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Pang EB, Pang KP, Cheong RCT, Pang KA, Montevecchi F, Vicini C, Chan YH, Rotenberg B. Expansion sphincter pharyngoplasty in OSA: a 15 year review. Eur Arch Otorhinolaryngol 2023; 280:3337-3344. [PMID: 36859707 DOI: 10.1007/s00405-023-07901-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVE A 15 year review of the outcomes and success rates of the Expansion Sphincter Pharyngoplasty (ESP) in the treatment of patients with obstructive sleep apnea (OSA). METHODS A systemic review with two independent searches of MEDLINE, Google Scholar, Cochrane Library and Evidence-Based Medicine Reviews to identify publications relevant to OSA and Expansion Pharyngoplasty. All relevant studies published before 31 December 2021 were included. RESULTS Sixteen studies were included in this strict systematic review with a total of 747 patients who had the ESP procedure were included. The mean age was 41.3 years, mean BMI 28.2, the mean pre-op AHI was 32.3 and post-op AHI was 10.0 (p < 0.05), the mean pre-op ESS was 11.4, had reduced to post-op 5.3 (p < 0.05), and the mean pre-op snore VAS decreased from 8.7 to 2.9 (p < 0.05), with a mean follow-up time of 9.5 months. The overall pooled success rate for all the 747 patients was 80.0%. There were no significant reported complications noted in these studies. CONCLUSION After 15 years of presence, the expansion sphincter pharyngoplasty has shown to be reliably effective in the management of patients with OSA.
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Affiliation(s)
| | - Kenny P Pang
- Otorhinolaryngology, Asia Sleep Centre, Paragon Medical Centre, Singapore, Singapore.
| | | | | | | | - Claudio Vicini
- GB Morgagni-L Pierantoni Hospital, University of Ferrara and Bologna, Forli, Italy
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
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Moffa A, Giorgi L, Carnuccio L, Cassano M, Montevecchi F, Baptista P, Casale M. New non-invasive electrical stimulation devices for treatment of snoring and obstructive sleep apnoea: a systematic review. Sleep Breath 2023; 27:103-108. [PMID: 35460429 DOI: 10.1007/s11325-022-02615-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Recently, new non-invasive electrical stimulation devices have been developed with the aim to increase the tongue muscle tone for patients with obstructive sleep apnoea (OSA) and snorers. The aim of this study was to provide a review of the first results found in the literature regarding the efficacy of non-invasive electric stimulation devices for the treatment of primary snoring and OSA. MATERIAL AND METHODS An electronic search was performed on PubMed/MEDLINE, Google Scholar, and Ovid databases. The PRISMA statement was followed. Databases were searched from inception through September, 2021. RESULTS Four studies met the criteria for inclusion in this review, for a total of 265 patients. Two devices were included in this review, Apone-Stim 400 Muscle Stimulator and eXciteOSA. All studies suggested that these new devices are effective in improving snoring by approximately 50% after device training, without major complications. However data regarding OSA improvement are conflicting. CONCLUSIONS Intraoral non-invasive electrical stimulation devices can be considered a valid option to current therapies for snoring. Further studies are needed to support these interesting new devices for treatment of OSA.
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Affiliation(s)
- Antonio Moffa
- School of Medicine, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128, Rome, Italy.
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy.
| | - Lucrezia Giorgi
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Luca Carnuccio
- School of Medicine, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Michele Cassano
- Unit of Otolaryngology, University of Foggia, Viale Luigi Pinto 1, 71122, Foggia, Italy
| | - Filippo Montevecchi
- ENT Head &Neck Surgery Unit, Sleep Disorder Breathing Unit, Forlì Private Hospital, Forlì, Italy
| | - Peter Baptista
- Unit of Otolaryngology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Manuele Casale
- School of Medicine, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128, Rome, Italy
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
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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, Dos Santos Sobreira Nunes H, De Vito A, Montevecchi F, Vicini C. Correction to: Sleep medicine in otolaryngology units: an international survey. Sleep Breath 2021; 25:2153. [PMID: 34519943 DOI: 10.1007/s11325-021-02486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Giovanni Cammaroto
- Unit of Otolaryngology, Hospital Morgagni Pierantoni, Via Carlo Forlanini 2, 47100, Forlì, Italy.
- Young-Otolaryngologists of the International Federations of Otorhino-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 Otorhino-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 Otorhino-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 Otorhino-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 Otorhino-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 Otorhino-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 Otorhino-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 Otorhino-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 ENTHead andNeck 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 Otorhino-laryngological Societies (YO-IFOS), Paris, France
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Pang KP, Montevecchi F, Vicini C, Carrasco‐Llatas M, Baptista PM, Olszewska E, Braverman I, Kishore S, Chandra S, Yang HC, Chan YH, Pang SB, Pang KA, Pang EB, Rotenberg B. Does nasal surgery improve multilevel surgical outcome in obstructive sleep apnea: A multicenter study on 735 patients. Laryngoscope Investig Otolaryngol 2020; 5:1233-1239. [PMID: 33364416 PMCID: PMC7752065 DOI: 10.1002/lio2.452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/20/2020] [Accepted: 08/24/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Does nasal surgery affect multilevel surgical success outcome. METHODS Prospective eight country nonrandomized trial of 735 obstructive sleep apnea (OSA) patients, who had multilevel palate and/or tongue surgery, divided into two groups, with or without nose surgery. RESULTS There were 575 patients in nose group, 160 patients in no nose group. The mean age for nose group 44.6 ± 11.4, no nose group 44.2 ± 11.8. Mean preoperative BMI for nose group 27.5 ± 3.6, no nose group 27.5 ± 4.1, mean postoperative BMI nose group 26.3 ± 3.7, no nose group 27.1 ± 3.8 (P = .006). Mean preoperative AHI nose group 32.7 ± 19.4, no nose group 34.3 ± 25.0 (P = .377); and mean postoperative AHI nose group 13.5 ± 10.2, no nose group 17.1 ± 16.0 (P = .001). Mean preoperative ESS nose group was 11.3 ± 4.7, no nose group was 10.4 ± 5.4 (P = .051); and mean postoperative ESS nose group was 5.3 ± 3.2, no nose group was 6.7 ± 2.8 (P = .001). The nose group had higher percentage change (adjusted for age, gender, BMI) in AHI (33.7%, 95% CI 14% to 53.5%) compared to the no nose group (P = .001); the nose group also had more percentage change in ESS (37%, 95% CI 23.6% to 50.3%) compared to the no nose group (P < .001). Change in BMI did not affect AHI nor ESS change (Cohen effect 0.03 and 0.14, respectively). AHI change in both groups were also statistically significant in the mild OSA (P = .008) and the severe OSA (P = .01). Success rate of surgery for the nose group 68.2%, while the no nose group 55.0% (P = .002). CONCLUSION Combining nose surgery in multilevel surgery improves surgical success. LEVEL OF EVIDENCE IIC.
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Affiliation(s)
- Kenny P. Pang
- OtolaryngologyAsia Sleep Centre, ParagonSingaporeSingapore
| | | | | | | | | | - Ewa Olszewska
- Sleep Apnea Surgery Center, ENTMedical University of BialystokBiałystokPoland
| | - Itzhak Braverman
- Otolaryngology Head and Neck Surgery, Hillel Yaffe Medical CenterTechnion Faculty MedicineHaifaIsrael
| | | | | | - Hyung Chae Yang
- OtolaryngologyChonnam National University Medical SchoolGwangjuSouth Korea
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of MedicineNational University SingaporeSingaporeSingapore
| | - Scott B. Pang
- OtolaryngologyAsia Sleep Centre, ParagonSingaporeSingapore
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Capaccio P, Montevecchi F, Meccariello G, Cammaroto G, Magnuson JS, Pelucchi S, Bresciani L, Vicini C. Transoral robotic submandibular sialadenectomy: how and when. Gland Surg 2020; 9:423-429. [PMID: 32420268 DOI: 10.21037/gs.2020.02.04] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Traditional removal of the submandibular gland is done through a transcervical approach; new proposals have come into the scientific limelight such as endoscopy-assisted transcervical sialadenectomy or (robot-assisted) submandibular sialadenectomy through a postauricular facelift transcervical approach. Transoral submandibular sialadenectomy has been described in the past, but with the advent of transoral robotic surgery, the proposal of removing the submandibular gland from the oral floor is gaining strength. A transoral robotic submandibular sialadenectomy by the Si Da Vinci Surgical Robot was performed in a 68-years-old female patient under general anaesthesia. The transoral robotic procedure was successful with no major postoperative complications. A mild tingling of the tip of the tongue was described by the patient 3 months after. The surgical time took 110 minutes. No residual gland was observed at ultrasonography. The transoral robotic submandibular sialadenectomy seems to be, with selective indication based on clinical and radiological assessment, a viable and safe alternative to traditional management in patients who refuse a cervical scar and the risk of paralysis of the facial nerve.
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Affiliation(s)
- Pasquale Capaccio
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Filippo Montevecchi
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni-L. Pierantoni Hospital of Forlì, Forlì, Italy
| | - Giuseppe Meccariello
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni-L. Pierantoni Hospital of Forlì, Forlì, Italy
| | - Giovanni Cammaroto
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni-L. Pierantoni Hospital of Forlì, Forlì, Italy
| | | | - Stefano Pelucchi
- Otolaryngology Head and Neck Surgery, University Hospital of Ferrara, Ferrara, Italy
| | - Lorenzo Bresciani
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudio Vicini
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni-L. Pierantoni Hospital of Forlì, Forlì, Italy.,Otolaryngology Head and Neck Surgery, University Hospital of Ferrara, Ferrara, Italy
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Bahgat A, Bahgat Y, Alzahrani R, Montevecchi F, Cammaroto G, Vicini C. Transoral Endoscopic Coblation Tongue Base Surgery in Obstructive Sleep Apnea: Resection versus Ablation. ORL J Otorhinolaryngol Relat Spec 2020; 82:201-208. [PMID: 32375151 DOI: 10.1159/000506994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/04/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND A new transoral tongue base surgical procedure for the treatment of snoring and obstructive sleep apnea (OSA) is described. It is named "Robo-Cob" technique because it is similar to transoral robotic surgery (TORS) but it is performed by means of coblation technology in order to resect the tongue base in countries where TORS is not an available option for such benign conditions. METHODS In this prospective, randomized, controlled trial, the new Robo-Cob technique was carried out in 25 adult OSA patients with confirmed tongue base hypertrophy at preoperative drug-induced sedation endoscopy. The results of this procedure were compared with the coblation endoscopic lingual lightening (CELL) technique used to ablate (or minimally resect) the central part of the tongue base, in another 25 adult OSA patients with similar characteristics (age, sex, preoperative body mass index and Apnea-Hypopnea Index, AHI). The base of tongue surgery was part of multilevel surgery including also septoturbinoplasty and barbed reposition pharyngoplasty (with/without tonsillectomy). RESULTS In this study, the Robo-Cob technique is proved to be feasible and effective in all cases either alone or when combined with other procedures in multilevel surgical settings. No/minimal intraoperative or postoperative complications were observed. Postoperative pain as measured by visual analog scale ranged from 3 to 7. No tracheostomy was done in any patient. Objective clinical improvement was confirmed by a level 3 polygraphy performed 6 months after surgery. There was significant difference in operative time at the level of the tongue base between Robo-Cob and CELL techniques, with shorter times observed within the Robo-Cob group. Moreover, the Robo-Cob technique provided tongue base tissue specimens that allowed measurement of the volume that ranged from 5 to 17 cm3 (mean 11.64 ± 3.49 cm3). It was found that resection of at least 10 cm3 of tongue base tissue was associated with better outcomes in terms of postoperative AHI reduction. CONCLUSION In this study, the added values of using coblation for resection and not ablation appear to be the short surgical time, the low postoperative tissue edema, and the possibility of providing tissue specimens to measure resected volumes.
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Affiliation(s)
- Ahmed Bahgat
- Department of Otorhinolaryngology, Alexandria University, Alexandria, Egypt,
| | - Yassin Bahgat
- Department of Otorhinolaryngology, Alexandria University, Alexandria, Egypt
| | - Rajab Alzahrani
- Department of Surgery, ENT Division, Medical College, Albaha University, Albaha, Saudi Arabia
| | - Filippo Montevecchi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Giovanni Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
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Cammaroto G, Vicini C, Montevecchi F, Bonsembiante A, Meccariello G, Bresciani L, Pelucchi S, Capaccio P. Submandibular gland excision: From external surgery to robotic intraoral and extraoral approaches. Oral Dis 2020; 26:853-857. [DOI: 10.1111/odi.13340] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/11/2020] [Accepted: 03/23/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Giovanni Cammaroto
- Head and Neck Department ENT & Oral Surgery Unit G.B. Morgagni – L. Pierantoni Hospital of Forlì Forlì Italy
| | - Claudio Vicini
- Head and Neck Department ENT & Oral Surgery Unit G.B. Morgagni – L. Pierantoni Hospital of Forlì Forlì Italy
- Otolaryngology Head and Neck Surgery University Hospital of Ferrara Ferrara Italy
| | - Filippo Montevecchi
- Head and Neck Department ENT & Oral Surgery Unit G.B. Morgagni – L. Pierantoni Hospital of Forlì Forlì Italy
| | - Anna Bonsembiante
- Otolaryngology Head and Neck Surgery University Hospital of Ferrara Ferrara Italy
| | - Giuseppe Meccariello
- Head and Neck Department ENT & Oral Surgery Unit G.B. Morgagni – L. Pierantoni Hospital of Forlì Forlì Italy
| | - Lorenzo Bresciani
- Department of Otolaryngology and Head and Neck Surgery Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Biomedical Surgical and Dental Sciences – University of Milan Milan Italy
| | - Stefano Pelucchi
- Otolaryngology Head and Neck Surgery University Hospital of Ferrara Ferrara Italy
| | - Pasquale Capaccio
- Department of Otolaryngology and Head and Neck Surgery Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Biomedical Surgical and Dental Sciences – University of Milan Milan Italy
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9
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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Iannella G, Magliulo G, Lo Iacono CAM, Bianchi G, Polimeni A, Greco A, De Vito A, Meccariello G, Cammaroto G, Gobbi R, Brunori M, Di Luca M, Montevecchi F, Pace A, Visconti IC, Milella C, Solito C, Pelucchi S, Cerritelli L, Vicini C. Positional Obstructive Sleep Apnea Syndrome in Elderly Patients. Int J Environ Res Public Health 2020; 17:ijerph17031120. [PMID: 32050596 PMCID: PMC7042812 DOI: 10.3390/ijerph17031120] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 12/13/2022]
Abstract
Background The purpose of this study was to evaluate the prevalence of position-dependent obstructive sleep apnea (POSA) in elderly patients (≥65 years old). Adult (range 19-65 years old) and elderly patients were also compared in order to show differences in the incidence of POSA between these two groups of patients. Methods A prospective bi-center study was performed between January 2018 and May 2019. A total of 434 participants underwent polysomnography (PSG) study at home (Embletta MPR). Body position during the PSG recordings was determined. Patients were subdivided in two groups: those aged between 19 and 65 years old (adult patients) and ≥65 years old (elderly patients). POSA patients were defined using Cartwright’s system, Bignold classification, and the new Amsterdam Positional OSA Classification (APOC). Results The prevalence of POSA in elderly patients differed according to the classification system used: 49.3% using Cartwright’s classification system, 20.5% with the Bignold classification, and 22.6%, 38.9%, and 5.4% of APOC 1, APOC 2, and APOC3 sub-classes were respectively identified for the APOC classification system. No difference between adult and elderly patients regarding the prevalence of POSA was observed. No statistical differences emerged between the two groups of patients in terms of supine (p = 0.9) and non-supine AHI (p = 0.4). Conclusions A significant number of elderly patients could be considered treatable with positional therapy according to the APOC classification. However, the efficacy and applicability of positional therapy in elderly patients must be confirmed by further research.
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Affiliation(s)
- Giannicola Iannella
- Department of ‘Organi di Senso’, University “Sapienza”,Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (A.G.); (A.P.); (I.C.V.); (C.M.); (C.S.)
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy; (A.D.V.); (G.M.); (G.C.); (R.G.); (C.V.)
- Correspondence: ; Tel.: +39-23878-93753; Fax: +39-06499-76817
| | - Giuseppe Magliulo
- Department of ‘Organi di Senso’, University “Sapienza”,Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (A.G.); (A.P.); (I.C.V.); (C.M.); (C.S.)
| | - Cristina Anna Maria Lo Iacono
- Department of Cardiovascular, Respiratory, Nephrologic, Anaesthesiologic and Geriatric Sciences, Sapienza University, Viale dell’Università, 33, 00185 Rome, Italy; (C.A.M.L.I.); (M.B.)
| | - Giulia Bianchi
- Department ENT & Audiology, University of Ferrara, Via Savonarola, 9, 44121 Ferrara, Italy; (G.B.); (S.P.); (L.C.)
| | - Antonella Polimeni
- Department of Oral and Maxillo Facial Sciences, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy;
| | - Antonio Greco
- Department of ‘Organi di Senso’, University “Sapienza”,Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (A.G.); (A.P.); (I.C.V.); (C.M.); (C.S.)
| | - Andrea De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy; (A.D.V.); (G.M.); (G.C.); (R.G.); (C.V.)
| | - Giuseppe Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy; (A.D.V.); (G.M.); (G.C.); (R.G.); (C.V.)
| | - Giovanni Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy; (A.D.V.); (G.M.); (G.C.); (R.G.); (C.V.)
| | - Riccardo Gobbi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy; (A.D.V.); (G.M.); (G.C.); (R.G.); (C.V.)
| | - Marco Brunori
- Department of Cardiovascular, Respiratory, Nephrologic, Anaesthesiologic and Geriatric Sciences, Sapienza University, Viale dell’Università, 33, 00185 Rome, Italy; (C.A.M.L.I.); (M.B.)
| | - Milena Di Luca
- Department of ENT, University of Catania, Via S. Sofia, 78, 95125 Catania, Italy;
| | | | - Annalisa Pace
- Department of ‘Organi di Senso’, University “Sapienza”,Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (A.G.); (A.P.); (I.C.V.); (C.M.); (C.S.)
| | - Irene Claudia Visconti
- Department of ‘Organi di Senso’, University “Sapienza”,Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (A.G.); (A.P.); (I.C.V.); (C.M.); (C.S.)
| | - Claudia Milella
- Department of ‘Organi di Senso’, University “Sapienza”,Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (A.G.); (A.P.); (I.C.V.); (C.M.); (C.S.)
| | - Carmen Solito
- Department of ‘Organi di Senso’, University “Sapienza”,Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (A.G.); (A.P.); (I.C.V.); (C.M.); (C.S.)
| | - Stefano Pelucchi
- Department ENT & Audiology, University of Ferrara, Via Savonarola, 9, 44121 Ferrara, Italy; (G.B.); (S.P.); (L.C.)
| | - Luca Cerritelli
- Department ENT & Audiology, University of Ferrara, Via Savonarola, 9, 44121 Ferrara, Italy; (G.B.); (S.P.); (L.C.)
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy; (A.D.V.); (G.M.); (G.C.); (R.G.); (C.V.)
- Department ENT & Audiology, University of Ferrara, Via Savonarola, 9, 44121 Ferrara, Italy; (G.B.); (S.P.); (L.C.)
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11
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Capaccio P, Montevecchi F, Meccariello G, D’Agostino G, Cammaroto G, Pelucchi S, Vicini C. Transoral robotic surgery for hilo-parenchymal submandibular stones: step-by-step description and reasoned approach. Int J Oral Maxillofac Surg 2019; 48:1520-1524. [DOI: 10.1016/j.ijom.2019.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/20/2019] [Accepted: 07/02/2019] [Indexed: 11/29/2022]
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12
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Vicini C, Meccariello G, Montevecchi F, De Vito A, Frassineti S, Gobbi R, Pelucchi S, Iannella G, Magliulo G, Cammaroto G. Effectiveness of barbed repositioning pharyngoplasty for the treatment of obstructive sleep apnea (OSA): a prospective randomized trial. Sleep Breath 2019; 24:687-694. [PMID: 31786746 DOI: 10.1007/s11325-019-01956-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of our randomized clinical trial is to produce stronger evidence supporting barbed repositioning pharyngoplasty (BRP) as a therapeutic option for the treatment of obstructive sleep apnea (OSA). METHODS The trial was a single-center prospective controlled trial with two parallel arms (group A: BRP; group B: observation) and randomization. Baseline and 6-month polygraphy evaluating the apnea hypopnea index (AHI), oxygen desaturation index (ODI), and lowest oxygen saturation (LOS) were performed. To test the differences among groups of Student's t test, the role of each factor (univariate analysis) and their independent effect (multivariate analysis) was explored using logistic regression model as appropriate. Linear regression was also conducted. RESULTS A significant reduction of AHI, ODI, LOS, and Epworth Sleepiness Scale (ESS) values was recorded in the BRP group. BRP showed to be more effective than observation. Logistic regression showed that preoperative AHI is related significantly to postoperative AHI within the BRP group. A linear regression showed that higher baseline AHI predicts more significant postoperative absolute AHI reduction. CONCLUSIONS BRP appears to be a promising technique and might be included within the surgical armamentarium of a sleep surgeon. Patients affected by severe OSA may benefit from this surgery with more significant reduction of AHI values.
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Affiliation(s)
- Claudio Vicini
- Unit of Otolaryngology, Hospital Morgagni Pierantoni, Forlì, Italy.,Unit of Otolaryngology, University of Ferrara, Ferrara, Italy
| | | | | | - Andrea De Vito
- Unit of Otolaryngology, Hospital Morgagni Pierantoni, Forlì, Italy
| | | | - Riccardo Gobbi
- Unit of Otolaryngology, Hospital Morgagni Pierantoni, Forlì, Italy
| | | | | | | | - Giovanni Cammaroto
- Unit of Otolaryngology, Hospital Morgagni Pierantoni, Forlì, Italy. .,Unit of Otolaryngology, University of Messina, Messina, Italy.
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13
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Pang KP, Vicini C, Montevecchi F, Piccin O, Chandra S, Yang HC, Agrawal V, Chung JCK, Chan YH, Pang SB, Pang KA, Pang EB, Rotenberg B. Long-term Complications of Palate Surgery: A Multicenter Study of 217 Patients. Laryngoscope 2019; 130:2281-2284. [PMID: 31765026 DOI: 10.1002/lary.28432] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/08/2019] [Accepted: 11/06/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate long-term complications of newer reconstructive palate surgery techniques. STUDY DESIGN Retrospective case-series analysis. METHODS Retrospective six-country clinical study of OSA patients who had nose and palate surgery. RESULTS There were 217 patients, mean age = 43.9 ± 12.5 years, mean body mass index = 25.9 ± 4.7, mean preoperative apnea-hypopnea index [AHI] = 30.5 ± 19.1, follow-up 41.3 months. A total of 217 palatal procedures were performed, including 50 expansion sphincter pharyngoplasties (ESP), 34 functional expansion pharyngoplasties (FEP), 40 barbed reposition pharyngoplasties (BRP), 64 modified uvulopalatopharyngoplasties (mUPPP), 11 uvulopalatal flap procedures (UPF), nine suspension pharyngoplasties (SP), eight relocation pharyngoplasties (RP), and one z-pharyngoplasty (ZPP). Complications included were constant and/or felt twice per week; dry throat (7.8%), throat lump feeling (11.5%), throat phlegm (10.1%), throat scar feeling (3.7%), and difficulty swallowing (0.5%). Of the 17 patients who had a dry throat complaint, two were constant (one SP, one RP), 15 were occasional (10 mUPPP, three SP, two BRP). Of the 25 patients with the throat lump feeling, four were constant (three RP, one ZPP), 21 were occasional (10 mUPPP, five SP, five UPF, one BRP). Of the 22 patients with the throat phlegm feeling, four were constant (two SP, two RP), 18 were occasional (10 mUPPP, four BRP, two FEP, two SP). Of the eight patients with throat scar feeling, eight were occasional (four SP, two mUPPP, one FEP, one RP), none were constant. One patient had difficulty swallowing (RP procedure). There was no velopharyngeal incompetence, taste disturbance, nor voice change. Highest symptom complaints were mUPPP, SP, and RP, whereas the lowest symptom complaint was ESP. CONCLUSIONS Newer palatal techniques have shown to have less long-term complications compared to the older ablative techniques. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2281-2284, 2020.
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Affiliation(s)
| | - Claudio Vicini
- G.B. Morgagni-L. Pierantoni Hospital, University of Ferrara and Bologna, Forli, Italy
| | - Filippo Montevecchi
- G.B. Morgagni-L. Pierantoni Hospital, University of Ferrara and Bologna, Forli, Italy
| | - Ottavio Piccin
- Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Hyung C Yang
- Chonnam National University Hospital, Gwangju, South Korea
| | | | | | | | | | - Kathleen A Pang
- School of Medicine, National University Singapore, Singapore
| | - Edward B Pang
- School of Medicine, University of Glasgow, Glasgow, United Kingdom
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14
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Meccariello G, Montevecchi F, D'Agostino G, Iannella G, Calpona S, Parisi E, Costantini M, Cammaroto G, Gobbi R, Firinu E, Sgarzani R, Nestola D, Bellini C, De Vito A, Amadori E, Vicini C. Trans-oral robotic surgery for the management of oropharyngeal carcinomas: a 9-year institutional experience. ACTA ACUST UNITED AC 2019; 39:75-83. [PMID: 31097824 PMCID: PMC6522856 DOI: 10.14639/0392-100x-2199] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/15/2018] [Indexed: 12/11/2022]
Abstract
Trans-oral robotic surgery (TORS) has changed surgical management
of patients with oropharyngeal squamous cell carcinomas (OPSCC). In
this study we present surgical and oncologic outcomes of patients with
oropharyngeal squamous cell carcinomas, treated using TORS, with and
without an adjuvant therapy. Sixty patients with oropharyngeal
squamous cell carcinomas treated with TORS between January 2008 and
December 2017 have been retrospectively evaluated considering
clinicopathologic features, disease characteristics, adjuvant
treatments and oncological outcomes. TORS was performed for OPSCC to
the base of tongue in 41.7%, tonsils in 46.7%, soft palate and
posterior pharyngeal wall in 3.3% and 5%, respectively. Neck
dissection was performed in 43.3% of patients. Management strategies
included surgery alone in 30%, TORS and adjuvant radiotherapy in
33.3%, and TORS plus adjuvant chemotherapy in 36.7%. The 5-year
overall survival of the total group was 77.6%, the 5-year disease-free
survival rate was 85.2%, and the 5-year local recurrence-free survival
rate was 90.6%. Finally, in selected patients TORS appears to yield
similar oncologic outcomes and functional outcomes to traditional
techniques and non-operative treatment with a possible benefit on
long-term quality of life. The future offers exciting opportunities to
combine TORS and radiotherapy in unique ways. However, further
research is urgently needed to clarify the indications for adjuvant
therapy following TORS resections.
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Affiliation(s)
- G Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - F Montevecchi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - G D'Agostino
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - G Iannella
- Department of Organs of Sense, Ear, Nose, and Throat Section, University of Rome "La Sapienza," Italy
| | - S Calpona
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola (FC), Italy
| | - E Parisi
- Radiotherapy Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola (FC), Italy
| | - M Costantini
- Department of Surgical Pathology, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - G Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy.,Department of Otolaryngology, University of Messina, Italy
| | - R Gobbi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - E Firinu
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - R Sgarzani
- Department of Emergency, Burn Center, Bufalini Hospital, Azienda USL della Romagna, Cesena, Italy
| | - D Nestola
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - C Bellini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - A De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - E Amadori
- Radiology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola (FC), Italy
| | - C Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
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15
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Meccariello G, Montevecchi F, Sgarzani R, Vicini C. Defect-oriented reconstruction after transoral robotic surgery for oropharyngeal cancer: a case series and review of the literature. ACTA ACUST UNITED AC 2019; 38:569-574. [PMID: 30623902 PMCID: PMC6325658 DOI: 10.14639/0392-100x-1473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 06/06/2017] [Indexed: 11/23/2022]
Abstract
Transoral robotic surgery (TORS) is a fascinating new technique that has been shown to be a safe and feasible treatment for selected oropharyngeal cancers. Furthermore, TORS might offer some advantages in selected locoregionally advanced cancers. Thus, the patient selection is the keypoint for the useful application of TORS. However, the reconstruction of large oropharyngeal defects is challenging due to the restoration of velopharyngeal competency and swallowing. Moreover, the absence of mandibular splitting increases the difficulties faced by reconstructive surgeons. The paradigm for oropharyngeal reconstruction has undergone changes paralleling reflecting the overall change in the trend of the treatment alternatives over the last few decades. Flap choice and harvesting should be tailored to obtain significant advantages both in functional terms and for easy insetting. In this review, we analyse the strengths and weaknesses of the various flaps used in TORS framework with particular regards on our preliminary experience.
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Affiliation(s)
- G Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - F Montevecchi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - R Sgarzani
- Department of Emergency, Burn Center, Bufalini Hospital, Azienda USL della Romagna, Cesena, Italy
| | - C Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
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16
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Dachuri S, Sachidananda R, Montevecchi F, Rashwan M, Vicini C, Gandla S, Pugazhendi SK, Vasista SR. Barbed Reposition Pharyngoplasty in Indian Population: A New Palatal Surgery for OSAS. Indian J Otolaryngol Head Neck Surg 2019; 71:249-253. [PMID: 31275839 DOI: 10.1007/s12070-018-1320-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 03/24/2018] [Indexed: 10/17/2022] Open
Abstract
Obstructive sleep apnoea (OSA) is a common problem affecting almost 4% of the population. Although continuous positive airway pressure (CPAP) is considered the standard of care, the patient compliance for long term use is poor. Clinicians have explored surgical options for cure with varying success. Uvulopalatopharyngoplasty was considered as a standard of surgical care but long-term results were not satisfactory. Surgical researchers have explored newer techniques to improve outcomes in the past decade with less morbidity and better quality of life outcomes. One of such development is Barbed Reposition Pharyngoplasty (BRP). We would like to discuss the technique of BRP for OSA patients step by step.
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Affiliation(s)
- Sandeep Dachuri
- Integrated ENT, Head and Neck Services, People Tree Hospitals, Goreguntapalya, Bangalore, India
| | - Ravi Sachidananda
- Integrated ENT, Head and Neck Services, People Tree Hospitals, Goreguntapalya, Bangalore, India
| | - Filippo Montevecchi
- 2ENT and Oral Surgery Unit, Head and Neck Department, G.B Morgagni- L. Pierantoni Hospital, Forlì, Italy
| | - Mohamed Rashwan
- 2ENT and Oral Surgery Unit, Head and Neck Department, G.B Morgagni- L. Pierantoni Hospital, Forlì, Italy
| | - Claudio Vicini
- 2ENT and Oral Surgery Unit, Head and Neck Department, G.B Morgagni- L. Pierantoni Hospital, Forlì, Italy
| | - Sowjanya Gandla
- 3Head and Neck Oncology Department, Kidwai Memorial Institute of Oncology, Bangalore, India
| | | | - Srividya Rao Vasista
- Integrated ENT, Head and Neck Services, People Tree Hospitals, Goreguntapalya, Bangalore, India
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Cammaroto G, Costa F, Ruiz MVG, Andò G, Vicini C, Montevecchi F, Galletti C, Galletti F, Valgimigli M. Obstructive sleep apnoea syndrome and endothelial function: potential impact of different treatment strategies-meta-analysis of prospective studies. Eur Arch Otorhinolaryngol 2019; 276:2331-2338. [PMID: 31197532 DOI: 10.1007/s00405-019-05486-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/07/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Previous studies have shown an association between obstructive sleep apnoea syndrome (OSAS) and cardiovascular events. Whether this association is mediated by an impairment of endothelial function, which is itself a driver of elevated cardiovascular risk, has yet to be clarified, as it is the eventual protective role of several OSAS treatments. The aim of our meta-analysis is to evaluate the effect of various OSAS treatments on endothelial function calculated by means of flow-mediated dilatation (FMD). METHODS We conducted a meta-analysis of prospective studies including patients affected by mild to severe OSAS treated with continuous positive airway pressure (CPAP), surgery, oral appliance and medical treatments. FMD was measured before and after treatment RESULTS: After pooling results from different treatment strategies, OSAS treatment showed a positive impact on endothelial function (Mean Difference [MD] = 2.58; 95% CI 1.95-3.20; p < 0.00001). CONCLUSIONS Our study supports the hypothesis that several modalities of treatment for OSAS positively impact endothelial function. Whether this effect also associates with an improvement of clinical outcomes remains to be ascertained.
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Affiliation(s)
- Giovanni Cammaroto
- Department of Otolaryngology, University of Messina, Messina, Italy.
- Department of Otolaryngology, Hospital Morgagni Pierantoni, Forlì, Italy.
| | - Francesco Costa
- Institut Clinic Cardiovascular, Hospital Clinic, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), IDIBAPS, University of Barcelona, Barcelona, Spain
- Department of Clinical and Experimental Medicine, Policlinic "G. Martino", University of Messina, Messina, Italy
| | - Maria Victoria Garcia Ruiz
- Área del Corazón, Hospital Universitario Virgen de La Victoria, Campus Teatinos s/n, 29010, Málaga, Spain
| | - Giuseppe Andò
- Department of Clinical and Experimental Medicine, Policlinic "G. Martino", University of Messina, Messina, Italy
| | - Claudio Vicini
- Department of Otolaryngology, Hospital Morgagni Pierantoni, Forlì, Italy
| | | | - Claudio Galletti
- Department of Anaesthesiology, University of Messina, Messina, Italy
| | | | - Marco Valgimigli
- Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
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18
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Meccariello G, Cammaroto G, Ofo E, Calpona S, Parisi E, D'Agostino G, Gobbi R, Firinu E, Bellini C, De Vito A, Montevecchi F, Costantini M, Amadori E, Nuzzo S, Pelucchi S, Vicini C. The emerging role of trans-oral robotic surgery for the detection of the primary tumour site in patients with head-neck unknown primary cancers: A meta-analysis. Auris Nasus Larynx 2019; 46:663-671. [PMID: 31064689 DOI: 10.1016/j.anl.2019.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/16/2019] [Accepted: 04/23/2019] [Indexed: 12/29/2022]
Abstract
The identification of the site in head neck unknown primary (HNUP) tumour is of utmost importance to help select best treatment while decreasing treatment-related morbidity and mortality. The primary purpose of this study is to demonstrate that TORS may be a valuable tool in detecting primary tumour. Studies were systematically searched in the PubMed, EMBASE, the Cochrane Library and CENTRAL electronic databases. A total of 12 selected studies (349 patients) were analyzed. The primary tumour detection and positive surgical margins rates were 70.8% and 19.4%, respectively. The rate of HPV-related tumour was 71.3%. The primary tumour was mainly in base of tongue (64%). In conclusion, TORS seems to be an effective surgical approach both in terms of detection of primary tumour site and in terms of therapeutic perspective for HNUP. In particular, a subset of HPV-related tumours might benefits all advantages from this surgical modality.
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Affiliation(s)
- Giuseppe Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy.
| | - Giovanni Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy; Department of Otolaryngology and Head-Neck Surgery, University of Messina, Italy
| | - Enyinnaya Ofo
- St George's University Hospital, Kingston Hospital NHS Foundation Trusts, London, UK
| | - Sebastiano Calpona
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori(IRST), IRCCS, Meldola, Italy
| | - Elisabetta Parisi
- Radiotherapy Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori(IRST), IRCCS, Meldola, Italy
| | - Giovanni D'Agostino
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Riccardo Gobbi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Elisabetta Firinu
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Chiara Bellini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Andrea De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Filippo Montevecchi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Matteo Costantini
- Department of Surgical Pathology, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Elena Amadori
- Radiology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori(IRST), IRCCS, Meldola, Italy
| | - Simona Nuzzo
- Department of Biostatistics, Azienda USL della Romagna, Forlì, Italy
| | | | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
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19
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Magliulo G, Iannella G, Ciofalo A, Polimeni A, De Vincentiis M, Pasquariello B, Montevecchi F, Vicini C. Nasal pathologies in patients with obstructive sleep apnoea. ACTA ACUST UNITED AC 2019; 39:250-256. [PMID: 30933181 PMCID: PMC6734203 DOI: 10.14639/0392-100x-2173] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/24/2018] [Indexed: 11/23/2022]
Abstract
Nasal obstruction is a frequent condition in patients with obstructive sleep apnoea (OSA). Nasal obstruction leads to mouth breathing, which is thought to destabilise the upper airway and aggravate the condition. Three conditions could be considered as the cause of the nasal breathing obstruction: anatomical conditions of the nose (septum deviation, hypertrophy of the inferior turbinates), chronic rhinosinusitis (CRS) and chronic nasal inflammation caused by allergic rhinitis or non-allergic cellular rhinitis. In this prospective study, we present an evaluation of all these possible rhino-sinusal aspects in OSA patients to correlate different nasal pathologies with nasal obstruction. Fifty patients with a diagnosis of OSA were enrolled in the study. In 70% of OSA patients, nasal obstruction was confirmed by clinical evaluation and rhinomanometry testing. Normal rhino-sinus aspects were present in only 20% of OSA patients, whereas one or more pathological rhino-sinus conditions were present in the remaining 80%. The percentage of OSA patients with a diagnosis of allergic rhinitis and non-allergic rhinitis was 18% and 26% respectively. Non-allergic rhinitis with neutrophils (NARNE) was the most frequent type of cellular rhinitis diagnosed in OSA patients (20% of cases). The results of the present study support and extend the observation that rhinitis is present in OSA patients. Mucosal inflammation caused by these conditions could be the cause of upper airway patency impairment inducing nasal mucosa swelling.
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Affiliation(s)
- G Magliulo
- Department of "Organi di Senso", University "Sapienza", Rome, Italy
| | - G Iannella
- Department of "Organi di Senso", University "Sapienza", Rome, Italy
| | - A Ciofalo
- Department of "Organi di Senso", University "Sapienza", Rome, Italy
| | - A Polimeni
- Department of Oral and Maxillo Facial Sciences, University "Sapienza", Rome, Italy
| | - M De Vincentiis
- Department of "Organi di Senso", University "Sapienza", Rome, Italy
| | - B Pasquariello
- Department of "Organi di Senso", University "Sapienza", Rome, Italy
| | - F Montevecchi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - C Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
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20
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Meccariello G, Georgalas C, Montevecchi F, Cammaroto G, Gobbi R, Firinu E, De Vito A, Vicini C. Management of idiopathic epistaxis in adults: what's new? ACTA ACUST UNITED AC 2019; 39:211-219. [PMID: 30933179 PMCID: PMC6734206 DOI: 10.14639/0392-100x-2155] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 05/27/2018] [Indexed: 11/25/2022]
Abstract
Epistaxis is one of the most common complaints presenting to emergency departments. The aim of this study is to systematically review and critically evaluate the evidence relating to treatment of idiopathic epistaxis for guiding best practice. A comprehensive review of the English language literature was performed using PubMed, Embase, Cochrane Library and Central electronic databases. The inclusion criteria were: retrospective or prospective or randomised controlled clinical trials which included outcomes in the management of idiopathic epistaxis. Twenty-three articles met inclusion criteria and were reviewed. Nasal packing still represents the first-line approach to epistaxis, although, at present, it appears that there is clear evidence in the literature to suggest that it is less effective and associated with more admissions and longer hospital stays than endoscopic electrocoagulation-based management of epistaxis. In conclusion, cauterisation should be the first-line approach for its high cost-effectiveness rate and low risk of complications. Further research is urgently needed to assess the efficacy of new biomaterials.
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Affiliation(s)
- G Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - C Georgalas
- Department of Otolaryngology, Hygeia Hospital, Athens, Greece & Leiden University Hospital, Leiden, The Netherlands
| | - F Montevecchi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - G Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy.,Department of Otolaryngology, University of Messina, Italy
| | - R Gobbi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - E Firinu
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - A De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - C Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
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21
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Meccariello G, Montevecchi F, D'Agostino G, Zeccardo E, Al-Raswashdeh MFH, De Vito A, Vicini C. Surgical site infections after parotidectomy: management and benefits of an antibiotic prophylaxis protocol. ACTA ACUST UNITED AC 2018; 39:139-144. [PMID: 30632521 PMCID: PMC6536030 DOI: 10.14639/0392-100x-1768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 11/03/2017] [Indexed: 12/15/2022]
Abstract
The use of perioperative prophylactic antibiotics in uncontaminated head and neck surgery is still controversial. The aim of this study was to assess the efficacy of an institutional antibiotic prophylactic protocol in preventing surgical site infection after parotidectomy. The medical charts of 448 patients who underwent parotidectomy were reviewed. Patients were divided in two groups according the use of perioperative administration of intravenous cefazolin or post-operative week course of antibiotics. Surgical site infection was registered in 29 (6.5%) cases, 16 (5.7%) within the group before the application of the perioperative protocol and 13 (7.9%) within the antibiotic prophylaxis protocol group. The univariate and multivariate logistic regression analyses showed that predictors for surgical site infection were the amount of drain output ≥ 50 ml in the first post-operative 24 hours (OR: 4.86; 1.59-14.82 95% CI; p < 0.01) and history of a previous parotid acute infection (OR: 13.83; 5.31-36 95% CI; p < 0.01). The majority of post-surgical infections (82%) were treated with intravenous antibiotic therapy. The remnants were treated surgically. Perioperative antibiotic treatment is recommended for patients undergoing parotid gland surgery and intravenous antibiotics during the post-operative course are highly suggested in case of history of previous acute parotid infection and drain output ≥ 50 ml in first 24 hours.
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Affiliation(s)
- G Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì and degli Infermi Hospital, Faenza, Azienda USL della Romagna, Italy
| | - F Montevecchi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì and degli Infermi Hospital, Faenza, Azienda USL della Romagna, Italy
| | - G D'Agostino
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì and degli Infermi Hospital, Faenza, Azienda USL della Romagna, Italy
| | - E Zeccardo
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì and degli Infermi Hospital, Faenza, Azienda USL della Romagna, Italy
| | - M F H Al-Raswashdeh
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì and degli Infermi Hospital, Faenza, Azienda USL della Romagna, Italy
| | - A De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì and degli Infermi Hospital, Faenza, Azienda USL della Romagna, Italy
| | - C Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì and degli Infermi Hospital, Faenza, Azienda USL della Romagna, Italy
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22
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Iannella G, Magliulo G, Montevecchi F, De Vito A, Polimeni A, De Vincentiis M, Meccariello G, D'Agostino G, Gobbi R, Cammaroto G, Stomeo F, Pang KP, Rotenberg B, Vicini C. Lingual tonsil lymphatic tissue regrowth in patients undergoing transoral robotic surgery. Laryngoscope 2018; 129:2652-2657. [PMID: 30582182 DOI: 10.1002/lary.27775] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate a possible regrowth of lingual tonsil lymphatic tissue in patients submitted to lingual tonsil resection with transoral robotic surgery (TORS). STUDY DESIGN Retrospective Study. METHODS Medical records of patients surgically treated by means of TORS to remove excessive lymphatic tissue of the lingual tonsil were retrospectively reviewed. Postoperative endoscopic data after long-term follow-up were analyzed to investigate possible lymphatic tissue regrowth. Preoperative and postoperative lingual tonsil lymphatic tissue were classified according to the standardized Friedman's grading scale ranging from 0 to 4. RESULTS Sixty-eight patients (41 male and 27 female; mean age = 51.3 years) were considered suitable for the study analysis. Clinical regrowth was observed in six (8.8%) patients: four (5.9%) and two (2.9%) patients with grade 2 and 3 lymphatic hypertrophy, respectively. No correlation between the grade of regrowth, the time interval from surgery, and the volume of lymphatic tissue removed was found. CONCLUSIONS The lymphatic tissue regrowth after TORS resection appears to be very low. LEVEL OF EVIDENCE 4 Laryngoscope, 129:2652-2657, 2019.
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Affiliation(s)
| | - Giuseppe Magliulo
- Department of Sensory Organs, University "Sapienza", Rome, Italy.,Otolaryngology-Head and Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Filippo Montevecchi
- Otolaryngology-Head and Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Andrea De Vito
- Otolaryngology-Head and Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Sciences, University "Sapienza", Rome, Italy
| | | | | | - Giovanni D'Agostino
- Otolaryngology-Head and Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Riccardo Gobbi
- Otolaryngology-Head and Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Giovanni Cammaroto
- Otolaryngology-Head and Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Francesco Stomeo
- Department of ENT and Audiology, University of Ferrara, Ferrara, Italy
| | - Kenny P Pang
- Department of Otolaryngology, Asia Sleep Centre, Paragon, Singapore
| | - Brian Rotenberg
- Department of Otolaryngology, Western University, London, Ontario, Canada
| | - Claudio Vicini
- Department of ENT and Audiology, University of Ferrara, Ferrara, Italy
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23
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Montevecchi F, Caranti A, Cammaroto G, Meccariello G, Vicini C. Transoral Robotic Surgery (TORS) for Bilateral Eagle Syndrome. ORL J Otorhinolaryngol Relat Spec 2018; 81:36-40. [DOI: 10.1159/000493736] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/12/2018] [Indexed: 11/19/2022]
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24
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Magliulo G, Iannella G, Polimeni A, De Vincentiis M, Meccariello G, Gulotta G, Pasquariello B, Montevecchi F, De Vito A, D'Agostino G, Gobbi R, Cammaroto G, Vicini C. Laryngopharyngeal reflux in obstructive sleep apnoea patients: Literature review and meta-analysis. Am J Otolaryngol 2018; 39:776-780. [PMID: 30224217 DOI: 10.1016/j.amjoto.2018.09.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/05/2018] [Accepted: 09/12/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Laryngopharyngeal reflux (LPR) is a frequent condition in Obstructive Sleep Apnoea (OSA) patients and different studies have been published in the last years about this topic. A review of the published literature regarding LPR in OSA patients has been reported. A meta-analysis to evaluate the incidence of LPR in OSA patients and correlate LPR positivity with OSA patients' characteristics has been performed. METHODS A comprehensive review of the English language literature about LPR in OSA patients was performed using the most important electronic databases (PubMed, EMBASE, the Cochrane Library etc.). A total of 10 papers studying LPR in OSA were assessed and considered eligible for the meta-analysis. RESULTS The data analysis regarding 870 identified OSA patients showed that 394 patients were LPR +, while 476 were LPR-. The meta-analysis showed no statistical difference regarding the AHI value between LPR + patients and LPR- patients (p = 0,3). Mean BMI was more higher in LPR + patients than in the patients without LPR, showing a significant statistical difference (p = 0.001). CONCLUSION Current international literature demonstrates a high incidence of LPR (45.2%) in OSA patients. The severity of AHI in OSA patients would not seem to correlate with the presence of laryngopharyngeal reflux. The OSA patients with LPR showed a higher BMI compared with LPR- patients.
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Affiliation(s)
- Giuseppe Magliulo
- Department of 'Organi di Senso', University "Sapienza", Rome, Italy.
| | | | - Antonella Polimeni
- Department of Oral and Maxillo Facial Sciences, University "Sapienza", Rome, Italy
| | | | - Giuseppe Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | | | | | - Filippo Montevecchi
- 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
| | - Giovanni D'Agostino
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Riccardo Gobbi
- 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
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy; Department ENT & Audiology, University of Ferrara, Ferrara, Italy
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25
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De Vito A, Carrasco Llatas M, Ravesloot MJ, Kotecha B, De Vries N, Hamans E, Maurer J, Bosi M, Blumen M, Heiser C, Herzog M, Montevecchi F, Corso RM, Braghiroli A, Gobbi R, Vroegop A, Vonk PE, Hohenhorst W, Piccin O, Sorrenti G, Vanderveken OM, Vicini C. European position paper on drug-induced sleep endoscopy: 2017 Update. Clin Otolaryngol 2018; 43:1541-1552. [PMID: 30133943 DOI: 10.1111/coa.13213] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/14/2018] [Accepted: 08/20/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The first edition of the European position paper (EPP) on drug-induced sleep endoscopy (DISE) was published in 2014 with the aim to standardise the procedure, to provide an in-depth insight into the main aspects of this technique and to have a basis for future research. Since 2014, new studies have been published concerning new sedative agents or new insights into the pattern/levels of the obstruction depending on the depth of sedation. Therefore, an enlarged group of European experts in the field of sleep breathing disorders (SBD), including the most of the first DISE EPP main authors, has decided to publish an update of the European position paper on DISE, in order to include new evidence and to find a common language useful for reporting the findings of this endoscopic evaluation in adult population affected by SBD. METHODS The authors have evaluated all the available evidence reported in the literature and have compared experience among various departments in leading European centres in order to provide an update regarding the standardisation of the DISE procedure and an in-depth insight into the main aspects of this technique. RESULTS After the first European Position Consensus Meeting on DISE and its update, consensus was confirmed for indications, required preliminary examinations, where to perform DISE, technical equipment required, staffing, local anaesthesia, nasal decongestion, other medications, patient positioning, basics and special diagnostic manoeuvres, drugs and observation windows. So far, no consensus could be reached on a scoring and classification system. However, regarding this aim, the idea of an essential classification, such as VOTE with the possibility of its graded implementation of information and descriptions, seems to be the best way to reach a universal consensus on DISE classification at this stage. A common DISE language is mandatory, and attempts to come to a generally accepted system should be pursued.
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Affiliation(s)
- Andrea De Vito
- Head and Neck Department, ENT & Oral Surgery Unit, Morgagni-Pierantoni Hospital, Forlì, Italy.,ENT Unit, Santa Maria delle Croci Hospital, Ravenna AUSL of Romagna, Romagna, Italy
| | | | - Madeline J Ravesloot
- Department of Otorhinolaryngology and Head and Neck Surgery, OLVG, Amsterdam, The Netherlands.,Medisch Centrum Jan van Goyen, Amsterdam, The Netherlands
| | - Bhik Kotecha
- Royal National Throat Nose & Ear Hospital, UCLH, London, UK
| | - Nico De Vries
- Department of Otolaryngology, OLVG Hospital and ACTA, Amsterdam, Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery, Multidisciplinary Sleep Disorders Center, University of Antwerp, Antwerp, Belgium.,Department of Oral Kinesiology, Academic Centre for Dentistry, MOVE Inst., Amsterdam, The Netherlands
| | - Evert Hamans
- Department of Otorhinolaryngology, Head and Neck Surgery, Jan Palfijn Hospital, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerpen, Belgium
| | - Joachim Maurer
- Sleep Disorders Centre, Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Mannheim, Mannheim, Germany
| | - Marcello Bosi
- Pulmonary Operative Unit, Department of Thoracic Diseases, Morgagni-Pierantoni Hospital, AUSL of Romagna, Forlì, Italy
| | - Marc Blumen
- Service ORL, Hopital Foch, Suresnes France and Centre Medical Veille Sommeil, Paris, France
| | - Clemens Heiser
- Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universitat Munchen, Munich, Germany
| | - Michael Herzog
- Department of Otorhinolaryngology, Head and Neck Surgery, Carl Thiem Klinikum, Cottbus, Germany
| | - Filippo Montevecchi
- Head and Neck Department, ENT & Oral Surgery Unit, Morgagni-Pierantoni Hospital, AUSL of Romagna, Forlì, Italy
| | | | - Alberto Braghiroli
- Sleep Lab. Pulmonary Rehabilitation Dept. Istituti Clinici Scientifici Maugeri, SPA SB, IRCCS, Veruno, Italy
| | - Riccardo Gobbi
- Head and Neck Department, ENT & Oral Surgery Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Anneclaire Vroegop
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Patty Elisabeth Vonk
- Department of Otorhinolaryngology and Head and Neck Surgery, OLVG, Amsterdam, The Netherlands
| | | | - Ottavio Piccin
- Department of Otolaryngology, Head and Neck Surgery, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giovanni Sorrenti
- Department of Otolaryngology, Head and Neck Surgery, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Olivier M Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp- Department ENT, Head and Neck Surgery, Antwerp University Hospital - Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Antwerp, Belgium
| | - Claudio Vicini
- Head and Neck Department, AUSL of Romagna, ENT & Oral Surgery Unit, Morgagni-Pierantoni Hospital, Forlì, Italy.,ENT Unit, Infermi Hospital, AUSL of Romagna, Faenza, Italy.,ENT Unit, Santa Maria delle Croci Hospital, Ravenna, Italy.,AUSL of Romagna, Romagna, Italy.,ENT Clinic, University of Ferrara, Ferrara, Italy
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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 Otorhinolaryngol Ital 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Cammaroto G, Meccariello G, Costantini M, Stomeo F, Hoff P, Montevecchi F, Vicini C. Trans-Oral Robotic Tongue Reduction for OSA: Does Lingual Anatomy Influence the Surgical Outcome? J Clin Sleep Med 2018; 14:1347-1351. [PMID: 30092891 DOI: 10.5664/jcsm.7270] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 04/12/2018] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVES To evaluate both the influence of the volume of the excised base of tongue (BOT) on the surgical outcome after robotic tongue reduction in patients affected by obstructive sleep apnea (OSA) and the role of the lymphatic or muscular predominance within the removed tissue. METHODS Fifty-one patients with OSA were included in this study. All patients were treated with a robotic tongue base reduction. Data registered for the analysis were: age, sex, preoperative body mass index, preoperative and postoperative apnea-hypopnea index (AHI), delta AHI (preoperative AHI - postoperative AHI), total volume of the excised BOT, total thickness of excised BOT, isolated lymphatic thickness and soft tissue thickness (including muscular component) of the excised BOT, and lymphatic/soft tissue ratio (lymphatic thickness / soft tissue thickness). RESULTS A statistically significant reduction of AHI values was seen postoperatively, and a success rate of 74.5% was recorded. However, no significant correlations between delta AHI and tongue volume in cubic centimeters, lymphatic/soft tissue ratio, and total thickness were found. CONCLUSIONS These findings reinforce the general opinion that OSA is not only influenced by anatomic factors but other phenomena may play a fundamental role in its genesis. A deeper understanding of OSA pathogenesis is needed in order to tailor an individual treatment strategy that could lead to a more effective therapy.
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Affiliation(s)
- Giovanni Cammaroto
- Department of Otolaryngology, University of Messina, Messina, Italy.,Department of Special Surgery, ENT and Oral Surgery Unit, Ospedale Morgagni Pierantoni, Forlì, Italy
| | - Giuseppe Meccariello
- Department of Special Surgery, ENT and Oral Surgery Unit, Ospedale Morgagni Pierantoni, Forlì, Italy
| | | | - Francesco Stomeo
- Department of Otolaryngology, University of Ferrara, Ferrara, Italy
| | - Paul Hoff
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Filippo Montevecchi
- Department of Special Surgery, ENT and Oral Surgery Unit, Ospedale Morgagni Pierantoni, Forlì, Italy
| | - Claudio Vicini
- Department of Special Surgery, ENT and Oral Surgery Unit, Ospedale Morgagni Pierantoni, Forlì, Italy.,Department of Otolaryngology, University of Ferrara, Ferrara, Italy
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Vicini C, Meccariello G, Cammaroto G, Rashwan M, Montevecchi F. Barbed reposition pharyngoplasty in multilevel robotic surgery for obstructive sleep apnoea. Acta Otorhinolaryngol Ital 2018; 37:214-217. [PMID: 28516964 PMCID: PMC5463511 DOI: 10.14639/0392-100x-1203] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 09/21/2016] [Indexed: 11/23/2022]
Abstract
The surgical treatment of obstructive sleep apnoea in patients who are non-compliant with continuous positive airway pressure therapy still represents a valid alternative. In recent years, the multilevel approach is becoming more diffuse in routine surgical practice, especially since the introduction of transoral robotic surgery. Barbed reposition pharyngoplasty in multilevel robotic surgery for OSA may represent a valid option to surgically approach the soft palate. Herein, we describe the technique and preliminary results of our experience.
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Affiliation(s)
- C Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - G Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - G Cammaroto
- Department of Otolaryngology, University of Messina, Italy
| | - M Rashwan
- Department of Otolaryngology, Suez Canal University Teaching Hospitals, Ismailia, Egypt
| | - F Montevecchi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
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Montevecchi F, Caranti A, Cammaroto G, Buci L, Brevi B, Vicini C. Congenital Pyriform Sinus Fistula: Management of an Extra-Delayed and Atypical Case. ORL J Otorhinolaryngol Relat Spec 2018; 80:65-68. [PMID: 29768279 DOI: 10.1159/000488322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/12/2018] [Indexed: 11/19/2022]
Abstract
Clinical presentations of pyriform sinus fistulas vary, and this sometimes leads to a delay in diagnosis and treatment. Recently, we experienced a case of recurrent cervical abscesses occurring after thyroidectomy in an adult affected by a bifidus pyriform sinus fistula. The diagnostic dilemma was related to the timing of events, with a single episode of acute suppurative thyroiditis having occurred 16 years before the onset of the more recent clinical scenario. An endoscopic approach allowed effective management of this clinical case.
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Affiliation(s)
- Filippo Montevecchi
- Head and Neck Department, ENT and Oral Surgery Unit, G.B. Morgagni, L. Pierantoni Hospital, Forlì, Italy
| | - Alberto Caranti
- Head and Neck Department, ENT and Oral Surgery Unit, G.B. Morgagni, L. Pierantoni Hospital, Forlì, Italy
| | - Giovanni Cammaroto
- Head and Neck Department, ENT and Oral Surgery Unit, G.B. Morgagni, L. Pierantoni Hospital, Forlì, Italy.,Department of Ear Nose and Throat and Audiology, University Hospital of Ferrara, Ferrara, Italy.,Department of Otorhinolaryngology, University of Messina, Messina, Italy
| | - Lisa Buci
- Department of Endocrinology, Careggi Hospital, Firenze, Italy
| | - Bruno Brevi
- Department of Maxillo-Facial Surgery, University of Pisa, Pisa, Italy
| | - Claudio Vicini
- Head and Neck Department, ENT and Oral Surgery Unit, G.B. Morgagni, L. Pierantoni Hospital, Forlì, Italy.,Department of Ear Nose and Throat and Audiology, University Hospital of Ferrara, Ferrara, Italy
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Montevecchi F, Cammaroto G, Meccariello G, Hoff PT, Corso RM, Galletti C, Al-Rawashdeh MFH, Vicini C. Transoral robotic surgery (TORS): a new tool for high risk tracheostomy decannulation. Acta Otorhinolaryngol Ital 2018; 37:46-50. [PMID: 28374870 PMCID: PMC5384309 DOI: 10.14639/0392-100x-1134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 04/06/2016] [Indexed: 11/23/2022]
Abstract
Tracheostomy decannulation has always been considered a procedure with an attendant risk, especially in patients with a reduced upper airway diameter as is commonly observed in the obstructive sleep apnoea (OSA) population. We report on 4 cases where transoral robotic surgery (TORS) helped in the management of long-term cannulated patients. The aims of our paper are: 1. To demonstrate how the otolaryngology team can help identify patients at high risk for decannulation failure; and 2. To demonstrate how TORS may aid in the decannulation process of patients at high risk for failure due to severe tongue base hypertrophy. From our experience, TORS appears to offer an effective option to aid in the decannulation of patients with a severe hypertrophy of the base of tongue and floppy epiglottis.
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Affiliation(s)
- F Montevecchi
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni, L. Pierantoni Hospital, Forlì, Infermi Hospital, Faenza, ASL of Romagna, Italy
| | - G Cammaroto
- Department of Otorhinolaryngology, University of Messina, Italy
| | - G Meccariello
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni, L. Pierantoni Hospital, Forlì, Infermi Hospital, Faenza, ASL of Romagna, Italy
| | - P T Hoff
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - R M Corso
- Emergency Department, Anaesthesia and Intensive Care Section, "GB Morgagni-L. Pierantoni" Hospital, Forlì, Italy
| | - C Galletti
- Department of Anaesthesiology, University of Messina, Italy
| | - M F H Al-Rawashdeh
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni, L. Pierantoni Hospital, Forlì, Infermi Hospital, Faenza, ASL of Romagna, Italy
| | - C Vicini
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni, L. Pierantoni Hospital, Forlì, Infermi Hospital, Faenza, ASL of Romagna, Italy
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Rashwan MS, Montevecchi F, Cammaroto G, Badr el Deen M, Iskander N, El Hennawi D, El Tabbakh M, Meccariello G, Gobbi R, Stomeo F, Vicini C. Evolution of soft palate surgery techniques for obstructive sleep apnea patients: A comparative study for single-level palatal surgeries. Clin Otolaryngol 2017; 43:584-590. [DOI: 10.1111/coa.13027] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Mohamed S. Rashwan
- Faculty of Medicine; Department of Otorhinolaryngology; Suez Canal University Teaching Hospitals; Ismailia Egypt
| | - Filippo Montevecchi
- Head and Neck Department - ENT & Oral Surgery Unit; G.B. Morgagni - L. Pierantoni Hospital; Forlì - ASL of Romagna Italy
| | - Giovanni Cammaroto
- Head and Neck Department - ENT & Oral Surgery Unit; G.B. Morgagni - L. Pierantoni Hospital; Forlì - ASL of Romagna Italy
- Department of Otorhinolaryngology; University of Messina; Messina Italy
| | - Mohamed Badr el Deen
- Faculty of Medicine; Department of Otorhinolaryngology; Suez Canal University Teaching Hospitals; Ismailia Egypt
| | - Nagi Iskander
- Faculty of Medicine; Department of Otorhinolaryngology; Suez Canal University Teaching Hospitals; Ismailia Egypt
| | - Diaa El Hennawi
- Faculty of Medicine; Department of Otorhinolaryngology; Suez Canal University Teaching Hospitals; Ismailia Egypt
| | - Mohammed El Tabbakh
- Faculty of Medicine; Department of Otorhinolaryngology; Suez Canal University Teaching Hospitals; Ismailia Egypt
| | - Giuseppe Meccariello
- Head and Neck Department - ENT & Oral Surgery Unit; G.B. Morgagni - L. Pierantoni Hospital; Forlì - ASL of Romagna Italy
| | - Riccardo Gobbi
- Head and Neck Department - ENT & Oral Surgery Unit; G.B. Morgagni - L. Pierantoni Hospital; Forlì - ASL of Romagna Italy
| | - Francesco Stomeo
- ENT & Audiology Department; University of Ferrara; Ferrara Italy
| | - Claudio Vicini
- Head and Neck Department - ENT & Oral Surgery Unit; G.B. Morgagni - L. Pierantoni Hospital; Forlì - ASL of Romagna Italy
- ENT & Audiology Department; University of Ferrara; Ferrara Italy
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Montevecchi F, Meccariello G, Firinu E, Rashwan MS, Arigliani M, De Benedetto M, Palumbo A, Bahgat Y, Bahgat A, Lugo Saldana R, Marzetti A, Pignataro L, Mantovani M, Rinaldi V, Carrasco M, Freire F, Delgado I, Salamanca F, Bianchi A, Onerci M, Agostini P, Romano L, Benazzo M, Baptista P, Salzano F, Dallan I, Nuzzo S, Vicini C. Prospective multicentre study on barbed reposition pharyngoplasty standing alone or as a part of multilevel surgery for sleep apnoea. Clin Otolaryngol 2017; 43:483-488. [PMID: 28981208 DOI: 10.1111/coa.13001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to demonstrate in a prospective multicentre study that Barbed Reposition Pharyngoplasty (BRP) procedure is safe and effective in management of obstructive sleep apnoea/hypopnea syndrome (OSAHS) patients. DESIGN Prospective study. SETTING Multicentre study. PARTICIPANTS Patients suffering from obstructive sleep apnoea. MAIN OUTCOMES MEASURES Values of postoperative apnoea-hypopnea index (AHI), oxygen desaturation index (ODI), epworth sleepiness scale (ESS). RESULTS 111 Barbed Reposition Pharyngoplasty procedures standing alone or as a part of multilevel surgery for OSAHS, performed between January and September 2016, were analysed in 15 different centres. The average hospitalisation period was 2.5 ± 0.5 days. The mean patient age was 46.3 ± 10.5 years. The average body mass index at the time of the procedure was 27.9 ± 3.2, and the majority of the patients were men (83%). The mean preoperative and postoperative apnoea/hypopnea index was 33.4 ± 19.5 and 13.5 ± 10.3, respectively (P < .001). The mean preoperative and postoperative ESS score was 10.2 ± 4.5 and 6.1 ± 3.6, respectively (P < .001). The mean preoperative and postoperative ODI were 29.6 ± 20.7 and 12.7 ± 10.8, respectively (P < .001). CONCLUSIONS Patients undergoing BRP standing alone or as part of a multilevel approach for the treatment of OSAHS have a reasonable expectation for success with minimal morbidity.
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Affiliation(s)
- F Montevecchi
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni - L. Pierantoni Hospital, Forlì - Infermi Hospital, Faenza - ASL of Romagna, Forli, University of Ferrrara, Italy
| | - G Meccariello
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni - L. Pierantoni Hospital, Forlì - Infermi Hospital, Faenza - ASL of Romagna, Forli, University of Ferrrara, Italy
| | - E Firinu
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni - L. Pierantoni Hospital, Forlì - Infermi Hospital, Faenza - ASL of Romagna, Forli, University of Ferrrara, Italy
| | - M S Rashwan
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni - L. Pierantoni Hospital, Forlì - Infermi Hospital, Faenza - ASL of Romagna, Forli, University of Ferrrara, Italy
| | - M Arigliani
- Department of Otolaryngology Head and Neck Surgery, Fazzi Hospital, Lecce, Italy
| | - M De Benedetto
- Department of Otolaryngology Head and Neck Surgery, Fazzi Hospital, Lecce, Italy
| | - A Palumbo
- Department of Otolaryngology Head and Neck Surgery, Fazzi Hospital, Lecce, Italy
| | - Y Bahgat
- Department of Otorhinolaryngology, Alexandria University, Alexandria, Egypt
| | - A Bahgat
- Department of Otorhinolaryngology, Alexandria University, Alexandria, Egypt
| | - R Lugo Saldana
- Department of Otorhinolaryngology, Grupo Medico San Pedro, Monterrey, Mexico
| | - A Marzetti
- Department of Otolaryngology, Fabrizio Spaziani Hospital, Frosinone, Italy
| | - L Pignataro
- Department of Otolaryngology, Department of Clinical Sciences and Community Health, Fondazione I.R.C.C.S. Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - M Mantovani
- Department of Otolaryngology, Department of Clinical Sciences and Community Health, Fondazione I.R.C.C.S. Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - V Rinaldi
- Department of Otolaryngology, Department of Clinical Sciences and Community Health, Fondazione I.R.C.C.S. Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - M Carrasco
- Department of Otorhinolaryngology, Doctor Peset University Hospital, Valencia, Spain
| | - F Freire
- Department of Otolaryngology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - I Delgado
- Department of Otolaryngology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - F Salamanca
- Department of Otolaryngology, S. Pio X Hospital, Milan, Italy
| | - A Bianchi
- Department of Otolaryngology, S. Pio X Hospital, Milan, Italy
| | - M Onerci
- Ear Nose Throat-Head and Neck Surgery Department, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - P Agostini
- Department of Otolaryngology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - L Romano
- Department of Otolaryngology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - M Benazzo
- Department of Otolaryngology Head Neck Surgery, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - P Baptista
- Department of Otolaringology, Campus Universitario, University of Navarra, Pamplona, Spain
| | - F Salzano
- Otorhinolaryngologic Unit, San Giovanni di Dio e Ruggi d' Aragona University Hospital, Salerno, Italy
| | - I Dallan
- First Otorhinolaryngologic Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - S Nuzzo
- Biostatistics Unit, G.B. Morgagni - L. Pierantoni Hospital, Forlì - ASL of Romagna, Forli, Italy
| | - C Vicini
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni - L. Pierantoni Hospital, Forlì - Infermi Hospital, Faenza - ASL of Romagna, Forli, University of Ferrrara, Italy
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Rashwan MS, Montevecchi F, Firinua E, Dachuri S, Obaidat H, Gobbi R, Cammaroto G, Nuzzo S, Vicini C. Let’s know from our patients: PPOPS score for palate surgery evaluation/a pilot study. Eur Arch Otorhinolaryngol 2017; 275:287-291. [DOI: 10.1007/s00405-017-4795-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/27/2017] [Indexed: 11/29/2022]
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Vicini C, Montevecchi F, Gobbi R, De Vito A, Meccariello G. Transoral robotic surgery for obstructive sleep apnea syndrome: Principles and technique. World J Otorhinolaryngol Head Neck Surg 2017; 3:97-100. [PMID: 29204586 PMCID: PMC5683592 DOI: 10.1016/j.wjorl.2017.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Indexed: 11/30/2022] Open
Abstract
Objective The present study is a review of transoral robotic surgery (TORS) for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods The review presents the experience of the robotic center that developed the technique with regards to patient selection, surgical method, and post-operative care. In addition, the review provides results of a systematic review and meta-analysis of the complications and clinical outcomes of TORS when applied in the management of OSAHS. Results The rate of success, defined as 50% reduction of pre-operative AHI and an overall AHI <20 events/h, is achieved in up to 76.6% of patients with a range between 53.8% and 83.3%. The safety of this approach is reasonable as the main complication (bleeding) affected 4.2% of patients (range 4.2%–5.3%). However, transient dysphagia (7.2%; range 5%–14%) does compromise the quality of life and must be discussed with patients preoperatively. Conclusions TORS for the treatment of OSAHS appears to be a promising and safe procedure for patients seeking an alternative to traditional therapy. Appropriate patient selection remains an important consideration for successful implementation of this novel surgical approach requiring further research.
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Affiliation(s)
- Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Filippo Montevecchi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Riccardo Gobbi
- 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
| | - Giuseppe Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
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35
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Canevari FR, Montevecchi F, Galla S, Sorrentino R, Vicini C, Sireci F. Trans-oral robotic surgery for a Ewing's sarcoma of tongue in a pediatric patient: a case report. Braz J Otorhinolaryngol 2017; 86 Suppl 1:26-29. [PMID: 28571929 PMCID: PMC9422648 DOI: 10.1016/j.bjorl.2017.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/05/2017] [Accepted: 04/10/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- Frank Rikki Canevari
- S.S. Antonio Biagio e Cesare Arrigo Hospital, Otorinolaryngology Section, Alessandria, Italy
| | - Filippo Montevecchi
- L. Pierantoni Hospital, G.B. Morgagni, ENT and Oral Surgery Unit, Forlì, Italy
| | - Stefania Galla
- S.S. Antonio Biagio e Cesare Arrigo Hospital, Otorinolaryngology Section, Alessandria, Italy
| | - Raffaele Sorrentino
- S.S. Antonio Biagio e Cesare Arrigo Hospital, Otorinolaryngology Section, Alessandria, Italy
| | - Claudio Vicini
- L. Pierantoni Hospital, G.B. Morgagni, ENT and Oral Surgery Unit, Forlì, Italy
| | - Federico Sireci
- P. Giaccone Hospital, Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), Otorhinolaryngology Section, Palermo, Italy.
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Meccariello G, Montevecchi F, Sgarzani R, De Vito A, D'Agostino G, Gobbi R, Bellini C, Vicini C. The reconstructive options for oropharyngeal defects in the transoral robotic surgery framework. Oral Oncol 2017; 66:108-111. [PMID: 28089208 DOI: 10.1016/j.oraloncology.2017.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/03/2017] [Accepted: 01/06/2017] [Indexed: 11/25/2022]
Abstract
Transoral robotic surgery (TORS) is a fascinating new technique that has been proved to be a safe and feasible for selected oropharyngeal cancers. Furthermore, TORS offers several advantages in the treatment of locoregionally advanced cancers. Nevertheless, the careful selection of patients is the keypoint for a successful application of this therapeutic modality. However, the reconstruction of large oropharyngeal defects is challenging due to the restoration of velopharyngeal competency and swallowing. Moreover, the absence of mandibular splitting increases the difficulties faced by reconstructive surgeons. The paradigm for oropharyngeal reconstruction has undergone changes reflecting the overall change in the trend of the treatment alternatives over the last few decades. The flap choice and harvesting should be tailored in order to obtain significant advantages both in terms of function and should be easy to inset. In this review, we analysed the strengths and weaknesses of the various flaps used in the TORS framework.
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Affiliation(s)
- Giuseppe Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Filippo Montevecchi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy.
| | - Rossella Sgarzani
- Department of Emergency, Burn Center, Bufalini Hospital, Azienda USL della Romagna, Cesena, Italy
| | - Andrea De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Giovanni D'Agostino
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Riccardo Gobbi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Chiara Bellini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
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Montevecchi F, Cammaroto G, Meccariello G, D'Agostino G, Hsu YS, Galletti B, Vicini C. Trans-oral robotic surgery (TORS) for the treatment of lingual tonsillitis. When conventional therapies fail. Int J Med Robot 2016; 13. [DOI: 10.1002/rcs.1763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/02/2016] [Accepted: 06/22/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Filippo Montevecchi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit; Morgagni Pierantoni Hospital; Forlì Italy
| | | | - Giuseppe Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit; Morgagni Pierantoni Hospital; Forlì Italy
| | - Giovanni D'Agostino
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit; Morgagni Pierantoni Hospital; Forlì Italy
| | - Ying-Shuo Hsu
- Department of Otolaryngology, Head and Neck surgery; Shin-Kong Wu-Ho-Su hospital; Taipei Taiwan
| | - Bruno Galletti
- Department of Otolaryngology; University of Messina; Messina Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit; Morgagni Pierantoni Hospital; Forlì Italy
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Meccariello G, Cammaroto G, Montevecchi F, Hoff PT, Spector ME, Negm H, Shams M, Bellini C, Zeccardo E, Vicini C. Transoral robotic surgery for the management of obstructive sleep apnea: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2016; 274:647-653. [PMID: 27221389 DOI: 10.1007/s00405-016-4113-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 05/20/2016] [Indexed: 11/30/2022]
Abstract
Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a serious social health problem with significant implications on quality of life. Surgery for OSAHS has been criticized due to a lack of evidence to support its efficacy as well as the heterogeneous reporting of published outcomes. Moreover, the transoral robotic surgery (TORS) in the management of OSAHS is still in a relative infancy. Nevertheless, a review and meta-analysis of the published articles may be helpful. Among 195 articles, eight studies were included in the analysis. The mean of enrolled patients was 102.5 ± 107.9 (range 6-289) comprising a total of 820 cases. The mean age was 49 ± 3.27 and 285 patients underwent a previous sleep apnea surgery. The uvulopalatopharyngoplasty (UPPP) was the most common palatal procedure. The mean rate of failure was 34.4 % (29.5-46.2 %). Complications occurred in 21.3 % of the patients included in the analysis, most of them were classified as minor. Transient dysphagia represented the most common complication (7.2 %) followed by bleeding (4.2 %). TORS for the treatment of OSAHS appears to be a promising and safe procedure for selected patients seeking an alternative to continuous positive airway pressure (CPAP), although further researches are urgently needed.
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Affiliation(s)
- Giuseppe Meccariello
- Otolaryngology and Stomatology Unit, Department of Head-Neck Surgeries, G.B. Morgagni-L.Pierantoni Hospital, Azienda USL della Romagna, via Carlo Forlanini, 34, Forlì, Italy.
| | - Giovanni Cammaroto
- Department of Otorhinolaryngology, University of Messina, Messina, Italy
| | - Filippo Montevecchi
- Otolaryngology and Stomatology Unit, Department of Head-Neck Surgeries, G.B. Morgagni-L.Pierantoni Hospital, Azienda USL della Romagna, via Carlo Forlanini, 34, Forlì, Italy
| | - Paut T Hoff
- Department of Otolaryngology-Head and Neck Surgery, St Joseph Mercy Health System, Ann Arbor, MI, USA
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Hesham Negm
- Department of Otolaryngology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Medhat Shams
- Department of Otolaryngology Head and Neck Surgery, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Chiara Bellini
- Otolaryngology and Stomatology Unit, Department of Head-Neck Surgeries, G.B. Morgagni-L.Pierantoni Hospital, Azienda USL della Romagna, via Carlo Forlanini, 34, Forlì, Italy
| | - Ermelinda Zeccardo
- Otolaryngology and Stomatology Unit, Department of Head-Neck Surgeries, G.B. Morgagni-L.Pierantoni Hospital, Azienda USL della Romagna, via Carlo Forlanini, 34, Forlì, Italy
| | - Claudio Vicini
- Otolaryngology and Stomatology Unit, Department of Head-Neck Surgeries, G.B. Morgagni-L.Pierantoni Hospital, Azienda USL della Romagna, via Carlo Forlanini, 34, Forlì, Italy
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Vicini C, D'Agostino G, Meccariello G, De Virgilio A, Montevecchi F. Robotic-assisted surgery for the management of velopharyngeal insufficiency and nasopharyngeal stenosis. Clin Otolaryngol 2016; 42:1432-1434. [PMID: 26923571 DOI: 10.1111/coa.12633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2016] [Indexed: 10/22/2022]
Affiliation(s)
- C Vicini
- Department of Special Surgery, ENT and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - G D'Agostino
- Department of Special Surgery, ENT and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - G Meccariello
- Department of Special Surgery, ENT and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - A De Virgilio
- Department of Organs of Sense, ENT section, 'Sapienza University of Rome, Rome, Italy
| | - F Montevecchi
- Department of Special Surgery, ENT and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
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Vicini C, Hendawy E, Campanini A, Eesa M, Bahgat A, AlGhamdi S, Meccariello G, DeVito A, Montevecchi F, Mantovani M. Barbed reposition pharyngoplasty (BRP) for OSAHS: a feasibility, safety, efficacy and teachability pilot study. "We are on the giant's shoulders". Eur Arch Otorhinolaryngol 2015; 272:3065-70. [PMID: 25864183 DOI: 10.1007/s00405-015-3628-3] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 04/08/2015] [Indexed: 10/23/2022]
Abstract
A new palatal procedure for snoring/obstructive sleep apnea (OSA) is described. The procedure was named as barbed reposition pharyngoplasty (BRP). The technique is described step by step. The new surgical technique was carried out in ten adult OSA patients with mean age of 53.4 ± 12.4 years (average 30-70) with confirmed retropalatal obstruction. In this pilot study; we assessed the feasibility by calculating the number of cases that failed to be operated and converted to other palatal technique during the same surgical setting, safety was assessed by evaluating both intra-operative and post-operative complications, teachability measured by the learning curve of our team members (the time of surgical procedure). In this study, the technique is proved to be feasible in all cases. There were no significant intra-operative or post-operative complications. Objective clinical improvement was confirmed by polysomnography 6 months post-operative with significant decrease in mean AHI from 43.65 ± 26.83 to 13.57 ± 15.41 (P = 0.007), daytime sleepiness assessed by Epworth Sleepiness Scale from 11.6 ± 4.86 to 4.3 ± 2 (P < 0.01), ODI from 44.7 ± 27.3 to 12.9 ± 16.3 (P = 0.004). Operative time decreased over the course of the study with an initial steep ascent in technical skill acquisition followed by more gradual improvement, and a steady decrease in operative time to as short as 20 min. Our preliminary results suggest that BRP technique is feasible, safe and effective in management of OSA patients. Moreover, it is easy to learn even for not experienced surgeons, less time consuming and with no significant complications.
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Affiliation(s)
- Claudio Vicini
- Department of Special Surgery, ENT and Oral Surgery Unit, G.B. Morgagni-L. Pierantoni Hospital, University of Pavia, Forlì, Italy
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Eesa M, Montevecchi F, Hendawy E, D’Agostino G, Meccariello G, Vicini C. Swallowing outcome after TORS for sleep apnea: short- and long-term evaluation. Eur Arch Otorhinolaryngol 2015; 272:1537-41. [DOI: 10.1007/s00405-014-3480-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 12/25/2014] [Indexed: 10/24/2022]
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De Vito A, Carrasco Llatas M, Vanni A, Bosi M, Braghiroli A, Campanini A, de Vries N, Hamans E, Hohenhorst W, Kotecha BT, Maurer J, Montevecchi F, Piccin O, Sorrenti G, Vanderveken OM, Vicini C. European position paper on drug-induced sedation endoscopy (DISE). Sleep Breath 2014; 18:453-65. [PMID: 24859484 DOI: 10.1007/s11325-014-0989-6] [Citation(s) in RCA: 188] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 04/04/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although drug-induced sedation endoscopy (DISE) represents the most widespread diagnostic tool for upper airway endoscopic evaluation of snoring and obstructive sleep apnea hypopnea syndrome (OSAHS), many controversies exist about how to perform the sedation, the indications for DISE, and how to report DISE findings. The present position paper reports on a consensus as proposed by a group of European experts in the field of DISE after discussion during a recent dedicated meeting. METHODS The authors have evaluated all the available evidence reported in the literature and have compared experience among various departments in leading European centers in order to provide a standardization of the DISE procedure and an in-depth insight in the main aspects of this technique. RESULTS A proposal of the DISE procedure standardization has been achieved with a general agreement concerning the terminology, indications, contraindications, required preliminary examinations, setting, technical equipment required, staffing, local anesthesia and nasal decongestion, patient positioning, basis and special diagnostic maneuvers, and the applied sedation drugs and observation windows. Otherwise, no consensus has been reached on a scoring and classification system. CONCLUSIONS Although consensus has been reached on several aspects of the DISE procedure, some topics remain open to future research, such as a better analysis of the importance of positional aspects during DISE and a further comparison of the differences in degree, level and pattern of upper airway collapse observed during DISE versus during natural sleep and awake endoscopy. Finally, a universally accepted scoring and classification system is lacking.
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Affiliation(s)
- Andrea De Vito
- Special Surgery Department, Ear-Nose-Throat Unit, Morgagni-Pierantoni Hospital, Via Forlanini 34, 47121, Forlì, Italy
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Vicini C, Leone CA, Montevecchi F, Dinelli E, Seccia V, Dallan I. Successful application of transoral robotic surgery in failures of traditional transoral laser microsurgery: critical considerations. ORL J Otorhinolaryngol Relat Spec 2014; 76:98-104. [PMID: 24801375 DOI: 10.1159/000359953] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 01/17/2014] [Indexed: 11/19/2022]
Abstract
AIMS To assess the role of transoral robotic surgery (TORS) in managing failures of conventional transoral laser microsurgery (TLM) in cases with difficult laryngeal exposure. METHODS Retrospective analysis of 3 patients with difficult laryngeal exposure treated with TORS. All 3 cases failed to be managed by conventional TLM after repeated attempts by experienced surgeons. In 2 cases, the initial disease was laryngeal cancer treated by a cricohyoidoepiglottopexy, with an obstructing residual epiglottis. The last case was a bilateral Reinke disease submitted to repeated TLM procedures, producing multiple supraglottic and glottic scars. In all cases, the difficult exposure was produced by a combination of concurrent elements including insufficient mouth opening, short and stiff neck, macroglossia and high-positioned larynx. RESULTS Two patients were exposed by means of a Davis Meyer mouth gag. The other patient was managed by a Feyh-Kastenbauer device. The key of the success was the possibility to work 'around the corner' (30° angle view) where straight alignment of the larynx was impossible. CONCLUSIONS Where possible, a TORS approach should be considered complementary to TLM in cases of very difficult or even impossible conventional transoral laryngoscopic approach.
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Affiliation(s)
- Claudio Vicini
- Oral Surgery Unit, Otolaryngology - Head and Neck Surgery Division, Department of Special Surgery, G.B. Morgagni L. Pierantoni Hospital, Forlì, Italy
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Vicini C, Montevecchi F, Campanini A, Dallan I, Hoff PT, Spector ME, Thaler E, Ahn J, Baptista P, Remacle M, Lawson G, Benazzo M, Canzi P. Clinical outcomes and complications associated with TORS for OSAHS: a benchmark for evaluating an emerging surgical technology in a targeted application for benign disease. ORL J Otorhinolaryngol Relat Spec 2014; 76:63-9. [PMID: 24777053 DOI: 10.1159/000360768] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 02/18/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND The aim of this study was to create benchmarks for evaluating clinical outcomes and complications of transoral robotic surgeries (TORS) in a multicenter setting. METHODS 243 TORS for obstructive sleep apnea/hypopnea syndrome (OSAHS) operations, carried out between 2008 and 2012, were analyzed at 7 different centers. The average hospitalization was 3.5 days. The mean patient age was 50 ± 12 years, the average BMI at the time of the procedure was 28.53 ± 3.87 and the majority of the patients were men (81%). RESULTS The mean preoperative and postoperative apnea/hypopnea index was 43.0 ± 22.6 and 17.9 ± 18.4, respectively (p < 0.001). The mean preoperative and postoperative Epworth Sleepiness Scale score was 12.34 ± 5.19 and 5.7 ± 3.49, respectively (p < 0.001). The mean pre- and postoperative lowest O2 saturation was 79.5 ± 8.77 and 83.9 ± 6.38%, respectively (p < 0.001). CONCLUSIONS Patients undergoing TORS as part of a multilevel approach for the treatment of OSAHS have a reasonable expectation of success with minimal long-term morbidity.
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Vicini C, Montevecchi F, Pang K, Bahgat A, Dallan I, Frassineti S, Campanini A. Combined transoral robotic tongue base surgery and palate surgery in obstructive sleep apnea-hypopnea syndrome: expansion sphincter pharyngoplasty versus uvulopalatopharyngoplasty. Head Neck 2013; 36:77-83. [PMID: 23765905 DOI: 10.1002/hed.23271] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Transoral robotic surgery (TORS) for obstructive sleep apnea-hypopnea syndrome is a relatively young technique principally devised for managing apneas in the tongue base (TB) area and supraglottic larynx. This procedure is included in the so-called "multilevel surgery" often including a palatal and nasal surgery. METHODS We carried out a retrospective analysis in order to understand in detail the relative impact on apneas of the 2 different procedures carried out in the palate area (expansion sphincter pharyngoplasty and uvulopalatopharyngoplasty). We evaluated 2 groups, each of 12 cases, which were sorted according to the primary selection criteria of statistically comparable preoperative apnea-hypopnea index (AHI), sex, age, body mass index (BMI), and volume of removed TB tissue. RESULTS Postoperative AHI registered was of 9.9 ± 8.6 SD for the expansion sphincter pharyngoplasty group and 19.8 ± 14.1 SD for the uvulopalatopharyngoplasty group. CONCLUSION As the palate component of our multilevel procedure, expansion sphincter pharyngoplasty, including conventional nose surgery and robotic surgery, seems to be superior to uvulopalatopharyngoplasty.
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Affiliation(s)
- Claudio Vicini
- Department of Special Surgery, ENT and Oral Surgery Unit, G.B. Morgagni - L. Pierantoni Hospital, University of Pavia in Forlì, Italy
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Dallan I, Castelnuovo P, Seccia V, Battaglia P, Montevecchi F, Tschabitscher M, Vicini C. Combined transnasal transcervical robotic dissection of posterior skull base: feasibility in a cadaveric model. Rhinology 2012; 50:165-70. [DOI: 10.4193/rhino11.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The current surgical trend is to expand the variety of minimally invasive approaches and, in particular, the possible application of robotic surgery in head and neck surgery. For this purpose, we explored the feasibility of a combined transcervical-transnasal approach to the posterior skull base, using the da Vinci Surgical System in 3 cadaver heads. Superb visualization of the sellar, suprasellar and clival regions was possible in all three specimens. The trocars` placement through a transcervical port made a more cephalad visualization possible, eliminating the need to split the palate. The advantages of robotic surgery applied to the posterior cranial fossa are similar to the ones already clinically experienced in other districts (oropharynx, tongue base), in terms of tremor-free, bimanual, precise dissection. The implementation of instruments for bony work will definitely increase the applicability of such a system in the forthcoming years.
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Vicini C, Montevecchi F, Tenti G, Canzi P, Dallan I, Huntley TC. Transoral robotic surgery: Tongue base reduction and supraglottoplasty for obstructive sleep apnea. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.otot.2011.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dallan I, Castelnuovo P, Seccia V, Battaglia P, Montevecchi F, Tschabitscher M, Vicini C. Combined transnasal transcervical robotic dissection of posterior skull base: feasibility in a cadaveric model. Rhinology 2012. [DOI: 10.4193/rhin11.117] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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