Long‐term swallowing performance following transoral robotic surgery for obstructive sleep apnea

Abstract

Objectives/Hypothesis This study aimed to evaluate the long‐term swallowing performance following transoral robotic surgery (TORS) to the base of tongue (BOT) in the treatment of obstructive sleep apnea (OSA). Study Design Retrospective and prospective cohort study. Methods Data analysis of 39 patients who underwent BOT reduction via TORS to treat OSA at our center from September 2013 to April 2016. Long‐term swallowing functions were assessed using subjective self‐evaluated swallowing disturbances questionnaire (SDQ) and objective fiberoptic endoscopic evaluation of swallowing (FEES). Results Seven patients underwent TORS BOT reduction alone, whereas 32 had also uvulopalatoplasty ± tonsillectomy, with a surgical success rate of 71.4%. Mean time for swallowing evaluation was 27.4 ± 9.43 months. Twenty‐five patients completed the SDQ with an average score of 9.26 ± 10.05. In 32%, the SDQ was positive for dysphagia. In 10 out of 14 patients who underwent FEES, swallowing problems were noticed. The most common pathological findings were food residue in the vallecula followed by early spillage of food into the hypopharynx, penetration of solid food and liquid on the vocal folds surface, and aspiration. Conclusions BOT reduction via TORS has a negative effect on long‐term swallowing function. A self‐assessment questionnaire can help detect patients who suffer from swallowing impairment. Postoperative objective swallowing tests are essential not only in the immediate postoperative period but also during late routine follow‐up. Proper patient selection and detailed information about surgery and possible late‐swallowing effect are important factors before scheduling BOT reduction via TORS for OSA treatment. Level of Evidence 4 Laryngoscope, 129:422–428, 2019

Surgical, clinical, and functional outcomes of transoral robotic surgery used in sleep surgery for obstructive sleep apnea syndrome: A systematic review and meta‐analysis

“…The electronic search identified 140 papers, of which 31 met our inclusion criteria 16‐47 . There were 22 retrospective, 8 prospective uncontrolled studies, and one controlled randomized trial.…”

“…The surgery was proposed in patients who did not respond to a nonsurgical treatment (i.e., CPAP) 18,19,26‐29,31‐34,37,39,42‐46 and oral appliance 16,20,23,36,38,41,47 in 23 studies. In one study, the authors included patients who have never been treated by medical treatment or CPAP 21 .…”

“…The following multilevel sleep surgeries were performed in the remaining 25 cohorts: palatal (uvulopharyngopalatoplasty and/or lateral pharyngoplasty; N = 24); pharyngeal tonsillectomies ( N = 16); and nasal (septoplasty, turbinoplasty; N = 8; Table 2). The BOT resection was limited to the lymphoid tissue resection in two studies, 37,46 while the surgery involved both lymphoid tissue and tongue muscle resection at the surgeon's discretion in eight studies 16,18‐20,22,24,25,27,28,30,33‐35,38,41,43,44 . There were no information about the potential excision of tongue muscle in five studies 29,31,39,40,42 .…”

“…The mean robotic time was reported in 7 of 31 cohorts and ranged from 21 min to 28 min 17,20,25,28,37,45,46 . The mean “total or console” operative times were reported in 13 cohorts and ranged from 8 to 86 min 17,19,21,23‐25,28,31,32,36,37,40,45 . Blood loss during surgery was reported in 7 studies and ranged from 11 mL to 50 mL 17,19,21,25,28,31,43 …”

The Impact of Upper Airway Stimulation on Swallowing Function

“…Postoperative dysphagia can present both in the immediate postoperative period and in late stage follow-up. 6 Upper airway stimulation (UAS) is a novel surgical alternative for patients with moderate to severe OSA who are unable to tolerate CPAP therapy. The UAS device (Inspire Medical Systems, Minneapolis, Minnesota) consists of 3 parts: a stimulation lead, an internal pulse generator, and the respiratory sensing lead.…”