Barbed snore surgery for concentric collapse at the velum: The Alianza technique

Mantovani, Mário; Carioli, Daniela; Torretta, Sara; Rinaldi, Vittorio; Ibba, Tullio

doi:10.1016/j.jcms.2017.08.007

Cited by 43 publications

(26 citation statements)

References 10 publications

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“…The AHI number dropped from baseline 34.7 events per hour to 20.2 events per hour after TE‐UPPP . Another study including 19 patients described the Alianza technique with barbed sutures to eliminate CCCp, with an AHI decrease from 22.3 events per hour to 7.0 events per hour . However, MMA is superior in decreasing AHI, but TE‐UPPP or the Alianza technique may be a helpful alternative.…”

Section: Discussionmentioning

confidence: 99%

“…32 Another study including 19 patients described the Alianza technique with barbed sutures to eliminate CCCp, with an AHI decrease from 22.3 events per hour to 7.0 events per hour. 33 However, MMA is superior in decreasing AHI, but TE-UPPP or the Alianza technique may be a helpful alternative. By changing the collapse pattern at the soft palate, patients might also fulfill the criteria for UA stimulation in case of persistent OSA of at least a moderate degree.…”

Section: Discussionmentioning

confidence: 99%

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Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

et al. 2019

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Objectives/Hypothesis To evaluate upper airway (UA) collapse patterns during drug‐induced sleep endoscopy (DISE) and maxillomandibular advancement (MMA) surgery outcome, paying particular attention to the DISE phenotype complete concentric collapse at the level of the palate (CCCp). Study Design Prospective case series. Methods Nineteen patients diagnosed with obstructive sleep apnea (OSA) prospectively underwent mandibular advancement device (MAD) treatment followed by MMA surgery. UA collapse patterns were evaluated before and after MMA surgery. Baseline apnea‐hypopnea index (AHI) was compared with AHI during MAD treatment and after MMA surgery. UA collapse patterns and the presence of baseline CCCp were assessed. AHI differences between patients with and without CCCp after MMA surgery were compared. Results In 14 patients, a full dataset was obtained: 8/6 (male/female), mean age = 51 ± 7 years, body mass index (BMI) = 25.6 ± 3.7 kg/m2, and baseline AHI = 40.2 ± 25.6 per hour of sleep. MMA surgery reduced AHI to 9.9 ± 7.2 per hour of sleep (P = .0001). Eight patients benefited from additional AHI reduction compared to MAD treatment (P = .0113). Six out of 14 (43%) patients showed baseline CCCp. Baseline patient characteristics (age, BMI, and AHI) did not significantly differ between patients with and without CCCp. AHI was equally reduced after MMA, whether (P = .0145) or not (P = .0075) CCCp was present at baseline. All patients showed resolution of CCCp (P = .0159) during postoperative DISE. Conclusions CCCp seems not to be a negative predictor for MMA surgery outcome measured by AHI reduction. Furthermore, MMA is likely to eliminate CCCp. Therefore, MMA might be a solution for OSA patients showing CCCp and broadens the perspective for personalized medicine and combination therapy. However, a large sample is required for definitive results. Level of Evidence 4 Laryngoscope, 130:E268–E274, 2020

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

et al. 2019

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“…24 Latest proposal dates back to 2017 when introduced the 'alianza' surgical method born from a combination of anterior and lateral pharyngoplasty with barbed suture. 25 The patients were all tonsillectomized: a rectangular area of mucosa is striped to expose the muscular plan of the soft palate as in Pang's procedure; postero-inferior nasal spina and hamulus were the anchorage structures and a suture of the palate, like in BRP, is done without transecting and isolating the palatopharyngeal muscle.…”

Section: Oropharyngeal Surgerymentioning

confidence: 99%

Surgical treatment in obstructive sleep apnea syndrome: an overview

Sparacino¹,

Bruschini²,

Vito³

et al. 2020

Int Surg J

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Obstructive sleep apnea syndrome is a common pathology affecting pediatric and adult population. It is caused by an increase upper airway resistance due to augmented collapsibility that cause alteration in ventilation and oxygen saturation. Sleep oxygen desaturations have multi-organ implications. Since many years, OSAS, has been recognized as a risk factors for comorbid cardiovascular disease. Well-known is the causal link with cognitive impairment and atherosclerosis. Healthcare professionals, should be trained to recognize signs and symptoms of the disease in order to send the patients forward for specialist care in centers dealing with sleep-disordered breathing. However treatment knowledge is of pivotal importance in the cultural baggage of all the physicians. Surgical and non-surgical therapies have undergone a great number of changes. Going along with the innovations in diagnostic evaluation and phenotyping of the patients, surgeries were heightened by new developments such as advances in tailoring procedures and technologies. The aim of this overview is to describe the evolution and main characteristics of encoded procedures classified into site of surgical correction.

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“…Although there are several barbed oropharyngeal surgeries described in the recent literature [10,26] there is only limited data on barbed techniques addressing concentric collapse of the velum and oropharynx. The Alianza technique by Mantiowani, is effective in mild to moderate cases of OSA with concentric collapse of the velum [27], but this study does not include severe cases. In our series, in spite of including patients with severe OSA, we have experienced encouraging results in terms of improvement in AHI, ESS and VAS for snoring.…”

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confidence: 99%

“…Our study also has certain limitations. Being a multilevel procedure it is difficult to quantify the contribution of other surgical procedures to the final outcome on polysomnography parameters.We have observed this limitation in other studies on multilevel OSA surgeries as well [17,27]. We have tried to overcome this limitation by selecting agroup of patients who have predominant collapse of the velum and by including MM evaluation in the post-operative evaluation.…”

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confidence: 99%

Management Concentric Collapse of Velopharynx in Obstructive Sleep Apnoea Using a Modified Barbed Palato-Pharyngoplasty Technique

K¹,

Ankur²,

Omprakash³

et al. 2020

J Sleep Disord Manag

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Background: Multilevel surgical techniques are important in the treatment of obstructive sleep apnoea especially when the patient is non-compliant to Continuous Positive Airway Pressure therapy (CPAP). A modified pharyngoplasty technique is described in OSA patients where the major cause of upper airway obstruction was due to concentric collapse of velopharynx. Methods: Twenty four patients with evidence of OSA on polysomnography were included. In all patients the major cause of obstruction was due to concentric collapse of velopharynx as evidenced on Muller Maneuver (MM) and Drug Induced Sleep Endoscopy (DISE). All had non-adherence to (CPAP) therapy and underwent Barbed Palato Pharyngoplasty (BPP) for correction of concentric collapse of velum. Apnoea-Hypopnoea Index (AHI), Lowest Oxygen Saturation (L-sat), Epworth Sleepiness Score (ESS), Visual Analog Score (VAS) for snoring were assessed both pre-operatively and six months post-operatively. All patients underwent awake flexible nasopharyngoscopy with MM to assess the site and score the severity of obstruction before and six months after surgery. Results: Post-operative flexible nasopharyngoscopy with Muller Maneuver revealed absence of collapse of velum in eleven patients, 25% collapse in 10 and 50% collapse in 3 patients. Post-operatively, significant reduction of mean values were observed in AHI, ESS, VAS for snoring from 32.04 to 15.27, 12.75 to 4.54 and from 7.17 to 2.54 respectively. The mean L-sat improved from 74.44 to 86.04. There were no major surgical complications. Conclusion: BPP is a minimally invasive knotless technique and is best suited in OSA, where the major obstruction is due to concentric collapse of the velum.

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Barbed snore surgery for concentric collapse at the velum: The Alianza technique

Cited by 43 publications

References 10 publications

Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

Surgical treatment in obstructive sleep apnea syndrome: an overview

Management Concentric Collapse of Velopharynx in Obstructive Sleep Apnoea Using a Modified Barbed Palato-Pharyngoplasty Technique

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