent cause of obstructive sleep apnea (OSA) and intolerance of positive airway pressure (PAP). These patients require different management. This prospective study aimed to compare transoral laser epiglottopexy outcomes in patients with OSA caused by epiglottic collapse with the patients’ previous PAP outcomes. Fifteen consecutive adult patients with OSA and epiglottic collapse during DISE were included; ten were analyzed. Before inclusion, PAP was indicated and ineffective in six patients, one of whom underwent unsuccessful uvulopalatopharyngoplasty. PAP was performed during DISE in all patients before epiglottopexy and was uniformly ineffective. ENT control was performed at 1 week and 1 month, and control limited polygraphy to 6 months after surgery. The apnea−hypopnea index (AHI) and Epworth Sleepiness Scale (ESS) were significantly improved (p < 0.001 and p = 0.003, respectively) in all patients after epiglottopexy. Surgery was successful in 9/10 patients; the remaining patient had a significantly decreased AHI and could finally tolerate PAP. Transoral laser epiglottopexy is used to treat OSA in patients with epiglottic collapse. Unlike other methods, it significantly reduces both AHI and ESS and should be considered for these patients. An active search for OSA patients with epiglottic collapse is recommended to prevent treatment failure.
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Affiliation(s)
- Michaela Masárová
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, 708 52 Ostrava, Czech Republic
| | - Martin Formánek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, 708 52 Ostrava, Czech Republic
- Correspondence: ; Tel.: +42-0597375812
| | - Ondřej Jor
- Department of Anesthesiology, Resuscitation and Intensive Medicine, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
| | - Vilém Novák
- Department of Pediatric Neurology, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
| | - Adéla Vrtková
- Department of Applied Mathematics, Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, 708 52 Ostrava, Czech Republic
| | - Petr Matoušek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, 708 52 Ostrava, Czech Republic
| | - Pavel Komínek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, 708 52 Ostrava, Czech Republic
| | - Karol Zeleník
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, 708 52 Ostrava, Czech Republic
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Askar SM, El-Anwar MW, Quriba AS. Positional awake nasoendoscopic pattern-based surgical decision for correction of retropalatal obstruction in OSA. Eur Arch Otorhinolaryngol 2021; 278:901-909. [PMID: 33386971 DOI: 10.1007/s00405-020-06559-7] [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: 09/19/2020] [Accepted: 12/10/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate differential surgical interventions for obstructive sleep apnea (OSA) patients with single-level retropalatal based on the preoperative topographical diagnosis using nasoendoscopy with Müller's maneuver during supine position (MM-P). SUBJECTS AND METHODS This case series included adult patients with OSA who showed a predominant single-level retropalatal collapse on MM-P. An anteroposterior pattern of collapse was managed by an anterior advancement procedure, while a transverse pattern of collapse was managed by lateral/anterolateral advancement procedures (double suspension sutures). A combined procedure was provided to the concentric type of collapse. All patients underwent evaluation of the polysomnography, Epworth Sleepiness Scale (ESS) values and snoring scores both preoperatively and 6-8 months after surgery. RESULTS Among 102 patients, the most commonly reported pattern of collapse at the retropalatal level was the concentric pattern (48.04%) followed by the transverse pattern (27.45%). The AP-pattern of collapse was reported in 24.51%. In the postoperative follow-up visits, no early or late complications were reported. All included groups showed significant improvement in polysomnographic data (mean AHI and lowest O2 saturation level). Significant improvement of VAS of snoring was reported. The overall success rate was ˃90%. CONCLUSION Preoperative differential diagnosis of OSA with MM-P allows for tailored surgical management. Tailored procedures could yield good surgical outcomes when patients are properly selected and the technique is chosen according to preoperative topographical diagnostic assessment. This study might provide an available less-costly and effective preoperative planning for OSA intervention. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Sherif Mohammad Askar
- Head and Neck Surgery, Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Othman Bin Affan St., Zagazig, Sharkia Governorate, Egypt.
| | - Mohammad Waheed El-Anwar
- Head and Neck Surgery, Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Othman Bin Affan St., Zagazig, Sharkia Governorate, Egypt
| | - Amal Saeed Quriba
- Phoniatric Unit, Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Gasparini G, Saponaro G, Todaro M, Ciasca G, Cigni L, Doneddu P, Azzuni C, Foresta E, De Angelis P, Barbera G, Parcianello RG, Hreniuc HV, Moro A. Functional Upper Airway Space Endoscopy: A Prognostic Indicator in Obstructive Sleep Apnea Treatment with Mandibular Advancement Devices. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2393. [PMID: 33804517 PMCID: PMC7967765 DOI: 10.3390/ijerph18052393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE The use of a mandibular advancement device (MAD) in the treatment of obstructive sleep apnea (OSA) is a consolidated therapy. This study aimed to evaluate the predictive value of awake upper airways (UA) functional endoscopy in identifying the outcome of MAD therapy. METHODS This observational prospective study included 30 adult OSA patients, all patients underwent pre-treatment awake UA functional endoscopy, during the exam subjects were instructed to advance their mandible maximally, and they were divided into three different groups according to the response of the soft tissue, group A (expansion), group B (stretch), group C (unchanged). The results of this test were used in combination with other noninvasive indexes to predict the treatment outcome in terms of apnea-hypopnea index (AHI) reduction. RESULTS We found that a substantial AHI reduction occurred in group A and group B while e slight AHI reduction was measured in group C. CONCLUSION Based on our experience the awake UA endoscopy is a valid prognostic exam for discriminating responder and non-responder patients; in addition our results indicate the possibility of predicting a range of post-treatment AHI index values.
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Affiliation(s)
- Giulio Gasparini
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Gianmarco Saponaro
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Mattia Todaro
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Gabriele Ciasca
- Dipartimento di Neuroscienze, Sezione di Fisica, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy;
| | - Lorenzo Cigni
- Department of Odonto-Stomatology, Azienda Ospedaliera Valtellina e Valchiavenna, 23100 Sondrio, Italy;
| | - Piero Doneddu
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Camillo Azzuni
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Enrico Foresta
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Paolo De Angelis
- Departement of Head, Division of Oral Surgery and Implantology, Neck and Sensory Organs, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy;
| | - Giorgio Barbera
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Roberta Gaia Parcianello
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Horia Vasile Hreniuc
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy;
| | - Alessandro Moro
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
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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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