Barbed Roman blinds technique for the treatment of obstructive sleep apnea: how we do it?

Abstract

Retro-palatal obstruction is often involved in the pathogenesis of obstructive sleep apnea syndrome (OSAS), which is currently treated by means of various surgical procedures. The aim of this paper is to describe our preliminary results using a new, minimally invasive and non-resective procedure called the "barbed Roman blinds technique" (BRBT), which was used to treat severe OSAS due to retro-palatal obstruction. The apnea-hypopnea index (AHI), time with <90 % O2 saturation, and Epworth Sleepiness Scale (ESS) of 32 consecutive adult outpatients (mean age 47.3 ± 8.6 years) were compared before and after surgery. The tolerability of the procedure was assessed using a 0-10 visual analog scale (VAS). All of the treated patients experienced a clinical and subjective improvement as documented by the significant differences (P < 0.001) in their pre- and post-BRBT AHI, time with <90 % O2 saturation, and ESS scores. There were no minor or major adverse events, and the good tolerability of the procedure was documented by the short mean hospital stay (1.2 ± 0.5 days) and the mean VAS value of 4.3 ± 0.7. The mean follow-up period was 12.2 ± 2.0 months. The preliminary results indicate that the BRBT is safe and effective, but long-term follow-up and comparative studies of larger case series are needed to confirm these encouraging findings.

Manipulation of Lateral Pharyngeal Wall Muscles in Sleep Surgery: A Review of the Literature

“…In order to further reduce the complications linked to muscle fiber section and fibrotic tissue development, some authors have proposed some minimally invasive and nonresective procedures. In 2015, Mantovani et al, modifying their previous “Roman blinds technique” for the treatment of retropalatal collapse [ 21 , 28 ], presented the barbed Roman blinds technique (BRBT), in which complete preservation of oropharyngeal fibromuscular structures is encouraged, and stiffening of LPW and of the soft palate is obtained through the use of a bidirectional barbed suture. With the aim of exposing the muscular fibers of PPM, a mucosectomy of the tonsillar fossa is performed.…”

Barbed expansion sphincter pharyngoplasty for the treatment of oropharyngeal collapse in obstructive sleep apnoea syndrome: A retrospective study on 17 patients

“…Expansion Sphincter Pharyngoplasty (ESP) is a promising surgical technique designed to treat patients with obstructive sleep apnoea syndrome (OSAS), characterised by oropharyngeal walls collapse, with reduced morbidity and high success rates compared to traditional uvulopalatopharyngoplasty (UPPP) . In addition, the use of knotless barbed sutures has been recently described in OSAS oropharyngeal surgery to improve the biomechanical effect of sutures on tissue collapse with positive results …”

“…1 In addition, the use of knotless barbed sutures has been recently described in OSAS oropharyngeal surgery to improve the biomechanical effect of sutures on tissue collapse with positive results. 2,3 We present here our surgical technique for ESP using barbed suture, Barbed Expansion Sphincter Pharyngoplasty (BESP), and report the results observed in a group of 17 patients.…”

“…No patient complained of uncontrolled pain after the procedure.Median hospital stay was 2 days (IQR[1][2][3]). Complications related to BESP included one chipped tooth caused by mouth gag displacement, 1 case of tonsillar haemorrhage, 1 case of acute postoperative infection and 1 case of temporary episodic nasal liquid regurgitation, which regressed spontaneously after 2 weeks.…”

“…4 Revision functional endoscopic sinus surgery is considered more difficult to perform, potentially due to previous resection of crucial anatomic landmarks, increased intraoperative bleeding, osteoneogenesis and presence of adhesions. 2,3 The purpose of this study is to determine the incidence of and factors associated with rFESS cases that presented at a tertiary rhinology centre.…”