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Dewey J, Shaikh N, Al-Asadi Z, Turner M. The influence of perioperative enoxaparin on bleeding after TORS oropharyngectomy. J Robot Surg 2024; 18:203. [PMID: 38713415 DOI: 10.1007/s11701-024-01965-z] [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: 03/07/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
Perioperative enoxaparin is often avoided in patients undergoing transoral robotic (TORS) oropharyngectomy. Our goal was to quantify the risk of postoperative hemorrhage (POH) in patients receiving enoxaparin after TORS oropharyngectomy. This was a retrospective database cohort study set up in 89 separate healthcare organizations. The TriNetX electronic database was queried for patients with OPSCC who underwent TORS oropharyngectomy. Propensity-score matching was used to create two cohorts, one receiving and one not receiving perioperative enoxaparin. Outcome measures were the POH rate within 1 day of surgery ("primary") and POH rate within 2-30 days of surgery ("secondary"). 1109 patients undergoing TORS for OPSCC were identified, 400 of which received perioperative enoxaparin. One-to-one propensity score matching resulted in 310 patients per cohort. After matching, the primary POH rates between patients receiving and not receiving enoxaparin were 3.23% for both cohorts (OR 1.000, 95% CI 0.410 to 2.438). The secondary POH rates between those receiving and not receiving enoxaparin were 5.47% vs. 3.54% (OR 1.577, 95% CI 0.726 to 3.424). The number needed to harm (NNH) with perioperative enoxaparin use for secondary POH after TORS was 53; no difference was found in primary POH rates. While not statistically significant, the use of perioperative enoxaparin after TORS is associated with increased odds of secondary POH with a NNH of 53; no difference was found in rates of primary POH. For patients undergoing TORS, enoxaparin use requires careful weighing of the risks and benefits.
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Affiliation(s)
- John Dewey
- Department of Otolaryngology, West Virginia University, PO Box 9100, Morgantown, WV, 26506-9600, USA
| | - Noah Shaikh
- Department of Otolaryngology, West Virginia University, PO Box 9100, Morgantown, WV, 26506-9600, USA
| | - Zayd Al-Asadi
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Meghan Turner
- Department of Otolaryngology, West Virginia University, PO Box 9100, Morgantown, WV, 26506-9600, USA.
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2
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Li Y, Inamochi Y, Wang Z, Fueki K. Clinical application of robots in dentistry: A scoping review. J Prosthodont Res 2024; 68:193-205. [PMID: 37302842 DOI: 10.2186/jpr.jpr_d_23_00027] [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] [Indexed: 06/13/2023]
Abstract
PURPOSE The surge in digitalization and artificial intelligence has led to the wide application of robots in various fields, but their application in dentistry started relatively late. This scoping review aimed to comprehensively explore and map the current status of the clinical application of robots in dentistry. STUDY SELECTION An iterative approach was used to gather as much evidence as possible from four online databases, including PubMed, the China National Knowledge Infrastructure, the Japan Science and Technology Information Aggregator, Electronic, and the Institute of Electrical and Electronics Engineers, from January 1980 to December 2022. RESULTS A total of 113 eligible articles were selected from the search results, and it was found that most of the robots were developed and applied in the United States (n = 56; 50%). Robots were clinically applied in oral and maxillofacial surgery, oral implantology, prosthodontics, orthodontics, endodontics, and oral medicine. The development of robots in oral and maxillofacial surgery and oral implantology is relatively fast and comprehensive. About 51% (n = 58) of the systems had reached clinical application, while 49% (n = 55) were at the pre-clinical stage. Most of these are hard robots (90%; n = 103), and their invention and development were mainly focused on university research groups with long research periods and diverse components. CONCLUSIONS There are still limitations and gaps between research and application in dental robots. While robotics is threatening to replace clinical decision-making, combining it with dentistry to gain maximum benefit remains a challenge for the future.
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Affiliation(s)
- Yajie Li
- Department of Masticatory Function and Health Science, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yuka Inamochi
- Department of Masticatory Function and Health Science, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Zuo Wang
- School & Hospital of Stomatology, Tongji University, Shanghai, China
| | - Kenji Fueki
- Department of Masticatory Function and Health Science, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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3
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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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4
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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: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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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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5
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Rha MS, Jeong Y, Kim CH, Yoon JH, Cho HJ. Clinical Characteristics and Surgical Outcomes of Obstructive Sleep Apnea Patients With Mixed Apnea Components. Otolaryngol Head Neck Surg 2023; 168:521-527. [PMID: 35671146 DOI: 10.1177/01945998221103800] [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: 02/22/2022] [Accepted: 04/21/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study was aimed to investigate clinical implications of mixed apnea (MA) in patients with obstructive sleep apnea (OSA), particularly whether surgical outcomes differ between OSA patients with and without MA events. STUDY DESIGN Retrospective cohort study. SETTING Single tertiary medical center. METHODS Eighty-eight patients with OSA who underwent multilevel upper airway surgery were included. Patients were divided into 2 groups according to the presence of MA events: "pure group" (n = 30) and "mixed group" (n = 58). The clinical characteristics and surgical outcomes were compared between the 2 groups. RESULTS The mixed group included more males (P = .020) and hypertensive patients (P = .009) and had a higher apnea-hypopnea index (AHI; P < .001) than the pure group. The surgical success rate was lower in the mixed group (29.3%) than in the pure group (73.3%; P < .001). Furthermore, the postoperative improvements in total AHI (P < .001), supine AHI (P < .001), and oxygen desaturation index (P = .006) were lower in the mixed group than in the pure group. Logistic regression analysis confirmed that the presence of MA (P = .002) was an independent predictor of poor surgical outcomes in patients with OSA. CONCLUSION OSA patients with MA showed different clinical features and poor surgical outcomes compared to those without MA. These results imply that OSA with MA components may have a distinct pathophysiology, and the presence of MA should be considered in the surgical treatment of OSA.
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Affiliation(s)
- Min-Seok Rha
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yeonsu Jeong
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang-Hoon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
- The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- The Korea Mouse Phenotyping Center, Yonsei University College of Medicine, Seoul, Republic of Korea
- Taste Research Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joo-Heon Yoon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
- The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- The Korea Mouse Phenotyping Center, Yonsei University College of Medicine, Seoul, Republic of Korea
- Global Research Laboratory for Allergic Airway Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Ju Cho
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
- The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- The Korea Mouse Phenotyping Center, Yonsei University College of Medicine, Seoul, Republic of Korea
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6
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Calvo-Henriquez C, Boronat-Catala B, Rivero-Fernández I, Cammaroto G, Ibrahim B, Lechien JR, Martínez-Capoccioni G, Carrasco-Llatas M, Capasso R, Martin-Martin C. Safety of tongue base procedures for sleep apnoea in adults: A systematic review and metanalysis from the YO-IFOS study group. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 73:384-393. [PMID: 36404101 DOI: 10.1016/j.otoeng.2021.10.004] [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: 06/19/2021] [Accepted: 10/06/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Tongue base and hypopharynx are the major sites of obstruction in OSA patients with failed palatal surgery. In recent years, several minimally invasive procedures have been developed to address tongue base obstruction. However, the research focus has consistently been on the effectiveness of surgery in reducing obstructive sleep apnoea rather than on postoperative complications. In this systematic review and metanalysis we aim to review the complication rate of minimally invasive base of tongue procedures for OSAS in adults. DATA SOURCES PubMed (Medline), the Cochrane Library, EMBASE, Scopus, SciELO and Trip Database. REVIEW METHODS Data sources were checked by three authors of the YO-IFOS sleep apnoea study group. Three authors extracted the data. Main outcome was expressed as the complication rate and 95% confidence interval for each surgical technique. RESULTS 20 studies (542 patients) met the inclusion criteria. The mean complication rate is 12.79%; 4.65% for minor complications, 6.42% if they are moderate, and 1.77% if severe. The most reported complication overall is infection, in 1.95% of cases, followed by transient swallowing disorder, occurring in 1.30% of the total sample. CONCLUSION The heterogeneity amongst the included studies prevents us from obtaining solid conclusions. The available evidence suggests that minimally invasive base of tongue procedures may present a wide spectrum of complication rates, ranging from 4.4% in tongue base radiofrequency to up to 42.42% in tongue base ablation.
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Affiliation(s)
| | - Borja Boronat-Catala
- Sleep Apnea Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris,France; Service of Otolaryngology, Rhinology Department, Hospital Complex of Santiago de Compostela,Spain
| | - Irene Rivero-Fernández
- Sleep Apnea Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris,France; Service of Otolaryngology, Hospital 12 de Octubre, Madrid,Spain
| | - Giovanni Cammaroto
- Sleep Apnea Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris,France; Department of Head-Neck Surgery, AUSL Romagna,Italy; Ear Nose Throat (ENT) Unit of Forlì and Faenza, University of Ferrara and Bologna, Morgagni-Pierantoni Hospital,Forlì,Italy
| | - Badr Ibrahim
- Sleep Apnea Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris,France; Department of Otolaryngology-Head and Neck Surgery, Sleep Medicine Division, Stanford Hospital and Clinics, Stanford, CA,USA
| | - Jerome R Lechien
- Sleep Apnea Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris,France; Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris,France
| | - Gabriel Martínez-Capoccioni
- Sleep Apnea Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris,France; Service of Otolaryngology, Rhinology Department, Hospital Complex of Santiago de Compostela,Spain
| | | | - Robson Capasso
- Department of Otolaryngology-Head and Neck Surgery, Sleep Medicine Division, Stanford Hospital and Clinics, Stanford, CA,USA
| | - Carlos Martin-Martin
- Service of Otolaryngology, Rhinology Department, Hospital Complex of Santiago de Compostela,Spain
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7
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Partial update of the German S3 Guideline Sleep-Related Breathing Disorders in Adults. SOMNOLOGIE 2022. [DOI: 10.1007/s11818-022-00349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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8
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Safety of tongue base procedures for sleep apnoea in adults: A systematic review and metanalysis from the YO-IFOS study group. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022. [DOI: 10.1016/j.otorri.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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9
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Baptista PM, Diaz Zufiaurre N, Garaycochea O, Alcalde Navarrete JM, Moffa A, Giorgi L, Casale M, O’Connor-Reina C, Plaza G. TORS as Part of Multilevel Surgery in OSA: The Importance of Careful Patient Selection and Outcomes. J Clin Med 2022; 11:jcm11040990. [PMID: 35207264 PMCID: PMC8878188 DOI: 10.3390/jcm11040990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/28/2022] [Accepted: 02/04/2022] [Indexed: 12/10/2022] Open
Abstract
Transoral robotic surgery (TORS) for Obstructive Sleep Apnea (OSA) is a relatively young technique principally devised for managing apneas in the tongue base area. This study summarizes and presents our personal experience with TORS for OSA treatment, with the aim to provide information regarding its safety, efficacy, and postoperative complications. A retrospective study was conducted on patients undergoing TORS with lingual tonsillectomy through the Da Vinci robot. The effectiveness of the surgical procedure was assessed employing the Epworth Sleepiness Scale (ESS) and overnight polysomnography with the Apnea-Hypopnea Index (AHI). A total of 57 patients were included. Eighteen patients (31.6%) had undergone previous surgery. The mean time of TORS procedure was 30 min. Base of tongue (BOT) management was associated with other procedures in all patients: pharyngoplasty (94%), tonsillectomy (66%), and septoplasty (58%). At 6 months follow-up visit, there was a significant improvement in AHI values (from 38.62 ± 20.36 to 24.33 ± 19.68) and ESS values (from 14.25 ± 3.97 to 8.25 ± 3.3). The surgical success rate was achieved in 35.5% of patients. The most frequent major complication was bleeding, with the need for operative intervention in three cases (5.3%). The most common minor complications were mild dehydration and pain. TORS for OSA treatment appears to be an effective and safe procedure for adequately selected patients looking for an alternative therapy to CPAP.
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Affiliation(s)
- Peter M. Baptista
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, Av. de Pío XII, 36, 31008 Pamplona, Spain; (P.M.B.); (N.D.Z.); (O.G.); (J.M.A.N.)
| | - Natalia Diaz Zufiaurre
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, Av. de Pío XII, 36, 31008 Pamplona, Spain; (P.M.B.); (N.D.Z.); (O.G.); (J.M.A.N.)
| | - Octavio Garaycochea
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, Av. de Pío XII, 36, 31008 Pamplona, Spain; (P.M.B.); (N.D.Z.); (O.G.); (J.M.A.N.)
| | - Juan Manuel Alcalde Navarrete
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, Av. de Pío XII, 36, 31008 Pamplona, Spain; (P.M.B.); (N.D.Z.); (O.G.); (J.M.A.N.)
| | - Antonio Moffa
- School of Medicine, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy; (L.G.); (M.C.)
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Correspondence:
| | - Lucrezia Giorgi
- School of Medicine, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy; (L.G.); (M.C.)
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Manuele Casale
- School of Medicine, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy; (L.G.); (M.C.)
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Carlos O’Connor-Reina
- Otolaryngology Head and Neck Surgery, USP Hospital, Av. Severo Ochoa, 20, 29603 Marbella, Spain;
| | - Guillermo Plaza
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Cam. del Molino, 2, 28942 Fuenlabrada, Spain;
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10
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Systematic review and updated meta-analysis of multi-level surgery for patients with OSA. Auris Nasus Larynx 2021; 49:421-430. [PMID: 34736806 DOI: 10.1016/j.anl.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/01/2021] [Accepted: 10/13/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To perform an updated systematic review for determining the surgical success rate of multilevel upper airway surgery for patients with obstructive sleep apnea/hypopnea syndrome (OSA). METHODS A systematic review was performed to identify English-language studies that evaluated the treatment of adult OSA patients with multilevel OSA surgery up to January, 2018. We used polysomnography as a metric of treatment success. Articles were only included if the surgery intervention involved at least two of the frequently involved anatomic sites: nose, oropharynx and hypopharynx. Eighty-seven studies fit the inclusion criteria and a meta-analysis was performed to determine the overall success. RESULTS The meta-analysis included 3931 subjects with a mean age of 46.1 years. The originally reported success rate in the included literature was 59.9%. A meta-analysis was performed to redefine the success rate to be consistent with the commonly agreed upon criteria - namely "a reduction in apnea/hypopnea index (AHI, /hr.) of 50% or more and an AHI of less than 20". The recalculated success rate was 60.2%. Standard meta-analytic techniques for combining p-values between studies after weighting for sample size found significant improvements in AHI, apnea index, % of rapid eye movement sleep, lowest saturation of oxygen (%), and Epworth Sleepiness Scale. CONCLUSION This study shows the significant improvement of treatment outcomes with multilevel surgery for OSA patients.
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11
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Hsu HJ, Wu JL, Hsiao JR, Lin CY. Quantification of the Impact of Intraoperative Ultrasound in Transoral Robotic Tongue Base Reduction. Laryngoscope 2021; 132:1125-1131. [PMID: 34713890 DOI: 10.1002/lary.29931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/22/2021] [Accepted: 10/19/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Transoral robotic surgery (TORS) in the base of the tongue (BOT) reduction has been shown to decrease the apnea-hypopnea index (AHI) and improve daytime sleepiness in obstructive sleep apnea (OSA) patients. Intraoperative ultrasound (IOU) can be employed to guide the surgery and prevent massive bleeding. STUDY DESIGN Cohort study with historical control. METHODS A cohort study to compare the outcomes between OSA patients who received TORS with and without IOU assistance. RESULTS From 2016 to 2019, this study enrolled 80 OSA patients who underwent TORS in BOT: 57 in the IOU(+) and 23 in IOU(-) groups. The TORS with IOU presented with shorter operative time, less blood loss, and greater excised BOT volume. The IOU(+) group had greater improvement in the AHI and subjective questionnaire evaluation. The excised volume of BOT was significantly associated with the change in AHI. CONCLUSION The IOU could improve outcomes in BOT reduction surgery without raising the risk of surgical complications. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Heng-Jui Hsu
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jiunn-Liang Wu
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jenn-Ren Hsiao
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Yu Lin
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Sleep Medicine Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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12
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Volner K, Mostales JC, Schoppy D, Lim JH. Utilization of Silicone Sheet as a Protective Guide During Transoral Robotic Tongue Base Surgery. OTO Open 2021; 5:2473974X211051315. [PMID: 34661043 PMCID: PMC8512282 DOI: 10.1177/2473974x211051315] [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: 04/24/2021] [Accepted: 09/18/2021] [Indexed: 12/03/2022] Open
Abstract
This article presents a simple technique where a silicone sheet is used during transoral
robotic surgery (TORS) to protect the upper airway structures from thermal damage during a
base of tongue procedure. We review 10 cases of TORS tongue base reduction with the use of
this technique, with no complications and with reduction of thermal damage to the lingual
epiglottis and surrounding pharyngeal wall. Furthermore, it served as a guide during
tongue base dissection to provide visual and tactile feedback to the inferior limit of
resection, as well as to protect the endotracheal tube. The silicone sheet is an ideal
material for use as a thermal barrier due to its widespread availability, intrinsic
thermal properties, and translucency. The technique of using the silicone sheet is easy to
implement and may prove useful to many transoral robotic surgeons, especially for newly
trained TORS users and trainees.
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Affiliation(s)
- Keith Volner
- Department of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Joshua C Mostales
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - David Schoppy
- Department of Otolaryngology-Head and Neck Surgery, Hawaii Permanente Medical Group, Kaiser Moanalua Medical Center, Honolulu, Hawaii, USA
| | - Jae H Lim
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA.,Department of Otolaryngology-Head and Neck Surgery, Hawaii Permanente Medical Group, Kaiser Moanalua Medical Center, Honolulu, Hawaii, USA
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13
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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: 4] [Impact Index Per Article: 1.3] [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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14
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Baptista PM, Garaycochea O, O’Connor C, Plaza G. Tongue Surgery That Works in OSA. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00357-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Lechien JR, Chiesa-Estomba CM, Fakhry N, Saussez S, Badr I, Ayad T, Chekkoury-Idrissi Y, Melkane AE, Bahgat A, Crevier-Buchman L, Blumen M, Cammaroto G, Vicini C, Hans S. Surgical, clinical, and functional outcomes of transoral robotic surgery used in sleep surgery for obstructive sleep apnea syndrome: A systematic review and meta-analysis. Head Neck 2021; 43:2216-2239. [PMID: 33860981 DOI: 10.1002/hed.26702] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 02/04/2021] [Accepted: 03/23/2021] [Indexed: 11/07/2022] Open
Abstract
We investigated safety and efficacy of transoral robotic surgery (TORS) for base of tongue (BOT) reduction in obstructive sleep apnea syndrome (OSAS) patients. PubMed, Cochrane Library, and Scopus were searched. A meta-analysis was performed. Random effects models were used. Thirty-one cohorts met our criteria (1693 patients). The analysis was based mostly on retrospective studies. The summary estimate of the reduction of Apnea-Hypoxia Index (AHI) was 24.25 abnormal events per hour (95% CI: 21.69-26.81) and reduction of Epworth Sleepiness Scale (ESS) was 7.92 (95% CI: 6.50-9.34). The summary estimate of increase in lowest O2 saturation was 6.04% (95% CI: 3.05-9.03). The success rate of TORS BOT reduction, either alone or combined with other procedures, was 69% (95% CI: 64-79). The majority of studies reported low level of evidence but suggested that TORS BOT reduction may be a safe procedure associated with improvement of AHI, ESS, and lowest O2 saturation.
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Affiliation(s)
- Jerome R Lechien
- Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.,Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France.,Department of Otorhinolaryngology-Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Carlos-Miguel Chiesa-Estomba
- Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain
| | - Nicolas Fakhry
- Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otorhinolaryngology-Head and Neck Surgery, APHM, Aix Marseille University, La Conception University Hospital, Marseille, France
| | - Sven Saussez
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.,Department of Otorhinolaryngology-Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Ibrahim Badr
- Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford School of Medicine, Stanford, USA
| | - Tareck Ayad
- Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Younes Chekkoury-Idrissi
- Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France
| | - Antoine E Melkane
- Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Ahmed Bahgat
- Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otorhinolaryngology, Faculty of Medicine, Alexandria Hospital, Alexandria, Egypt
| | - Lise Crevier-Buchman
- Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France
| | - Marc Blumen
- Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France
| | - Giovanni Cammaroto
- Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Unit of Otolaryngology, Hospital Morgagni Pierantoni, Forlì, Italy
| | - Claudio Vicini
- Unit of Otolaryngology, Hospital Morgagni Pierantoni, Forlì, Italy
| | - Stéphane Hans
- Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France
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16
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Huang HH, Tsao CH, Wei JCC. Voice Assessment in Patients With Obstructive Sleep Apnea Syndrome After Transoral Robotic Surgery. Front Surg 2021; 8:647792. [PMID: 33816548 PMCID: PMC8011657 DOI: 10.3389/fsurg.2021.647792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/15/2021] [Indexed: 12/01/2022] Open
Abstract
Objectives: Removal of part of the tongue base, in combination with uvulopharyngopalatoplasty via transoral robotic surgery (TORS), for treating obstructive sleep apnea syndrome (OSAS) results in enlargement of the oropharynx and hypopharynx and change in the size of the resonance chamber. These procedures may also alter the laryngeal-hyoid bone complex, which is linked to vocal fold tension. Thus, there is the potential for change in phonation and pitch after surgery. Study Design: Prospective, nonrandomized, institutional board-approved study. Methods: From January to August 2018, 15 patients with OSAS receiving TORS underwent voice and pitch sampling. The multi-dimensional voice program (MDVP) was applied to the evaluation of preoperative sound parameters. Highest pitch and lowest pitch were obtained with real-time pitch software, with pitch synchronized to electronic organ or tuner. Subjects also completed the Voice Handicap Index-10 scale (VHI-10), to assess their subjective perception and to detect factors affecting the VHI-10 score. The relevant parameters were analyzed again 3 months after the operation. Results: There was an increase in VHI-10 score 3 months after operation that did not reach statistical significance. There were also no significant differences in sound parameters. Increases in highest pitch (353.18 Hz shift to 387.99 Hz), highest semitone (F5# shift to F5#), lowest pitch (117.45 Hz shift to 131.42 Hz), and lowest semitone (C3 shift to C3) did not reach statistical significance. The increase in the lowest semitone was significantly related to change in VHI-10 score (r = −0.808, P = 0.028). Conclusion: Patients with OSA undergoing TORS showed a negative correlation coefficient over 0.8 with change in VHI-10 score. That is, increase in the lowest semitone after operation correlated with increase in VHI-10 score which may cause perceive changes in subjective pronunciation.
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Affiliation(s)
- Hsin-Hsin Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chien-Han Tsao
- Department of Otolaryngology, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
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Outcomes of multilevel upper airway surgery, including tongue base resection, in patients with torus mandibularis. J Craniomaxillofac Surg 2021; 49:682-687. [PMID: 33608199 DOI: 10.1016/j.jcms.2021.02.008] [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: 02/17/2020] [Revised: 11/09/2020] [Accepted: 02/07/2021] [Indexed: 11/22/2022] Open
Abstract
By affecting the tongue position and oropharyngeal airway volume, torus mandibularis is an anatomical factor associated with obstructive sleep apnea (OSA). This study aimed to investigate the influence of torus mandibularis on the surgical outcomes of multilevel upper airway surgery with tongue base resection (TBR) in patients with OSA. Patients with OSA who underwent palatal surgery and TBR were retrospectively analyzed. The patients were divided into two groups according to the presence or absence of torus mandibularis upon physical examination or on computed tomography images. The anatomical characteristics of the upper airway and pre/postoperative polysomnography were analyzed. The control and torus mandibularis groups comprised 69 and 35 patients, respectively, with all of them showing improved sleep quality after surgery. Apnea-hypopnea index (AHI) scores decreased from 42.1 ± 22.2 preoperatively to 23.9 ± 21.4 postoperatively in the control group (p < 0.001), and from 45.2 ± 19.9 to 22.5 ± 13.5 in the torus mandibularis group (p < 0.001). Comparing the postoperative changes in AHI, the AHI of the torus mandibularis group improved by 22.7 ± 23.4, whereas that of the control group improved by 18.1 ± 19.6 (p = 0.296). Sleep efficiency improved from 90.0 ± 7.5 to 92.8 ± 6.8 in the control group, and from 90.3 ± 8.7 to 93.6 ± 6.5 in the torus mandibularis group; however, there was no statistical difference between the two groups (p = 0.816). The presence of torus mandibularis did not appear to significantly affect the surgical results in OSA patients, but it did elicit significant changes in polysomnographic parameters compared with the control group. Therefore, following the identification of torus mandibularis in OSA patients, TBR should be considered as part of planning, as it may help to predict surgical outcomes.
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18
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Kim J, Poole B, Cen SY, Sanossian N, Kezirian EJ. Transoral Robotic Surgery (TORS) Versus Non-TORS Tongue Resection for Obstructive Sleep Apnea. Laryngoscope 2020; 131:E1735-E1740. [PMID: 33314211 DOI: 10.1002/lary.29316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/17/2020] [Accepted: 11/24/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare transoral robotic surgery (TORS) versus non-TORS tongue resection procedures performed for obstructive sleep apnea from January 2010 to September 2015 using a national database, focusing on patient characteristics, performance of concurrent procedures, operative time, length of hospital stay, and postoperative complications. METHODS A cohort of adults undergoing TORS and non-TORS tongue resection procedures was identified in the Nationwide Inpatient Sample, a publicly-available national administrative database incorporating a stratified sample of hospital discharge records. Outcomes were annual case volumes, prolonged (≥3 days) hospital stay, and complications. Statistical analyses examined potential associations between TORS and prolonged hospital stay and complications. RESULTS From 2010 to 2015, 5709 hospital discharges included tongue resection surgery to treat obstructive sleep apnea. There was a gradual decline and stabilization in overall volumes, with the proportion of TORS use showing an initial increase, followed by a decrease and rebound increase. TORS patients were less likely to undergo concurrent nasal surgery (15% vs. 44%, P < .01), but there was no association between the use of TORS and concurrent palatal surgery. TORS use was not associated with concurrent hypopharyngeal surgery overall, but it was associated with specific types of hypopharyngeal surgery. TORS use was associated with patient age, payor, and certain hospital characteristics. TORS use was associated with an increased risk of prolonged hospital stay (33% vs. 25%, P = .045) but was not associated with complications. CONCLUSION This study provides insight into TORS use in tongue resection surgery for obstructive sleep apnea during this period of early TORS adoption. LEVEL OF EVIDENCE Level 3 (cohort study). Laryngoscope, 131:E1735-E1740, 2021.
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Affiliation(s)
- Jeehong Kim
- USC Caruso Department of Otolaryngology - Head & Neck Surgery, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Barish Poole
- Department of Internal Medicine, NYU Winthrop Hospital, Mineola, New York, USA
| | - Steven Yong Cen
- Department of Neurology and Radiology, Keck School of Medicine of USC and Division of Dental Public Health & Pediatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA.,Department of Neurology, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Nerses Sanossian
- Department of Neurology, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Eric James Kezirian
- USC Caruso Department of Otolaryngology - Head & Neck Surgery, Keck School of Medicine of USC, Los Angeles, California, USA
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Cammaroto G, Bianchi G, Zhang H, Veer V, Kotecha B, Jacobowitz O, Llatas MC, de Apodaca PMR, Lugo R, Meccariello G, Iannella G, Gobbi R, Toh ST, Hsu YS, Baghat AY, Lechien JR, Calvo-Henriquez C, Chiesa-Estomba C, Barillari MR, Ibrahim B, Ayad T, Fakhry N, Hoff P, Thuler ER, Chan L, Kastoer C, Ravesloot M, De Vito A, Montevecchi F, Vicini C. Sleep medicine in otolaryngology units: an international survey. Sleep Breath 2020; 25:2141-2152. [PMID: 33216312 DOI: 10.1007/s11325-020-02243-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/16/2020] [Accepted: 10/31/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE No study to date has described the overall landscape of sleep disorders management and training in otolaryngology departments of different countries. The aim of our study was to investigate and compare settings, diagnostic and therapeutic approaches and training programmes. METHODS An international online survey was developed with the collaboration of the YO-IFOS (Young Otolaryngologists-International Federation of Otorhinolaryngological Societies) to assess the current practice of otolaryngologists in the management of sleep disorders. The survey also included a session dedicated to training. RESULTS A total of 126 otolaryngologists completed the survey. The larger part of responses was collected from Central/South America and Europe. The majority of responders from South/Central America (97%) declared to be certified as sleep specialist while 49% of Europeans stated the opposite. Of responders 83% perform a drug-induced sleep endoscopy (DISE) before planning a possible surgical intervention. Soft palate and base of tongue interventions were the most common procedure, respectively performed in 94% and 79% of the cases. Residents were allowed to perform soft palate surgery in 77% of the cases. Upper airway stimulation (26% vs 10%), trans-oral robotic surgery (36% vs 11%) and radiofrequency of the base of the tongue (58% vs 25%) were preferred more frequently by European responders. The highest caseloads of soft palate surgery and bi-maxillary advancement were registered in the academic institutions. CONCLUSION Significant concordance and few interesting divergences in diagnosis and treatment of sleep disorders were observed between nationalities and types of institution. Economic resources might have played a significant role in the therapeutic choice. Trainees' lack of exposure to certain interventions and to a sufficient caseload appeared to be the main burden to overcome.
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Affiliation(s)
- Giovanni Cammaroto
- Unit of Otolaryngology, Hospital Morgagni Pierantoni, Via Carlo Forlanini 2, 47100, Forlì, Italy. .,Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.
| | - Giulia Bianchi
- Unit of Otolaryngology, University of Ferrara, Ferrara, Italy
| | - Henry Zhang
- Unit of Otolaryngology, Head and Neck Surgery, Royal National Throat, Nose and Ear Hospital, London, UK
| | - Vik Veer
- Unit of Otolaryngology, Head and Neck Surgery, Royal National Throat, Nose and Ear Hospital, London, UK
| | - Bhik Kotecha
- Unit of Otolaryngology, Head and Neck Surgery, Royal National Throat, Nose and Ear Hospital, London, UK
| | | | | | | | - Rodolfo Lugo
- Department of Otorhinolaryngology, Grupo Medico San Pedro, Monterrey, Mexico
| | - Giuseppe Meccariello
- Unit of Otolaryngology, Hospital Morgagni Pierantoni, Via Carlo Forlanini 2, 47100, Forlì, Italy
| | - Giannicola Iannella
- Unit of Otolaryngology, Hospital Morgagni Pierantoni, Via Carlo Forlanini 2, 47100, Forlì, Italy
| | - Riccardo Gobbi
- Unit of Otolaryngology, Hospital Morgagni Pierantoni, Via Carlo Forlanini 2, 47100, Forlì, Italy
| | - Song Tar Toh
- Department of Otolaryngology, Singapore General Hospital, Singhealth Duke-NUS Sleep Centre, National University of Singapore, Yong Loo Lin School of Medicine & Duke-NUS Medical School, Singapore, Singapore
| | - Ying-Shuo Hsu
- Department of Otolaryngology, Shin Kong Wu Ho-Su memorial Hospital, Taipei, Taiwan
| | | | - Jerome R Lechien
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Christian Calvo-Henriquez
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Service of Otolaryngology, Travesía de Choupana, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Carlos Chiesa-Estomba
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Service of Otolaryngology, Donostia University Hospital, San Sebastian, Spain
| | - Maria Rosaria Barillari
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Mental and Physical Health and Preventive Medicine, University of L. Vanvitelli, Naples, Italy
| | - Badr Ibrahim
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Tareck Ayad
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Nicolas Fakhry
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otorhinolaryngology-Head and Neck Surgery, La Conception University Hospital, APHM, Aix Marseille University, Marseille, France
| | - Paul Hoff
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Lyndon Chan
- Illawarra ENT Head and Neck Clinic, Wollongong, NSW, Australia
| | - Chloe Kastoer
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Madeline Ravesloot
- Department of Otorhinolaryngology - Head and Neck Surgery, OLVG, Amsterdam, the Netherlands
| | - Andrea De Vito
- Head & Neck Department, Ear Nose Throat (ENT) Unit, Santa Maria delle Croci Hospital, Romagna Health Company, Ravenna, Italy
| | - Filippo Montevecchi
- Unit of Otolaryngology, Hospital Morgagni Pierantoni, Via Carlo Forlanini 2, 47100, Forlì, Italy
| | - Claudio Vicini
- Unit of Otolaryngology, Hospital Morgagni Pierantoni, Via Carlo Forlanini 2, 47100, Forlì, Italy.,Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
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Comparison of transoral robotic surgery with other surgeries for obstructive sleep apnea. Sci Rep 2020; 10:18163. [PMID: 33097783 PMCID: PMC7585414 DOI: 10.1038/s41598-020-75215-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/12/2020] [Indexed: 11/22/2022] Open
Abstract
This study compared the characteristic surgical parameters and clinical effects of transoral robotic surgery (TORS) and other available methods used to alleviate obstructive sleep apnea. Articles on TORS and other surgeries for obstructive sleep apnea were identified in the PubMed and EMBASE databases. Two investigators independently reviewed the articles and classified the data for meta-analysis. The pooled effect sizes of TORS (standardized mean difference; SMD = − 2.38), coblation tongue base resection (CTBR; SMD = − 2.00) and upper airway stimulation (UAS; SMD = − 0.94) revealed significant improvement in the apnea–hypopnea index (AHI; p < 0.05). The lowest O2 saturation reported was significantly increased following TORS (SMD = 1.43), CTBR (SMD = 0.86) and UAS (SMD = 1.24, p < 0.05). Furthermore, TORS (SMD = − 2.91) and CTBR (SMD = − 1.51, p < 0.05) significantly reduced the Epworth Sleepiness Scale (ESS) score. No significant difference in operation time, success rate, or instances of complication were observed between TORS and the other compared interventions. The use of TORS in obstructive sleep apnea has the same rate of success and failure as other methods of surgical intervention for obstructive sleep apnea with no statistical difference in operation times. The reported clinical effects on the AHI, lowest O2 saturation, and ESS scores of TORS were similar to those of other surgeries.
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21
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Stuck BA, Arzt M, Fietze I, Galetke W, Hein H, Heiser C, Herkenrath SD, Hofauer B, Maurer JT, Mayer G, Orth M, Penzel T, Randerath W, Sommer JU, Steffen A, Wiater A. Teil-Aktualisierung S3-Leitlinie Schlafbezogene Atmungsstörungen bei Erwachsenen. SOMNOLOGIE 2020. [DOI: 10.1007/s11818-020-00257-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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22
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Lin HC, Friedman M. Transoral robotic OSA surgery. Auris Nasus Larynx 2020; 48:339-346. [PMID: 32917413 DOI: 10.1016/j.anl.2020.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/03/2020] [Accepted: 08/27/2020] [Indexed: 01/11/2023]
Abstract
Continuous positive airway pressure (CPAP) is the primary treatment of obstructive sleep apnea/hypopnea syndrome (OSA). Most sleep physicians are in agreement that a certain number of OSA patients cannot or will not use CPAP. Although other conservative therapies such as oral appliance, sleep hygiene and sleep positioning may help some of these patients, there are many who fail all conservative treatments. As experts of upper airway diseases, we often view an airway clearly and help OSA patients understand the importance of assessment and treatment for OSA. Surgery for OSA is not a substitute for CPAP but is an alternative treatment for those who failed conservative therapies and therefore have no other options. Transoral robotic surgery (TORS) is a relatively new technique and a valid option with minor post-operative morbidities for selected OSA patients. In the article, we provide an updated overview of the role and evidence of TORS for the treatment of OSA.
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Affiliation(s)
- Hsin-Ching Lin
- Department of Otolaryngology, Sleep Center, Robotic Surgery Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Center for Quality Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Business Administration and Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.
| | - Michael Friedman
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Rush University Medical Center, Chicago, IL, USA; Department of Otolaryngology, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
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Waxman JA, Shenouda KG, Lin HS. Assessment and Management of Postoperative Pain Associated with Sleep Apnea Surgery. Otolaryngol Clin North Am 2020; 53:765-777. [PMID: 32564947 DOI: 10.1016/j.otc.2020.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A literature review was conducted regarding the assessment and treatment of postoperative pain following surgery for obstructive sleep apnea (OSA). Given the risks of opioid use by patients with OSA, special attention to opioid risk reduction and avoidance is warranted in this population. The results of this review demonstrate the existence of a body of evidence that supports the use of nonopioid analgesics and nonpharmacologic approaches pain management. Strategies for managing postoperative pain should emphasize the use of local anesthetic infiltration, nonsteroidal antiinflammatory drugs, acetaminophen, topical analgesics, surgical wound cooling, and when necessary, safer opioid medications, such as tramadol and intranasal butorphanol.
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Affiliation(s)
- Jonathan A Waxman
- Department of Otolaryngology, Head and Neck Surgery, Wayne State University, 4201 St. Antoine, 5E-UHC, Detroit, MI 48201, USA.
| | - Kerolos G Shenouda
- Department of Otolaryngology, Head and Neck Surgery, Wayne State University, 4201 St. Antoine, 5E-UHC, Detroit, MI 48201, USA
| | - Ho-Sheng Lin
- Department of Otolaryngology, Head and Neck Surgery, Wayne State University, 4201 St. Antoine, 5E-UHC, Detroit, MI 48201, USA
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24
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Shah RR, Thaler ER. Base of Tongue Surgery for Obstructive Sleep Apnea in the Era of Neurostimulation. Otolaryngol Clin North Am 2020; 53:431-443. [PMID: 32334869 DOI: 10.1016/j.otc.2020.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Retroglossal collapse is commonly seen in patients with obstructive sleep apnea. The role of upper airway stimulation surgery for these patients continues to evolve. However, base of tongue reduction surgery continues to have usefulness for appropriately selected patients with obstructive sleep apnea. Specific tongue base approaches may vary in response to patient and surgeon preferences and be used in multilevel surgery where appropriate. Key factors include patient age, willingness to undergo device implantation, and preferences for outpatient versus inpatient procedure, single procedure versus multiple, and tolerance for various procedure-specific postoperative restrictions and potential complications.
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Affiliation(s)
- Ravi R Shah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, 3400 Spruce Street, 5th Floor Silverstein Building, Philadelphia, PA 19104, USA
| | - Erica R Thaler
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, 3400 Spruce Street, 5th Floor Silverstein Building, Philadelphia, PA 19104, USA.
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Di Luca M, Iannella G, Montevecchi F, Magliulo G, De Vito A, Cocuzza S, Maniaci A, Meccariello G, Cammaroto G, Sgarzani R, Ferlito S, Vicini C. Use of the transoral robotic surgery to treat patients with recurrent lingual tonsillitis. Int J Med Robot 2020; 16:e2106. [PMID: 32223059 DOI: 10.1002/rcs.2106] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/19/2020] [Accepted: 03/19/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study evaluates the efficacy of lingual tonsil resection by transoral robotic surgery (TORS) in a large group of patients with recurrent lingual tonsillitis (RLT). METHODS Eighty-four patients with RLT treated with a lingual tonsil surgical resection using TORS were analyzed in terms of their postoperative results, disease recurrence, postoperative dysphagia, and quality of life. RESULTS A reduction of the mean number/year of acute lingual tonsillitis (LT) episodes emerged after surgery (5.17 vs 0.54 events), comparing the mean number of preoperative and postoperative LT episodes, a statistical significance emerged (P = .0001). The postoperative endoscopic evaluation showed 94.1% of patients with absent or poor lymphatic tissue on the tongue base. Evaluation of postoperative dysphagia showed good results with an average score of 85.9 ± 7.5. CONCLUSION This article explains how in patients with chronic LT with medical therapy failure and impaired quality of life, TORS could represent a valid therapeutic option.
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Affiliation(s)
- Milena Di Luca
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Giannicola Iannella
- Department of 'Organi di Senso', University "Sapienza", Rome, Italy.,Department of Head-Neck Surgery, Otolaryngology, Head-Neck, and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | | | | | - Andrea De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck, and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, 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
| | | | - Salvatore Ferlito
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck, and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy.,Department ENT and Audiology, University of Ferrara, Ferrara, Italy
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Lee JA, Byun YJ, Nguyen SA, Lentsch EJ, Gillespie MB. Transoral Robotic Surgery versus Plasma Ablation for Tongue Base Reduction in Obstructive Sleep Apnea: Meta-analysis. Otolaryngol Head Neck Surg 2020; 162:839-852. [PMID: 32204654 DOI: 10.1177/0194599820913533] [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: 11/17/2022]
Abstract
OBJECTIVES To compare the effectiveness of transoral robotic surgery (TORS) versus plasma ablation (PA) in tongue base reduction surgery for obstructive sleep apnea (OSA). DATA SOURCES PubMed, Scopus, Cochrane Library, OVID. REVIEW METHODS Keywords searched included OSA, tongue base surgery, TORS, and coblation. Outcomes included pre- to postoperative apnea-hypopnea index, Epworth Sleepiness Scale (ESS), and lowest oxygen saturation. Additional outcomes included surgical success rate, postoperative bleeding, operative time, and length of stay. RESULTS A total of 690 unique articles were identified, of which 60 underwent full-text review. Twenty-six articles were included in final analysis, comprising 18 studies on TORS (834 patients) and 11 studies on PA (294 patients). Mean differences of apnea-hypopnea index, ESS, and lowest oxygen saturation for TORS were -23.92, -7.6, and 5.83% (all P < .01). Corresponding values for PA were -22.07, -4.14, and 5.48% (all P < .00001). TORS had greater ESS reduction than PA (P = .02). Follow-up duration was shorter in TORS than PA (mean ± SD: 4.2 ± 2.6 vs 4.6 ± 1.4 months, P = .0482). Surgical success rates in TORS and PA were similar (57.6% vs 60.3%, P = .4474). Postoperative bleeding occurred less frequently in TORS versus PA (3.3% vs 7.5%, P = .0103). Operative time was longer for TORS than PA (77.9 ± 16.4 minutes vs 44.0 ± 12.9 minutes, P < .0001). Length of stay was similar between TORS and PA (3.9 ± 1.6 days vs 3.9 ± 2.5 days, P = .9047). CONCLUSION Tongue base reduction with TORS or PA each effectively treats OSA and provides comparable results. The choice between techniques might depend on patient factors, availability of technology, and associated costs.
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Affiliation(s)
- Joshua A Lee
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Young Jae Byun
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.,College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Eric J Lentsch
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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27
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Zhao W, Zhao L, Zhao Y, Guo Z, Guo J, Lin C, Chiang RPY. Technology on sleep surgery. Sleep Biol Rhythms 2020. [DOI: 10.1007/s41105-020-00261-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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28
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Transoral Robotic Surgery for Obstructive Sleep Apnea. CURRENT OTORHINOLARYNGOLOGY REPORTS 2019. [DOI: 10.1007/s40136-019-00253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lan WC, Chang WD, Tsai MH, Tsou YA. Trans-oral robotic surgery versus coblation tongue base reduction for obstructive sleep apnea syndrome. PeerJ 2019; 7:e7812. [PMID: 31592178 PMCID: PMC6778434 DOI: 10.7717/peerj.7812] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/01/2019] [Indexed: 01/04/2023] Open
Abstract
Objectives To compare the efficacy of trans-oral robotic surgery (TORS) with that of coblation assisted tongue base reduction surgery in patients with obstructive sleep apnea syndrome (OSAS). Subjects and Methods The medical charts were retrospectively reviewed for all OSAS patients admitted to one institution for surgical intervention between 2012 and 2017. We analyzed 33 cases; 16 patients received TORS and 17 received coblation surgery for tongue base reduction. Both groups received concomitant uvulopalatoplasty. Surgical outcomes were evaluated by comparing the initial polysomnography (PSG) parameters with the follow-up PSG data (at least 3 months after the surgery). Epworth sleepiness scale (ESS) and complications were also compared between the 2 groups. Results The success rate (≥50% reduction of pre-operative AHI and post-operative AHI <20) in the TORS group and coblation group were 50% and 58%, respectively, and there was no significant difference (p = .611). The AHI (mean ± SD) reduction in the TORS and coblation groups were 24.9 ± 26.5 events/h and 19.4 ± 24.8 events/h, respectively; the between-group difference was not significant (p = .631). ESS improvement did not differ significantly between the TORS and coblation groups (3.8 ± 6.6 and 3.1 ± 9.2, respectively, p = .873). The rates of minor complication were higher in the TORS group (50%) than that of the coblation group (35.3%) without statistical significance (p = .393). Conclusion TORS achieved comparable surgical outcomes compared to coblation assisted tongue base reduction surgery in OSAS patients. Multilevel surgery using either TORS or coblation tongue base reduction combined with uvulopalatoplasty is an effective approach for the management of OSAS.
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Affiliation(s)
- Wei-Che Lan
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Dien Chang
- Department of Sport Performance, National Taiwan University of Sport, Taichung, Taiwan
| | - Ming-Hsui Tsai
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan.,Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
| | - Yung-An Tsou
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan.,Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
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Affiliation(s)
- Ghali E Ghali
- Department of Oral & Maxillofacial Surgery/Head & Neck Surgery, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA
| | - Andrew T Meram
- Department of Oral & Maxillofacial Surgery/Head & Neck Surgery, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA.
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Abstract
Surgery for obstructive sleep apnea/hypopnea syndrome (OSA) is not a substitute for continuous positive airway pressure (CPAP) but is a salvage procedure for those who failed CPAP and other conservative therapies and therefore have no other options. The hypopharyngeal/tongue base procedures for the treatment of OSA are usually challenging to most sleep surgeons. In recent years, several procedures for OSA patients with hypopharyngeal obstructions have been developed to achieve higher response rates with decreased postoperative morbidities.
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Affiliation(s)
- Hsin-Ching Lin
- Department of Otolaryngology, Sleep Center, Robotic Surgery Center, Kaohsiung Chang Gung Memorial Hospital, 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City 833, Taiwan.
| | - Michael Friedman
- Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA; Department of Otolaryngology, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Chicago, IL 60657, USA
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Paker M, Duek I, Awwad F, Benyamini L, Meshyeev T, Gil Z, Cohen JT. Long-term swallowing performance following transoral robotic surgery for obstructive sleep apnea. Laryngoscope 2018; 129:422-428. [PMID: 30443909 DOI: 10.1002/lary.27364] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to evaluate the long-term swallowing performance following transoral robotic surgery (TORS) to the base of tongue (BOT) in the treatment of obstructive sleep apnea (OSA). STUDY DESIGN Retrospective and prospective cohort study. METHODS Data analysis of 39 patients who underwent BOT reduction via TORS to treat OSA at our center from September 2013 to April 2016. Long-term swallowing functions were assessed using subjective self-evaluated swallowing disturbances questionnaire (SDQ) and objective fiberoptic endoscopic evaluation of swallowing (FEES). RESULTS Seven patients underwent TORS BOT reduction alone, whereas 32 had also uvulopalatoplasty ± tonsillectomy, with a surgical success rate of 71.4%. Mean time for swallowing evaluation was 27.4 ± 9.43 months. Twenty-five patients completed the SDQ with an average score of 9.26 ± 10.05. In 32%, the SDQ was positive for dysphagia. In 10 out of 14 patients who underwent FEES, swallowing problems were noticed. The most common pathological findings were food residue in the vallecula followed by early spillage of food into the hypopharynx, penetration of solid food and liquid on the vocal folds surface, and aspiration. CONCLUSIONS BOT reduction via TORS has a negative effect on long-term swallowing function. A self-assessment questionnaire can help detect patients who suffer from swallowing impairment. Postoperative objective swallowing tests are essential not only in the immediate postoperative period but also during late routine follow-up. Proper patient selection and detailed information about surgery and possible late-swallowing effect are important factors before scheduling BOT reduction via TORS for OSA treatment. LEVEL OF EVIDENCE 4 Laryngoscope, 129:422-428, 2019.
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Affiliation(s)
- Miki Paker
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Center, Rambam Health Care Campus, Haifa, Israel
| | - Irit Duek
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Center, Rambam Health Care Campus, Haifa, Israel.,the Rappaport Institute of Medicine and Research, Technion-Israel Institute of Technology, Haifa, Israel
| | - Faten Awwad
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Center, Rambam Health Care Campus, Haifa, Israel
| | - Limor Benyamini
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Center, Rambam Health Care Campus, Haifa, Israel.,the Rappaport Institute of Medicine and Research, Technion-Israel Institute of Technology, Haifa, Israel
| | - Tsipi Meshyeev
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Center, Rambam Health Care Campus, Haifa, Israel
| | - Ziv Gil
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Center, Rambam Health Care Campus, Haifa, Israel.,the Rappaport Institute of Medicine and Research, Technion-Israel Institute of Technology, Haifa, Israel
| | - Jacob T Cohen
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Center, Rambam Health Care Campus, Haifa, Israel.,the Rappaport Institute of Medicine and Research, Technion-Israel Institute of Technology, Haifa, Israel
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de Bonnecaze G, Vairel B, Dupret-Bories A, Serrano E, Vergez S. Transoral robotic surgery of the tongue base for obstructive sleep apnea: Preliminary results. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:411-415. [PMID: 30430999 DOI: 10.1016/j.anorl.2018.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Obstructive sleep apnea syndrome (OSAS) is a major public health issue. Robotic tongue-base reduction surgery is being developed, but needs assessment. The present study reports clinical and polygraphic results at 6 months' follow-up. METHOD Single-center prospective study of 8 patients undergoing transoral robotic surgery (TORS) for severe OSAS. RESULTS Mean age was 47 years. M/F sex ratio was 5:3. Initial body-mass index ranged from 18 to 35kg/m2. Mean Epworth score was 12. Mean preoperative apnea-hypopnea index (AHI) was 47 (range, 36-60). At 6 months, only 1 patient did not meet usual success criteria (AHI<20 with>50% decrease); 2 patients had residual AHI between 10 and 20; the other 5 had non-significant event rates. CONCLUSION TORS tongue-base reduction showed promising results, which need confirmation on long-term multicenter studies.
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Affiliation(s)
- G de Bonnecaze
- Service d'otorhinolaryngologie, chirurgie cervico-faciale, hôpital Ragueil-Larrey, 24, Chemin de Pouvourville, 31059 Toulouse, France.
| | - B Vairel
- Service d'otorhinolaryngologie, chirurgie cervico-faciale, hôpital Ragueil-Larrey, 24, Chemin de Pouvourville, 31059 Toulouse, France; Département de chirurgie, institut universitaire du cancer, 31100 Toulouse, France
| | - A Dupret-Bories
- Département de chirurgie, institut universitaire du cancer, 31100 Toulouse, France
| | - E Serrano
- Service d'otorhinolaryngologie, chirurgie cervico-faciale, hôpital Ragueil-Larrey, 24, Chemin de Pouvourville, 31059 Toulouse, France
| | - S Vergez
- Service d'otorhinolaryngologie, chirurgie cervico-faciale, hôpital Ragueil-Larrey, 24, Chemin de Pouvourville, 31059 Toulouse, France; Département de chirurgie, institut universitaire du cancer, 31100 Toulouse, France
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Sukato DC, Ballard DP, Abramowitz JM, Rosenfeld RM, Mlot S. Robotic versus conventional neck dissection: A systematic review and meta-analysis. Laryngoscope 2018; 129:1587-1596. [DOI: 10.1002/lary.27533] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Daniel C. Sukato
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - Daniel P. Ballard
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - Jason M. Abramowitz
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - Richard M. Rosenfeld
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - Stefan Mlot
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
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Huntley C, Topf MC, Christopher V, Doghramji K, Curry J, Boon M. Comparing Upper Airway Stimulation to Transoral Robotic Base of Tongue Resection for Treatment of Obstructive Sleep Apnea. Laryngoscope 2018; 129:1010-1013. [DOI: 10.1002/lary.27484] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Colin Huntley
- Department of Otolaryngology–Head and Neck Surgery Philadelphia Pennsylvania U.S.A
- Sidney Kimmel Medical College Philadelphia Pennsylvania U.S.A
| | - Michael C. Topf
- Department of Otolaryngology–Head and Neck Surgery Philadelphia Pennsylvania U.S.A
| | - Vanessa Christopher
- Department of Otolaryngology–Head and Neck Surgery Philadelphia Pennsylvania U.S.A
| | - Karl Doghramji
- Jefferson Sleep Disorders CenterThomas Jefferson University Philadelphia Pennsylvania U.S.A
| | - Joseph Curry
- Department of Otolaryngology–Head and Neck Surgery Philadelphia Pennsylvania U.S.A
| | - Maurits Boon
- Department of Otolaryngology–Head and Neck Surgery Philadelphia Pennsylvania U.S.A
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Cammaroto G, Montevecchi F, D'Agostino G, Zeccardo E, Bellini C, Meccariello G, Vicini C. Palatal surgery in a transoral robotic setting (TORS): preliminary results of a retrospective comparison between uvulopalatopharyngoplasty (UPPP), expansion sphincter pharyngoplasty (ESP) and barbed repositioning pharyngoplasty (BRP). ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 37:406-409. [PMID: 28530254 PMCID: PMC5717986 DOI: 10.14639/0392-100x-1321] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 10/18/2016] [Indexed: 11/28/2022]
Abstract
It has become increasingly clear in the past decade that surgical management of obstructive sleep apnoea hypopnoea syndrome (OSAHS) is most successfully managed with multilevel surgery. We evaluated the outcomes of multilevel interventions comparing three different palatal techniques added to TORS: uvulopalatopharyngoplasty (UPPP), a modified expansion sphincter pharyngoplasty (ESP), inspired by the Pang expansion sphincter pharyngoplasty technique and the latest barbed repositioning pharyngoplasty (BRP). Thirty patients were retrospectively evaluated. Ten patients underwent UPPP by Fairbanks, 10 BRP and 10 a modified ESP already described. All patients underwent TORS, tonsillectomy and septo-turbinoplasty. For all cases, the following data were retrieved and revaluated: preoperative and postoperative apnoea-hypopnoea index (AHI), preoperative and postoperative Epworth Sleepiness Scale (ESS), pain visual analogue scale (VAS; 0–10) for the first 5 days postoperatively, palatal operative time for each surgical technique, discharge date and complication types and rate. Both BRP and ESP resulted in better postoperative AHI values and higher surgical success rates in comparison with UPPP. On the other hand, BRP was not more effective than ESP. ESP surgery time was significantly higher than UPPP, while BRP was the quickest procedure. In summary, ESP and BRP seem to be more effective than UPPP in a multilevel surgical robotic setting. However, being quicker, easy to learn and with a low rate of complications, BRP is a safe, effective and promising option for treatment of OSAHS patients.
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Affiliation(s)
- G Cammaroto
- Department of Otolaryngology, University of Messina, Italy
| | - F Montevecchi
- Department of Special Surgery, ENT and Oral Surgery Unit, Ospedale Morgagni Pierantoni, Forlì, Italy
| | - G D'Agostino
- Department of Special Surgery, ENT and Oral Surgery Unit, Ospedale Morgagni Pierantoni, Forlì, Italy
| | - E Zeccardo
- Department of Special Surgery, ENT and Oral Surgery Unit, Ospedale Morgagni Pierantoni, Forlì, Italy
| | - C Bellini
- Department of Special Surgery, ENT and Oral Surgery Unit, Ospedale Morgagni Pierantoni, Forlì, Italy
| | - G Meccariello
- Department of Special Surgery, ENT and Oral Surgery Unit, Ospedale Morgagni Pierantoni, Forlì, Italy
| | - C Vicini
- Department of Special Surgery, ENT and Oral Surgery Unit, Ospedale Morgagni Pierantoni, Forlì, Italy
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Sethukumar P, Kotecha B. Tailoring surgical interventions to treat obstructive sleep apnoea: one size does not fit all. Breathe (Sheff) 2018; 14:e84-e93. [PMID: 30364490 PMCID: PMC6196320 DOI: 10.1183/20734735.020118] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
While continuous positive airway pressure (CPAP) remains the gold standard treatment of choice in patients with moderate or severe obstructive sleep apnoea (OSA), surgery has been established as a means to improve compliance and facilitate the use of CPAP, both of which are potential pitfalls in the efficacy of this treatment modality. In a minority of cases, with obvious oropharyngeal anatomical obstruction, corrective surgery may completely alleviate the need for CPAP treatment. In this review, we summarise clinical assessment, surgical options, discuss potential new treatments, and outline the importance of investigating and addressing the multiple anatomical levels that can contribute to OSA. Research into effectiveness of these procedures is rapidly accumulating, and surgery can be an effective treatment. However, given the myriad of options available and multiple levels of anatomical pathology that can present, it is imperative that correctly selected patients are matched with the most appropriate treatment for the best outcomes. KEY POINTS OSA is an increasingly prevalent disorder which has significant systemic effects if left untreated.Anatomical abnormalities can be corrected surgically to good effect with a growing and robust evidence base.Drug-induced sleep endoscopy is a key tool in the otolaryngologist's armamentarium to tailor specific surgery to address specific anatomical concerns, and to facilitate appropriate patient selection.Multilevel surgical approaches are often indicated instead of a "one size fits all" model. EDUCATIONAL AIMS To discuss how to assess patients presenting with OSA in clinic, from an otorhinolaryngology perspective.To discuss the indications for intervention.To provide an overview of nonsurgical interventions for treating OSA, with evidence.To discuss the different surgical modalities available for treatment of OSA, with evidence.
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Affiliation(s)
- Priya Sethukumar
- Otolaryngology, Head and Neck Surgery, Queen's Hospital, Romford, UK
| | - Bhik Kotecha
- Otolaryngology, Head and Neck Surgery, Queen's Hospital, Romford, UK
- Royal National Throat, Nose and Ear Hospital, UCLH, London, UK
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Aynacı E, Karaman M, Kerşin B, Fındık MO. Comparison of radiofrequency and transoral robotic surgery in obstructive sleep apnea syndrome treatment. Acta Otolaryngol 2018; 138:502-506. [PMID: 29298526 DOI: 10.1080/00016489.2017.1417635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Radiofrequency tissue ablation (RFTA) and transoral robotic surgery (TORS) are the methods used in OSAS surgery. We also aimed to compare the advantages and disadvantages of RF and TORS as treatment methods applied in OSAS patients in terms of many parameters, especially apnea hypopnea index (AHI). MATERIALS AND METHODS Patients were classified by performing a detailed examination and evaluation before surgery. 20 patients treated with anterior palatoplasty and uvulectomy -/+ tonsillectomy + RFTA (17 males, 3 females) and 20 patients treated with anterior palatoplasty and uvulectomy -/+ tonsillectomy + TORS (16 males, 4 females) were included in the study. PSG was performed preoperatively and postoperatively in all patients and Epworth sleepiness questionnaire was applied. All operations were performed by the same surgeon and these surgical methods -RF and TORS- were compared in terms of many parameters. RESULTS When the patients treated with RF and TORS were compared in operation time, length of hospitalization and duration of transition to oral feeding; all parameters were significantly greater in the patients treated with TORS. CONCLUSIONS TORS technique was found to be more successful than RF in terms of reduction of AHI value, correcting minimum arterial oxygen saturation value and decreasing Epworth Sleepiness Scale score.
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Affiliation(s)
- Engin Aynacı
- The Department of Pulmonology, İstanbul Medipol University, İstanbul, Turkey
| | - Murat Karaman
- The Department of Otorhinolaryngology, Acıbadem University, Acıbadem Altunizade Hospital, İstanbul, Turkey
| | - Burak Kerşin
- The Department of Otorhinolaryngology, İstanbul Medipol University, İstanbul, Turkey
| | - Mahmut Ozan Fındık
- The Department of Otorhinolaryngology, Acıbadem University, Acıbadem Altunizade Hospital, İstanbul, Turkey
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Abstract
In the head and neck region, great potential is seen in robot-assisted surgery (RAS). Mainly in cancer surgery, the use of robotic systems seems to be of interest. Until today, two robotic systems (DaVinci® und FLEX®) have gained approval for clinical use in the head and neck region, and multiple other systems are currently in pre-clinical testing. Although, certain groups of patients may benefit from RAS, no unbiased randomized clinical studies are available. Until today, it was not possible to satisfactorily prove any advantage of RAS as compared to standard procedures. The limited clinical benefit and the additional financial burden seem to be the main reasons, why the comprehensive application of RAS has not been realized so far.This review article describes the large variety of clinical applications for RAS in the head and neck region. In addition, the financial and technical challenges, as well as ongoing developments of RAS are highlighted. Special focus is put on risks associated with RAS and current clinical studies. We believe, that RAS will find its way into clinical routine during the next years. Therefore, medical staff will have to increasingly face the technical, scientific and ethical features of RAS.
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Affiliation(s)
- Patrick J Schuler
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm
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41
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Surgical outcomes of overlapping lateral pharyngoplasty with or without coblator tongue base resection for obstructive sleep apnea. Eur Arch Otorhinolaryngol 2018; 275:1189-1196. [DOI: 10.1007/s00405-018-4940-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 03/14/2018] [Indexed: 11/26/2022]
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Ferguson MS, Magill JC, Kotecha BT. Narrative review of contemporary treatment options in the care of patients with obstructive sleep apnoea. Ther Adv Respir Dis 2017; 11:411-423. [PMID: 29059008 DOI: 10.1177/1753465817736263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Snoring and obstructive sleep apnoea (OSA) are increasingly common conditions, and confer a significant health and socioeconomic burden. Furthermore, untreated OSA represents a significant mortality risk. Patients require careful assessment, including detailed clinical history and examination, sleep study and drug-induced sleep endoscopy (DISE). Although nasal continuous positive airway pressure (nCPAP) is the gold standard treatment for moderate and severe OSA, multidisciplinary team assessment is often required to develop the best treatment plan for an individual, especially when nasal CPAP is poorly tolerated. There is a wide range of medical and surgical treatment options, and following appropriate patient selection and assessment, a focused site-specific, often multilevel, intervention is indicated. There is an increasing body of evidence in the literature supporting these multilevel interventions and with agreement on standardized outcome measures more trials are likely to improve the robustness of these data further.
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Affiliation(s)
- Mark S Ferguson
- Department of Otolaryngology, Royal National Throat, Nose & Ear Hospital, London, UK
| | | | - Bhik T Kotecha
- Department of Otolaryngology, Royal National Throat, Nose & Ear Hospital, 330 Grays Inn Road, London WC1X 8DA, UK
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Hwang CS, Kim JW, Kim JW, Lee EJ, Kim CH, Yoon JH, Cho HJ. Comparison of robotic and coblation tongue base resection for obstructive sleep apnoea. Clin Otolaryngol 2017; 43:249-255. [PMID: 28800204 DOI: 10.1111/coa.12951] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the efficacy and safety of transoral robotic surgery (TORS) with endoscope-guided coblation tongue base resection. DESIGN Retrospective case-control study. SETTING University-based tertiary care medical center. PARTICIPANTS Patients with obstructive sleep apnoea (OSA) who underwent endoscope-guided tongue base coblation resection or transoral robotic surgery (TORS) in combination with lateral pharyngoplasty at a single institution in South Korea between April 2013 and December 2016 were investigated. Forty-five patients who had moderate-to-severe OSA with tongue base collapse and a minimum follow-up period of 6 months with postoperative polysomnography (PSG) were enrolled in this study. MAIN OUTCOME MEASURES All patients underwent pre- and postoperative (at least 4 months after surgery) overnight PSG. Available information on results of the PSG, Epworth sleepiness scale and complications of the TORS and coblation groups were compared. RESULTS Postoperative PSG studies showed improved sleep quality for most patients. The mean postoperative apnoea-hypopnea index (AHI) was reduced significantly from 45.0 to 17.0 events/h (P < .0001) in the TORS group and from 45.6 to 16.2 events/h (P < .0001) in the coblation group. The mean rates of improvement (AHI reduction > 50%) were 75.0% in TORS patients and 62.1% in coblation patients and the difference was not significant. Less frequent postoperative morbidity, including bleeding, taste dysfunction and foreign body sensation, was recorded in TORS patients. CONCLUSIONS Both the coblation and TORS groups showed similar surgical outcomes, TORS achieved PSG results non-inferior to and complication rates comparable to coblation.
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Affiliation(s)
- C S Hwang
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - J W Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - J W Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - E J Lee
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - C-H Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.,The Airway Mucus Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - J-H Yoon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.,The Airway Mucus Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - H-J Cho
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.,The Airway Mucus Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
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44
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Transoral robotic-assisted surgery for the approach to anterior cervical spine lesions. Eur Arch Otorhinolaryngol 2017; 274:4011-4016. [PMID: 28864959 DOI: 10.1007/s00405-017-4731-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 08/22/2017] [Indexed: 10/18/2022]
Abstract
The Da Vinci robotic surgical system is increasingly being used by head and neck surgeons in transoral approaches for head and neck cancer. Our experience using the Da Vinci system for transoral robotic-assisted surgery (TORS) is presented. The feasibility of TORS for lesions involving the anterior portion of C1-C2 and the cranio-cervical junction has been evaluated from an anatomical viewpoint in a cadaveric laboratory. Two patients treated using the Da Vinci system to reach C1-C2 benign lesions are presented. The anatomical cadaveric study showed that this approach is safe and feasible. The first two cases which we describe confirmed the advantages of the Da Vinci system in the anterior approach to the cervical spine and allowed the limitations of this procedure to be assessed. TORS may be useful to reach anterior lesions of the cervical spine localized at the level of C1 and C2: first, for removal of small benign and well-delineated lesions; and second, for diagnostic purposes with biopsy of large lesions. Further studies and new instruments are needed to confirm the safety and results of this approach in terms of morbidity.
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45
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Folk D, D'Agostino M. Transoral robotic surgery vs. endoscopic partial midline glossectomy for obstructive sleep apnea. World J Otorhinolaryngol Head Neck Surg 2017; 3:101-105. [PMID: 29204587 PMCID: PMC5683621 DOI: 10.1016/j.wjorl.2017.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Indexed: 12/04/2022] Open
Abstract
Objective To compare sleep-related outcomes in obstructive sleep apnea hypopnea syndrome (OSAHS) patients following base of tongue resection via robotic surgery and endoscopic midline glossectomy. Methods This was a retrospective study. A total of 114 robotic and 37 endoscopic midline glossectomy surgeries were performed between July 2010 and April 2015 as part of single or multilevel surgery. Patients were excluded for indications other than sleep apnea or if complete sleep studies were not obtained. Thus, 45 robotic and 16 endoscopic surgeries were included in the analysis. Results In the robotic surgery group there were statistically significant improvements in AHI [(44.4 ± 22.6) events/h–(14.0 ± 3.0) events/h, P < 0.001] Epworth Sleepiness Scale (12.3 ± 4.6 to 4.5 ± 2.9, P < 0.001), and O2 nadir (82.0% ± 6.1% to 85.0% ± 5.4%, P < 0.001). In the endoscopic group there were also improvements in AHI (48.7 ± 30.2 to 27.4 ± 31.9, P = 0.06), Epworth Sleepiness Scale (12.6 ± 5.5 to 8.3 ± 4.5, P = 0.08), and O2 nadir (80.2% ± 8.6% to 82.7% ± 6.5%, P = 0.4). Surgical success rate was 75.6% and 56.3% in the robotic and endoscopic groups, respectively. Greater volume of tissue removed was predictive of surgical success in the robotic cases (10.3 vs. 8.6 ml, P = 0.02). Conclusions Both robotic surgery and endoscopic techniques for tongue base reduction improve objective measures of sleep apnea. Greater success rates may be achieved with robotic surgery compared to traditional methods.
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Affiliation(s)
- David Folk
- Yale University, Section of Otolaryngology, Department of Surgery, New Haven, CT, USA
| | - Mark D'Agostino
- Yale University, Section of Otolaryngology, Department of Surgery, New Haven, CT, USA.,Middlesex Hospital, Middletown, CT, USA
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46
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Mahmoud AF, Thaler ER. Transoral Robotic Surgery for Obstructive Sleep Apnea. CURRENT SLEEP MEDICINE REPORTS 2017. [DOI: 10.1007/s40675-017-0074-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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47
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Liu HH, Li LJ, Shi B, Xu CW, Luo E. Robotic surgical systems in maxillofacial surgery: a review. Int J Oral Sci 2017; 9:63-73. [PMID: 28660906 PMCID: PMC5518975 DOI: 10.1038/ijos.2017.24] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 12/26/2022] Open
Abstract
Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical systems, maxillofacial surgery is performed with less blood loss, fewer complications, shorter hospitalization and better cosmetic results than standard open surgery. However, the application of robotic surgery techniques to the treatment of head and neck diseases remains in an experimental stage, and the long-lasting effects on surgical morbidity, oncologic control and quality of life are yet to be established. More well-designed studies are needed before this approach can be recommended as a standard treatment paradigm. Nonetheless, robotic surgical systems will inevitably be extended to maxillofacial surgery. This article reviews the current clinical applications of robotic surgery in the head and neck region and highlights the benefits and limitations of current robotic surgical systems.
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Affiliation(s)
- Hang-Hang Liu
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - Long-Jiang Li
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - Bin Shi
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - Chun-Wei Xu
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - En Luo
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
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S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen – Kapitel „Schlafbezogene Atmungsstörungen“. SOMNOLOGIE 2016. [DOI: 10.1007/s11818-016-0093-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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49
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50
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Transoral robotic-assisted tongue base resection in pediatric obstructive sleep apnea syndrome: case presentation, clinical and technical consideration. Eur Arch Otorhinolaryngol 2016; 274:1161-1166. [PMID: 27568349 DOI: 10.1007/s00405-016-4269-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 08/13/2016] [Indexed: 12/19/2022]
Abstract
Pediatric obstructive sleep apnea syndrome (OSAS) is primarily caused by adenotonsillar hypertrophy. However, tongue base hypertrophy is increasingly being recognized as a cause, even after adenotonsillectomy. We report three cases of pediatric OSAS successfully treated by transoral robotic reduction of the tongue base. In all children, we were able to achieve improved retrolingual patency while avoiding significant procedure-related morbidity. In conclusion, tongue base reduction by transoral robotic surgery appears to be a feasible solution for the base of tongue obstruction due to lingual tonsil hypertrophy in pediatric patients.
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