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Pang KA, Pang KP, Lim JW, Pang EB, Cheong RCT, Baptista PM, Plaza G, Siow JK, Rotenberg B. Clinical outcomes of expansion sphincter pharyngoplasty-a 17-year systematic review. Eur Arch Otorhinolaryngol 2024; 281:2691-2698. [PMID: 38315175 DOI: 10.1007/s00405-024-08469-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVES To systematically review long-term (> 5 years) outcomes of ESP surgery for OSA treatment over 17 years. METHODS Systemic review of MEDLINE, Google Scholar, Cochrane Library and Evidence Based Medicine Reviews to identify publications relevant to OSA and Expansion Pharyngoplasty and its variants. All relevant studies published between January 2007 and June 2023 were included. RESULTS Twelve studies were included in this systematic review with a combined total of 1373 patients who had the ESP procedure were included. The clinical outcomes included encouraging long-term success rate, reductions in Epworth sleepiness scale, good mean disease alleviation, anatomical structural area and volume improvements, blood pressure reductions, biochemical improvements in acute phase reactants after ESP surgery, reductions in intra-ocular pressures, and post-operative reduction of sympathetic overdrive. CONCLUSIONS Seventeen years on, the expansion sphincter pharyngoplasty has demonstrated not only increase in anatomical area and volume but significant desired improvements in polysomnographic, clinical and biochemical parameters post-surgery.
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Affiliation(s)
| | | | - Joon Wei Lim
- General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | | | | | - Peter M Baptista
- Otolaryngology, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Guillermo Plaza
- Otolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
| | - Jin Keat Siow
- Otolaryngology Head and Neck Surgery, Tan Tock Seng Hospital, Nanyang Technological University, National University Singapore, Singapore, Singapore
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Massoni-Badosa R, Aguilar-Fernández S, Nieto JC, Soler-Vila P, Elosua-Bayes M, Marchese D, Kulis M, Vilas-Zornoza A, Bühler MM, Rashmi S, Alsinet C, Caratù G, Moutinho C, Ruiz S, Lorden P, Lunazzi G, Colomer D, Frigola G, Blevins W, Romero-Rivero L, Jiménez-Martínez V, Vidal A, Mateos-Jaimez J, Maiques-Diaz A, Ovejero S, Moreaux J, Palomino S, Gomez-Cabrero D, Agirre X, Weniger MA, King HW, Garner LC, Marini F, Cervera-Paz FJ, Baptista PM, Vilaseca I, Rosales C, Ruiz-Gaspà S, Talks B, Sidhpura K, Pascual-Reguant A, Hauser AE, Haniffa M, Prosper F, Küppers R, Gut IG, Campo E, Martin-Subero JI, Heyn H. An atlas of cells in the human tonsil. Immunity 2024; 57:379-399.e18. [PMID: 38301653 PMCID: PMC10869140 DOI: 10.1016/j.immuni.2024.01.006] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/07/2023] [Accepted: 01/09/2024] [Indexed: 02/03/2024]
Abstract
Palatine tonsils are secondary lymphoid organs (SLOs) representing the first line of immunological defense against inhaled or ingested pathogens. We generated an atlas of the human tonsil composed of >556,000 cells profiled across five different data modalities, including single-cell transcriptome, epigenome, proteome, and immune repertoire sequencing, as well as spatial transcriptomics. This census identified 121 cell types and states, defined developmental trajectories, and enabled an understanding of the functional units of the tonsil. Exemplarily, we stratified myeloid slan-like subtypes, established a BCL6 enhancer as locally active in follicle-associated T and B cells, and identified SIX5 as putative transcriptional regulator of plasma cell maturation. Analyses of a validation cohort confirmed the presence, annotation, and markers of tonsillar cell types and provided evidence of age-related compositional shifts. We demonstrate the value of this resource by annotating cells from B cell-derived mantle cell lymphomas, linking transcriptional heterogeneity to normal B cell differentiation states of the human tonsil.
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Affiliation(s)
| | | | - Juan C Nieto
- Centro Nacional de Análisis Genómico (CNAG), Barcelona, Spain
| | - Paula Soler-Vila
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | | | - Marta Kulis
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Amaia Vilas-Zornoza
- Hemato-Oncology Program, Center for Applied Medical Research (CIMA), University of Navarra, IDISNA, Universidad de Navarra, Pamplona, Spain; Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
| | - Marco Matteo Bühler
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland; Hematopathology Section, Pathology Department, Hospital Clinic, Barcelona, Spain
| | - Sonal Rashmi
- Centro Nacional de Análisis Genómico (CNAG), Barcelona, Spain
| | - Clara Alsinet
- Centro Nacional de Análisis Genómico (CNAG), Barcelona, Spain
| | - Ginevra Caratù
- Centro Nacional de Análisis Genómico (CNAG), Barcelona, Spain
| | - Catia Moutinho
- Centro Nacional de Análisis Genómico (CNAG), Barcelona, Spain
| | - Sara Ruiz
- Centro Nacional de Análisis Genómico (CNAG), Barcelona, Spain
| | - Patricia Lorden
- Centro Nacional de Análisis Genómico (CNAG), Barcelona, Spain
| | - Giulia Lunazzi
- Centro Nacional de Análisis Genómico (CNAG), Barcelona, Spain
| | - Dolors Colomer
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain; Hematopathology Section, Pathology Department, Hospital Clinic, Barcelona, Spain; Departament de Fonaments Clínics, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Gerard Frigola
- Hematopathology Section, Pathology Department, Hospital Clinic, Barcelona, Spain
| | - Will Blevins
- Centro Nacional de Análisis Genómico (CNAG), Barcelona, Spain
| | - Lucia Romero-Rivero
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Anna Vidal
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Judith Mateos-Jaimez
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alba Maiques-Diaz
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sara Ovejero
- Department of Biological Hematology, CHU Montpellier, Montpellier, France; Institute of Human Genetics, UMR 9002 CNRS-UM, Montpellier, France
| | - Jérôme Moreaux
- Department of Biological Hematology, CHU Montpellier, Montpellier, France; Institute of Human Genetics, UMR 9002 CNRS-UM, Montpellier, France; Department of Clinical Hematology, CHU Montpellier, Montpellier, France
| | - Sara Palomino
- Translational Bioinformatics Unit (TransBio), Navarrabiomed, Navarra Health Department (CHN), Public University of Navarra (UPNA), Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - David Gomez-Cabrero
- Translational Bioinformatics Unit (TransBio), Navarrabiomed, Navarra Health Department (CHN), Public University of Navarra (UPNA), Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Bioscience Program, Biological and Environmental Sciences and Engineering Division (BESE), King Abdullah University of Science and Technology KAUST, Thuwal, Saudi Arabia
| | - Xabier Agirre
- Hemato-Oncology Program, Center for Applied Medical Research (CIMA), University of Navarra, IDISNA, Universidad de Navarra, Pamplona, Spain; Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
| | - Marc A Weniger
- Institute of Cell Biology (Cancer Research), Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Hamish W King
- Epigenetics and Development Division, Walter and Eliza Hall Institute, Parkville, Australia
| | - Lucy C Garner
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Federico Marini
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Peter M Baptista
- Department of Otorhinolaryngology, University of Navarra, Pamplona, Spain
| | - Isabel Vilaseca
- Otorhinolaryngology Head-Neck Surgery Department, Hospital Clínic, IDIBAPS Universitat de Barcelona, Barcelona, Spain
| | - Cecilia Rosales
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Silvia Ruiz-Gaspà
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Benjamin Talks
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK; Department of Otolaryngology, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Keval Sidhpura
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Anna Pascual-Reguant
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Immune Dynamics, Deutsches Rheuma-Forschungszentrum (DRFZ), Berlin, Germany
| | - Anja E Hauser
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Immune Dynamics, Deutsches Rheuma-Forschungszentrum (DRFZ), Berlin, Germany
| | - Muzlifah Haniffa
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK; Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK; Department of Dermatology and NIHR Newcastle Biomedical Research Centre, Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Felipe Prosper
- Hemato-Oncology Program, Center for Applied Medical Research (CIMA), University of Navarra, IDISNA, Universidad de Navarra, Pamplona, Spain; Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain; Departamento de Hematología, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Ralf Küppers
- Institute of Cell Biology (Cancer Research), Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Ivo Glynne Gut
- Centro Nacional de Análisis Genómico (CNAG), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Elias Campo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain; Hematopathology Section, Pathology Department, Hospital Clinic, Barcelona, Spain; Departament de Fonaments Clínics, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - José Ignacio Martin-Subero
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Departament de Fonaments Clínics, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain.
| | - Holger Heyn
- Centro Nacional de Análisis Genómico (CNAG), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain.
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Baptista PM, Diaz Zufiaurre N, Garaycochea O, Alcalde Navarrete JM, Moffa A, Giorgi L, Casale M, O’Connor-Reina C, Plaza G. TORS as Part of Multilevel Surgery in OSA: The Importance of Careful Patient Selection and Outcomes. J Clin Med 2022; 11:jcm11040990. [PMID: 35207264 PMCID: PMC8878188 DOI: 10.3390/jcm11040990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [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: 12/06/2021] [Revised: 01/28/2022] [Accepted: 02/04/2022] [Indexed: 12/10/2022] Open
Abstract
Transoral robotic surgery (TORS) for Obstructive Sleep Apnea (OSA) is a relatively young technique principally devised for managing apneas in the tongue base area. This study summarizes and presents our personal experience with TORS for OSA treatment, with the aim to provide information regarding its safety, efficacy, and postoperative complications. A retrospective study was conducted on patients undergoing TORS with lingual tonsillectomy through the Da Vinci robot. The effectiveness of the surgical procedure was assessed employing the Epworth Sleepiness Scale (ESS) and overnight polysomnography with the Apnea-Hypopnea Index (AHI). A total of 57 patients were included. Eighteen patients (31.6%) had undergone previous surgery. The mean time of TORS procedure was 30 min. Base of tongue (BOT) management was associated with other procedures in all patients: pharyngoplasty (94%), tonsillectomy (66%), and septoplasty (58%). At 6 months follow-up visit, there was a significant improvement in AHI values (from 38.62 ± 20.36 to 24.33 ± 19.68) and ESS values (from 14.25 ± 3.97 to 8.25 ± 3.3). The surgical success rate was achieved in 35.5% of patients. The most frequent major complication was bleeding, with the need for operative intervention in three cases (5.3%). The most common minor complications were mild dehydration and pain. TORS for OSA treatment appears to be an effective and safe procedure for adequately selected patients looking for an alternative therapy to CPAP.
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Affiliation(s)
- Peter M. Baptista
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, Av. de Pío XII, 36, 31008 Pamplona, Spain; (P.M.B.); (N.D.Z.); (O.G.); (J.M.A.N.)
| | - Natalia Diaz Zufiaurre
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, Av. de Pío XII, 36, 31008 Pamplona, Spain; (P.M.B.); (N.D.Z.); (O.G.); (J.M.A.N.)
| | - Octavio Garaycochea
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, Av. de Pío XII, 36, 31008 Pamplona, Spain; (P.M.B.); (N.D.Z.); (O.G.); (J.M.A.N.)
| | - Juan Manuel Alcalde Navarrete
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, Av. de Pío XII, 36, 31008 Pamplona, Spain; (P.M.B.); (N.D.Z.); (O.G.); (J.M.A.N.)
| | - Antonio Moffa
- School of Medicine, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy; (L.G.); (M.C.)
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Correspondence:
| | - Lucrezia Giorgi
- School of Medicine, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy; (L.G.); (M.C.)
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Manuele Casale
- School of Medicine, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy; (L.G.); (M.C.)
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Carlos O’Connor-Reina
- Otolaryngology Head and Neck Surgery, USP Hospital, Av. Severo Ochoa, 20, 29603 Marbella, Spain;
| | - Guillermo Plaza
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Cam. del Molino, 2, 28942 Fuenlabrada, Spain;
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Baptista PM, Martin F, Ross H, O’Connor Reina C, Plaza G, Casale M. A systematic review of smartphone applications and devices for obstructive sleep apnea. Braz J Otorhinolaryngol 2022; 88 Suppl 5:S188-S197. [PMID: 35210182 PMCID: PMC9801062 DOI: 10.1016/j.bjorl.2022.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/06/2021] [Accepted: 01/10/2022] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Sleep is fundamental for both health and wellness. The advent of "on a chip" and "smartphone" technologies have created an explosion of inexpensive, at-home applications and devices specifically addressing sleep health and sleep disordered breathing. Sleep-related smartphone Applications and devices are offering diagnosis, management, and treatment of a variety of sleep disorders, mainly obstructive sleep apnea. New technology requires both a learning curve and a review of reliability. Our objective was to evaluate which app have scientific publications as well as their potential to help in the diagnosis, management, and follow-up of sleep disordered breathing. METHODS We search for relevant sleep apnea related apps on both the Google Play Store and the Apple App Store. In addition, an exhaustive literature search was carried out in MEDLINE, EMBase, web of science and Scopus for works of apps or devices that have published in the scientific literature and have been used in a clinical setting for diagnosis or treatment of sleep disordered breathing performing a systematic review. RESULTS We found 10 smartphone apps that met the inclusion criteria. CONCLUSIONS The development of these apps and devices has a great future, but today are not as accurate as other traditional options. This new technology offers accessible, inexpensive, and continuous at home data monitoring of obstructive sleep apnea, but still does not count with proper testing and their validation may be unreliable.
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Affiliation(s)
- Peter M. Baptista
- Clínica Universidad de Navarra, Otorhinolaryngology Department, Pamplona, Spain,Corresponding author.
| | - Fabricio Martin
- Hospital de Trauma y Emergencias Dr. Federico Abete, Otorhinolaryngology Department, Malvinas Argentinas, Buenos Aires, Argentina
| | - Harry Ross
- 3405 Penrose place, Suite 201, Boulder, CO, United States
| | | | - Guillermo Plaza
- Universidad Rey Juan Carlos, Hospital Sanitas La Zarzuela, Hospital Universitario de Fuenlabrada, Otorhinolaryngology Department, Madrid, Spain
| | - Manuele Casale
- Campus Bio-Medico University, Otorhinolaryngology Department, Roma, Italy
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Andrews P, Anschuetz L, Baptista PM, Bast F, Beule AG, De Carpentier J, Fitzgerald D, Furtado LMPC, Knox B, Marzetti A, Perkins NW, Randhawa PS. Awake Rhinology Surgery in Response to the COVID-19 Pandemic in Europe. ORL J Otorhinolaryngol Relat Spec 2021; 84:93-102. [PMID: 34464957 PMCID: PMC8450852 DOI: 10.1159/000517155] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 05/10/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND European health-care systems are faced with a backlog of surgical procedures following the suspension of routine surgery during the COVID-19 crisis. Routine rhinology surgery under general anaesthetic (GA) is now faced with significant challenges which include limited theatre capacity, the negative ramifications of surgical prioritization, reduced patient throughput in secondary care, and additional personal protective equipment requirements. Delayed surgery in rhinology, particularly with regards to chronic rhinosinusitis, has previously been shown to have poorer surgical outcomes, a detrimental effect on quality of life and long-term negative health socio-economic effects. Awake rhinology surgery under local anaesthetic (LA) provides an ideal alternative to GA. It provides a means of operating on patients in a setting alternative to currently oversubscribed main theatres, by utilizing satellite facilities, while ensuring identical surgical outcomes for patients who may otherwise have been forced to wait a long time for their procedure. It also confers additional benefits in terms of shorter recovery time and hospital stay for patients. OBJECTIVES We have developed a set of recommendations that are intended to help support clinicians and managers to better adopt LA rhinology protocols and minimize the risk to the patient and health-care professionals involved. METHODOLOGY International roundtable forums were conducted and supplemented by individual interviews. The international board consisted of 12 rhinologists experienced in awake rhinology surgery. Feedback was analysed and shared to develop a consensus of best practice. RECOMMENDATIONS Local and national guidelines need to be adhered to with specific focus on patient and clinician safety. When performing awake rhinology procedures in the COVID-19 recovery process, consider implementing specific safety measures and workflow practices to safeguard patients and staff and minimize the risk of infection. CONCLUSION Awake surgery potentially provides quicker access to routine rhinology surgery in the post-COVID-19 recovery phase, ensuring patients are treated in a timely matter, thereby avoiding higher downstream costs, and improving outcomes.
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Affiliation(s)
- Peter Andrews
- Department of Rhinology, Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Peter M Baptista
- Department of ENT, Clinica Universidad de Navarra, Pamplona, Spain
| | - Florian Bast
- ENT Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Achim G Beule
- Klinik für Hals-Nasen-und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsmedizin Greifswald, Münster, Germany
| | - John De Carpentier
- ENT Department, Lancashire Teaching Hospitals NHS Trust, Preston, United Kingdom
| | - Deirdre Fitzgerald
- ENT Department, Beacon Hospital & Fitzgerald Private Clinic, Dublin, Ireland
| | | | - Barton Knox
- Partner Colorado ENT & Allergy, Colorado Springs, Colorado, USA
| | - Andrea Marzetti
- Frosinone-Alatri Unified Hospital Group, ASL, Frosinone, Italy
| | | | - Prem Singh Randhawa
- Department of Rhinology, Royal National Throat, Nose and Ear Hospital, London, United Kingdom
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Baptista PM, Garaycochea O, O’Connor C, Plaza G. Tongue Surgery That Works in OSA. Curr Otorhinolaryngol Rep 2021. [DOI: 10.1007/s40136-021-00357-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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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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Steffen A, König IR, Baptista PM, Abrams N, Jeschke S, Hasselbacher K. Home Sleep Testing to Direct Upper Airway Stimulation Therapy Optimization for Sleep Apnea. Laryngoscope 2020; 131:E1375-E1379. [PMID: 32865831 DOI: 10.1002/lary.29043] [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] [Received: 03/04/2020] [Revised: 07/26/2020] [Accepted: 07/31/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVES/HYPOTHESIS Selective upper airway stimulation (sUAS) is a well-established treatment option for obstructive sleep apnea (OSA). This study aimed to determine if there are benefits in performing a home sleep test (HST) to evaluate postoperative sUAS effectiveness after patient acclimatization compared to the generally used polysomnography (PSG) titration, as measured by long-term follow-up outcomes. STUDY DESIGN Retrospective comparative cohort analysis. METHODS We conducted an analysis of consecutive patients at our center who had completed a 6-month follow-up (month 6 [M6]) and recorded data from M6, month 12 (M12), and month 24 (M24). After device activation, we performed an HST with the patient's stimulation settings, and measured the apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and device usage. These values were compared to patients who had undergone PSG-based device titration. RESULTS Baseline values of the initial 131 patients show high ESS and moderate OSA. At the 2-month time point of the HST, nearly half of the patients (46.2%) reached an AHI ≤15/hr, and approximately a fifth (19.2%) reached <5/hr. The PSG and HST groups differed in median ESS at M24, but no other differences were observed for ESS at M6 and M12. Both groups showed similar AHI, oxygen desaturation, and usage hours per week. CONCLUSIONS Adjusting therapy by using the HST technique after device activation and acclimatization has clinical and economic advantages. These advantages are contingent on several conditions being met when deviating from the standard device protocol, including precise communication with the referring sleep medicine physicians, especially their role in helping with long-term follow-up. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1375-E1379, 2021.
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Affiliation(s)
- Armin Steffen
- Department of Otorhinolaryngology, University of Lübeck, Lübeck, Germany
| | - Inke R König
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - Peter M Baptista
- Department of Otorhinolaryngology, Navarra University Hospital, Pamplona, Spain
| | - Nils Abrams
- Department of Otorhinolaryngology, University of Lübeck, Lübeck, Germany
| | - Stephanie Jeschke
- Department of Otorhinolaryngology, University of Lübeck, Lübeck, Germany
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Pang KP, Baptista PM, Olszewska E, Braverman I, Carrasco-Llatas M, Kishore S, Chandra S, Yang HC, Chan YH, Pang KA, Pang EB, Rotenberg B. SLEEP-GOAL: A multicenter success criteria outcome study on 302 obstructive sleep apnoea (OSA) patients. Med J Malaysia 2020; 75:117-123. [PMID: 32281591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To demonstrate SLEEP-GOAL as a more holistic and comprehensive success criterion for Obstructive Sleep Apnoea (OSA) treatment. METHODS A prospective 7-country clinical trial of 302 OSA patients, who met the selection criteria, and underwent nose, palate and/or tongue surgery. Pre- and post-operative data were recorded and analysed based on both the Sher criteria (apnoea hypopnea index, AHI reduction 50% and <20) and the SLEEP-GOAL. RESULTS There were 229 males and 73 females, mean age of 42.4±17.3 years, mean BMI 27.9±4.2. The mean VAS score improved from 7.7±1.4 to 2.5±1.7 (p<0.05), mean Epworth score (ESS) improved from 12.2±4.6 to 4.9±2.8 (p<0.05), mean body mass index (BMI) decreased from 27.9±4.2 to 26.1±3.7 (p>0.05), gross weight decreased from 81.9±14.3kg to 76.6±13.3kg. The mean AHI decreased 33.4±18.9 to 14.6±11.0 (p<0.05), mean lowest oxygen saturation (LSAT) improved 79.4±9.2% to 86.9±5.9% (p<0.05), and mean duration of oxygen <90% decreased from 32.6±8.9 minutes to 7.3±2.1 minutes (p<0.05). The overall success rate (302 patients) based on the Sher criteria was 66.2%. Crosstabulation of respective major/minor criteria fulfilment, based on fulfilment of two major and two minor or better, the success rate (based on SLEEP-GOAL) was 69.8%. Based solely on the Sher criteria, 63 patients who had significant blood pressure reduction, 29 patients who had BMI reduction and 66 patients who had clinically significant decrease in duration of oxygen <90% would have been misclassified as "failures". CONCLUSION AHI as a single parameter is unreliable. Assessing true success outcomes of OSA treatment, requires comprehensive and holistic parameters, reflecting true end-organ injury/function; the SLEEP-GOAL meets these requirements.
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Affiliation(s)
- K P Pang
- Asia Sleep Centre, Department of Otolaryngology, Paragon, Singapore,.
| | - P M Baptista
- Clinica Universidad de Navarra, Department of Otolaryngology, Pamplona, Navarra, Spain
| | - E Olszewska
- Medical University of Bialystok, ENT Department, Poland
| | - I Braverman
- Hillel Yaffe Medical Center, Technion Faculty Medicine, Department of Otolaryngology Head and Neck Surgery, Haifa, Israel
| | | | - S Kishore
- Nova Specialty Hospital, Otolaryngology Department, Hyderabad, India
| | - S Chandra
- Belle Vue Clinic & Hospital, ENT Department, Kolkata, India
| | - H C Yang
- Chonnam National University Hospital, Otolaryngology Department, Korea
| | - Y H Chan
- National University Singapore, School of Medicine, Biostatistics Unit, Singapore
| | - K A Pang
- Asia Sleep Centre, Department of Otolaryngology, Paragon, Singapore
| | - E B Pang
- University of Glasgow, Medicine Faculty, Scotland
| | - B Rotenberg
- Western University, Otolaryngology Department, London, Ontario, Canada
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Casale M, Costantino A, Sabatino L, Luchena A, Moffa A, Cassano M, Rinaldi V, Baptista PM. Minimally invasive surgery under local anaesthesia for chronic rhinosinusitis with nasal polyps: our experience in older adults. J Laryngol Otol 2020; 134:1-5. [PMID: 32046795 DOI: 10.1017/s0022215120000304] [Citation(s) in RCA: 1] [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] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This paper aims to report our experience with a minimally invasive surgical procedure for the treatment of chronic rhinosinusitis with nasal polyps, performed in a day-surgery setting under local anaesthesia. METHODS A retrospective study of 30 patients with chronic rhinosinusitis with nasal polyps was conducted. Sino-Nasal Outcome Test 22 and modified Lund-Kennedy scores were collected. Intra- and post-operative pain was evaluated using a 10-point visual analogue scale. RESULTS The mean Sino-Nasal Outcome Test 22 score decreased from 41.8 ± 15.8 pre-operatively to 13.3 ± 9.5 post-operatively (p < 0.001). Accordingly, the mean endoscopic score decreased from 6.8 ± 1.8 to 0.2 ± 0.7 (p < 0.001). The mean intra-operative pain score was 2.9 ± 3.2, and 29 patients (96.7 per cent) reported no pain in the post-operative period (visual analogue scale score = 0). CONCLUSION Our study confirms that minimally invasive surgery represents a safe, repeatable procedure that results in remarkable subjective and objective improvement, without intra- and post-operative pain or discomfort.
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Affiliation(s)
- M Casale
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - A Costantino
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - L Sabatino
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - A Luchena
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - A Moffa
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
- Department of Otolaryngology, University of Foggia, Italy
| | - M Cassano
- Department of Otolaryngology, University of Foggia, Italy
| | - V Rinaldi
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - P M Baptista
- Department of Otolaryngology, University Clinic of Navarra, Pamplona, Spain
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Baptista PM, Costantino A, Moffa A, Rinaldi V, Casale M. Hypoglossal Nerve Stimulation in the Treatment of Obstructive Sleep Apnea: Patient Selection and New Perspectives. Nat Sci Sleep 2020; 12:151-159. [PMID: 32104122 PMCID: PMC7026121 DOI: 10.2147/nss.s221542] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/01/2020] [Indexed: 12/22/2022] Open
Abstract
Hypoglossal nerve stimulation (HNS) is an increasingly widespread OSA treatment. It is a non-anatomical modifying surgery able to achieve an adequate objective and subjective result with a reasonable complication rate. HNS exploits the neurostimulation to reduce upper airway collapsibility providing a multilevel upper airway improvement within a single procedure. Proper patient selection has a fundamental role in determining an adequate long-term clinical outcome. All patient candidates for HNS undergo a standard comprehensive sleep medicine assessment and upper airway surgical examination. Several features should be assessed preoperatively in order to predict patients' response to HNS treatment. In particular, the assessment of OSA severity, BMI > 32 Kg/m2, collapse pattern during drug-induced sleep endoscopy (DISE), and many other parameters, is central for a good patient selection and customization of OSA treatment. HNS is indeed one of the most promising tools in the widespread context of personalized sleep medicine. HNS is an adjustable medical device that could be titrated in order to improve HNS effectiveness, maintaining patient comfort. Moreover, HNS provides the opportunity for patients to play an active role in their own care, with a potential improvement in therapy adherence and efficacy. This review summarizes the current evidence in patient selection for HNS, highlighting the reasons behind the optimistic future of this OSA treatment in the context of personalized medicine.
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Affiliation(s)
- Peter M Baptista
- Department of ORL, Clínica Universidad de Navarra, Pamplona, Spain
| | - Andrea Costantino
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Antonio Moffa
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, University Campus Bio-Medico, Rome, Italy.,Department of Otolaryngology, University of Foggia, Foggia, Italy
| | - Vittorio Rinaldi
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, University Campus Bio-Medico, Rome, Italy
| | - Manuele Casale
- Department of Otolaryngology, Integrated Therapies in Otolaryngology, University Campus Bio-Medico, Rome, Italy
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Pang KP, Baptista PM, Olszewska E, Braverman I, Carrasco-Llatas M, Kishore S, Chandra S, Yang HC, Wang CMZ, Chan YH, Pang KA, Pang EB, Rotenberg B. Does drug-induced sleep endoscopy affect surgical outcome? A multicenter study of 326 obstructive sleep apnea patients. Laryngoscope 2019; 130:551-555. [PMID: 30993741 DOI: 10.1002/lary.27987] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 01/29/2019] [Revised: 02/27/2019] [Accepted: 03/18/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES/HYPOTHESIS Our objective was to determine whether drug-induced sleep apnea (DISE) affects the successfulness of the surgical outcome. STUDY DESIGN Prospective, seven-country, nonrandomized trial. METHODS There were 326 consecutive obstructive sleep apnea (OSA) patients who had nose, palate, and/or tongue surgery included in the study. DISE was performed in only one group. RESULTS There were 170 patients in the DISE group and 156 patients in no-DISE group. The mean preoperative body mass index (BMI) for the DISE group was 27.6 ± 4.6, whereas in the no-DISE group it was 28.1 ± 3.9 (P = .23). The mean preoperative systolic blood pressure (SBP) for the DISE group was 130.4 ± 16.7, whereas in the no-DISE group it was 142.9 ± 15.5 (P < .001). The mean preoperative diastolic blood pressure (DBP) for the DISE group was 81.4 ± 9.7, whereas in the no-DISE group it was 89.1 ± 9.7 (P < .001). The mean preoperative apnea-hypopnea index (AHI) for the DISE group was 32.6 ± 18.8, whereas in the no-DISE group it was 33.7 ± 19.6 (P = .61). The mean postoperative AHI for the DISE group was 15.9 ± 12.6, whereas in the no-DISE group it was 13.2 ± 8.8 (P = .023). The age-, gender-, BMI-adjusted percentage change in AHI for the DISE group was -48.4 ± 31.9, whereas in the no-DISE group it was -59.8 ± 18.6 (P < .001). The age-, gender-, and BMI-adjusted success rate for the DISE group was 66.5%, whereas in the no-DISE group it was 80.8% (P = .004). The age-, gender-, and BMI-adjusted change in SBP for the DISE group was -6.1 ± 8.6, whereas in the no-DISE group it was -13.3 ± 11.1 (P < .001). The age-, gender-, and BMI-adjusted change in DBP in the DISE group was -5.2 ± 12.1, whereas in the no-DISE group it was -12.4 ± 11.7 (P < .001). The mean age- and gender-adjusted change in BMI for the DISE group was -4.6 ± 12.9, whereas in the no-DISE group it was -6.3 ± 18.5 (P = .34). The Cohen effect of BMI on the overall AHI, lowest oxygen saturation, and blood pressure changes was 0.08. CONCLUSIONS DISE may not significantly affect surgical success in OSA. LEVEL OF EVIDENCE 2c Laryngoscope, 130:551-555, 2020.
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Affiliation(s)
- Kenny P Pang
- Otolaryngology Department, Asia Sleep Centre, Paragon, Singapore
| | - Peter M Baptista
- Otolaryngology Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Ewa Olszewska
- Ear, Nose, and Throat Department, Medical University of Bialystok, Bialystok, Poland
| | - Itzhak Braverman
- Department of Otolaryngology-Head and Neck Surgery, Hillel Yaffe Medical Center, Technion Faculty Medicine, Haifa, Israel
| | | | - Srivinas Kishore
- Otolaryngology Department, Nova Specialty Hospital, Hyderabad, India
| | - Sudipta Chandra
- Ear, Nose, and Throat Department, Belle Vue Clinic and Hospital, Kolkata, India
| | - Hyung Chae Yang
- Otolaryngology Department, Chonnam National University Hospital, Gwangju, South Korea
| | | | - Yiong Huak Chan
- Biostatistics Unit, School of Medicine, National University Singapore, Singapore
| | - Kathleen A Pang
- Otolaryngology Department, Asia Sleep Centre, Paragon, Singapore
| | - Edward B Pang
- Medicine Faculty, University of Glasgow, Glasgow, United Kingdom
| | - Brian Rotenberg
- Otolaryngology Department, Western University, London, Ontario, Canada
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Fernandez S, Alcalde JM, Baptista PM, Barona L. Aerodynamic Phonatory Pattern as a New Sign of Superior Laryngeal Nerve Injury. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541629a150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Reduced quality of life after thyroid surgery is multifactorial and may include the need of lifelong different treatments. About 1 in 20 patients experience voice changes, and it is very frequent that these changes may not be caused by neural lesions. The purpose of this study is to describe aerodynamic phonatory features in thyroidectomized patients in order to determine what mechanisms are involved in voice changes in these patients and what are the best rehabilitative options. Methods: We studied 58 thyroidectomized patients with neither apparent neural cause of thyroidectomy-related dysphonia nor recurrent laryngeal nerve injury nor external branch of the superior laryngeal nerve (EBSLN) injury. The patients were asked to produce sustained vowels, syllables, and sentences. Three items were recorded in upright and sitting positions. Afterward, acoustic and aerodynamic measurements were made: fundamental frequency, jitter, shimmer, intensity, harmonic/noise ratio, spectrographic analysis, subglottic pressure, mean transglottic flow, and laryngeal resistance. All measurements were made using Voice Plus from Alamed Corporation software. STATA software was used to analyze variables. Results: We describe 2 different groups of patients with different aerodynamic pattern in voice production that correlate with voice quality. In 66% of patients there was no change and in 34% the glottal pressure and laryngeal resistance decreased as a result of lower tension in the vocal fold as a consequence of an injury of the EBSLN. Conclusions: This aerodynamic phonatory pattern that may be understood by objective aerodynamic measurements could be another new sign of EBSLN injury.
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Abstract
Objective: Patients with chronic rhinosinusitis resistant to systemic treatment have as an alternative endoscopic nasal surgery. The Relieva Stratus system has allowed local treatment in paranasal cavities, avoiding an aggressive surgery and high corticoesteroids systemic treatment. We describe our experience with the system in the first six patients. Method: Four patients suffering ethmoid and 2 with frontal chronic rhinosinusitis have been included. The Stratus catheter was implanted endoscopically under general anesthesia in combination with balloon sinuplasty technique for either the maxillary or the frontal sinus. Triamcinolone was used for local delivery. Stratus was removed in office 4 week later. Results: Stratus Relieva was implanted in patients with chronic inflammation of the ethmoid or frontal sinus. No major complications were observed. Four catheters were implanted in the ethmoid bulla and 2 in the frontal sinus. They were removed in office under local anesthesia. Intraoperaory bleeding was minimal. Patients described no foreign object sensation after surgery. We observed good evolution in all patients but one, in which Stratus Relieva was performed. This patient persisted with chronic inflammation of the maxillary and ethmoid sinus and functional endoscopy surgery was performed as alternative for definitive treatment. Conclusion: Results with this device are promising although longer observation period is needed. It is possible that the patient that did not show an improvement of disease may have not been an adequate candidate for this surgery. Therefore, we consider that appropriate selection of patients is necessary for a good outcome.
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de Abajo J, Cervera J, Baptista PM. Reducing Risks in Tonsillectomy. Otolaryngol Head Neck Surg 2012. [DOI: 10.1177/0194599812451426a50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Tonsillectomy is one of the most common procedures performed by the otolaryngologist. Now, many different surgical systems offer advantages related to less pain or postoperative bleeding. In our institution Tissue Welding Starion System (TW) has been used for over 281 patients. We have compared results using TW with bipolar cautery (BC). Method: Between August 2008 and January 2012, 482 consecutive surgeries were performed in our institution by 2 different surgeons using the clinical guidelines of the AAO-HNS. Two hundred eighty-one patients (58.2%) were operated using the TW technology, and 201 (41.8%) were operated using BC. We have evaluated surgical outcomes and complications. Results: Surgeries performed with TW were significantly faster with less bleeding and carbonization of tissue in comparison with BC. Postoperative pain was significantly lower and patients returned to normal diet faster in the TW group. Eleven patients (2.3%) developed major complications (need for revision surgery, or admission to hospital). Seven of them (1.4%) were from the BC group (3 postoperative bleeding and 4 admissions because of pain). Four of them (0.8%) were from the TW group (3 postoperative bleeding and 1 admission due to persistent fever). Conclusion: Tonsillectomy with TW proved to reduce by half postoperative bleeding and admissions to hospital compared to BC. These suggest that TW could be an advantageous technique concerning safety.
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Baptista PM, Alcalde J, de Abajo J, Gallegos V. da Vinci System for Treatment of Sleep Apnea Syndrome. Otolaryngol Head Neck Surg 2012. [DOI: 10.1177/0194599812451426a429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Tongue base hypertrophy is frequently related with sleep apnea-hypopnea syndrome (OSAHS). The objectives were: 1) To determine which patients are candidates for tongue base resection by means of trans ral robotic Surgery (TORS). 2) To evaluate the clinical results of this technique associated or not with other treatments. Method: All patients were diagnosed with OSAHS with obstructing tongue base through polysomnography, office endoscopy, and drug-induced sleep endoscopy (DISE). Ten patients with OSAHS and obstructive tongue base were surgically treated with TORS using the Intuitive da Vinci system and traditional surgical techniques for OSAHS between August and December 2011. Results: The mean preoperative apnea-hyponea index (IAH) was 40.67 (22.26-78.21). Patients did not require tracheotomy, and no major complications were observed during or after surgery. Tongue base and epiglottis were managed securely, and no problems with hemostasis were observed. Swallowing pain was present a mean of 10 days after surgery with satisfactory response to therapy with corticoesteroids and nonsteroidal anti-inflammatory drugs. One of the patients presented an epidermoid tumor in the right side of the tongue base causing the obstructive syndrome; it was resected with no affected margins using the TORS technique. Conclusion: The DISE technique is a useful test to determinate which patients are candidates for tongue base surgery. All patients archived a significant improvement of their IAH and Epworth Sleepiness Scale (ESS). The Intuitive da Vinci system provides excellent visualization and tissue management with low morbidity.
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Baptista PM, Gimeno-Vilar C, Rey-Martínez JA, Casale-Falcone M. [Sialoendoscopy: a new alternative for the treatment of salivary pathology. Our experience]. Acta Otorrinolaringol Esp 2008; 59:120-123. [PMID: 18364204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Sialoendoscopy is a procedure used to visualize the salivary ducts and their pathology. It can be used either as a diagnostic method to rule out inflammatory processes in the parotid and submandibular glands (diagnostic sialoendoscopy) or to treat pathological areas (stenosis, extract foreign bodies or sialolithiasis) through the use of appropriate instruments (interventionist sialoendoscopy). We attempt to prove a declining rate of salivary gland excision. PATIENTS AND METHOD Sialoendoscopy was performed in 8 patients. RESULTS Of these, 50 % of patients were diagnosed as having sialolithiasis and the other 50 % had chronic sialoadenitis. In patients with sialolithiasis, sialoendoscopy allowed the extraction of the calculus in two patients (50 %). In the remainder, sialoendoscopy provided confirmation of the diagnosis in all cases. CONCLUSIONS Sialoendoscopy is a new technique for use in the diagnosis, treatment and post-operative management of sialolithiasis, sialoadenitis and other salivary gland pathologies.
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Affiliation(s)
- Peter M Baptista
- Departamento de Otorrinolaringología, Clínica Universitaria de Navarra, Pamplona, Navarra, Spain
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Baptista PM, Gimeno-Vilar C, Rey-Martínez JA, Casale-Falcone M. Sialoendoscopia: una nueva alternativa en el tratamiento de la patología salival. Nuestra experiencia. Acta Otorrinolaringológica Española 2008. [DOI: 10.1016/s0001-6519(08)73278-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Baptista PM, Gimeno-Vilar C, Rey-Martínez JA, Casale-Falcone M. Sialoendoscopy: A New Alternative for the Treatment of Salivary Pathology. Our Experience. Acta Otorrinolaringologica (English Edition) 2008. [DOI: 10.1016/s2173-5735(08)70206-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Baptista PM. [Surgery for obstructive sleep apnea]. An Sist Sanit Navar 2007; 30 Suppl 1:75-88. [PMID: 17486148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Nasal continuous positive airway pressure (CPAP) is considered an ideal treatment for treating Obstructive Sleep Apnea Syndrome (OSAS), due to its being conservative and reversible; however, there is a poor rate of adherence in its long-term use. Surgery can significantly complement those cases where CPAP is not tolerated. Surgery for OSAS must be carried out taking into account the degree of obstructive apnea, the place of greatest obstruction and the experience of the medical team. The more severe the OSAS, the more aggressive the surgical therapy can be. The place of obstruction must not be considered in a simplistic way, in which only one place of obstruction is defined, but as a general alteration of the airway where the surgeon must act in order to carry out an effective remodelling. This paper describes different types of surgery and their efficacy in OSAS according to the anatomical area involved (nose, adenoidal surgery, tonsils, soft palate, base of the tongue, hypopharynx and bimaxillary protrusion). The scientific evidence shows that at present reconstructive surgery of the airway competes effectively with medical treatment.
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Affiliation(s)
- P M Baptista
- Departamento de Otorrinolaringología, Clínica Universitaria de Navarra, Pamplona.
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Baptista PM, Mercadante MT, Macedo EC, Schwartzman JS. Cognitive performance in Rett syndrome girls: a pilot study using eyetracking technology. J Intellect Disabil Res 2006; 50:662-6. [PMID: 16901293 DOI: 10.1111/j.1365-2788.2006.00818.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Rett syndrome (RS) is a pervasive developmental disorder with cognitive and neuromotor impairments (including loss of handiness and loss of communicative skills). OBJECTIVE To verify whether girls with RS use their gaze intentionally, by observing their performance in three cognitive tasks: (1) verbal instruction condition (look at picture X), (2) recognition and matching of pictures (look at the one that is the same), and (3) categorization of pictures (look at the one that is similar). METHOD Seven girls diagnosed with RS according to DSM-IV criteria were studied. Eyegaze technology was used to record the girls' eye movements' responses to visual stimulation. RESULTS The comparison of fixation time on the alternatives revealed a higher percentage (62.4%) of correct alternatives (chi(2) = 76.31; P = 0.000). Of the seven children assessed, only one did not present predominance of fixations on the correct alternatives in any one of the tasks. One did well in all tasks. Six responded correctly to all verbal instructions. CONCLUSION The rate of correct answers suggests that there is measurable and intentional gaze in RS girls and it can be used as a path to explore their cognitive performance.
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Affiliation(s)
- P M Baptista
- Development Disorders Program, Mackenzie Presbyterian University, São Paulo, Brazil.
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Baptista PM, Garcia-Tapia R, Vazquez JJ. Pleomorphic adenoma of the epiglottis. J Otolaryngol 1992; 21:355-7. [PMID: 1335093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Pleomorphic adenoma is the most common benign tumor of the major salivary glands. A pleomorphic adenoma in the larynx constitutes a rarity. A small number of cases have been reported in the literature. We report on a case seen in our hospital, and have reviewed those cases published in the medical literature during the last 25 years.
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Affiliation(s)
- P M Baptista
- Department of Otorhinolaryngology, Clínica Universitaria of Navarra, Spain
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