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

Cammaroto, Giovanni; Stringa, L; Iannella, Giannicola; Meccariello, Giuseppe; Zhang, Henry; Bahgat, Ahmed; Calvo‐Henríquez, Christian; Chiesa‐Estomba, Carlos Miguel; Lechien, Jérôme R.; Barillari, Maria Rosaria; Galletti, Bruno; Galletti, Francesco; Freni, Francesco; Galletti, C; Vicini, Claudio

doi:10.3390/ijerph17155315

Cited by 16 publications

(8 citation statements)

References 28 publications

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“…In recent years, lateral pharyngeal wall collapse has been reconsidered in OSA pathogenesis, and palatal surgical techniques have evolved from ablative techniques towards the remodeling of the pharyngeal lateral walls and enlargement of the velopharyngeal lumen [ 51 ].…”

Section: Oropharyngeal Surgerymentioning

confidence: 99%

OSA Upper Airways Surgery: A Targeted Approach

et al. 2021

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Obstructive sleep apnea syndrome (OSA) is a multi-factorial disorder, with quite complex endotypes, consisting of anatomical and non-anatomical pathophysiological factors. Continuous positive airway pressure (CPAP) is recognized as the first-line standard treatment for OSA, whereas upper airway (UA) surgery is often recommended for treating OSA patients who have refused or cannot tolerate CPAP. The main results achievable by the surgery are UA expansion, and/or stabilization, and/or removal of the obstructive tissue to different UA levels. The site and pattern of UA collapse identification is of upmost importance in selecting the customized surgical procedure to perform, as well as the identification of the relation between anatomical and non-anatomical factors in each patient. Medical history, sleep studies, clinical examination, UA endoscopy in awake and drug-induced sedation, and imaging help the otorhinolaryngologist in selecting the surgical candidate, identifying OSA patients with mild UA collapsibility or tissue UA obstruction, which allow achievement of the best surgical outcomes. Literature data reported that the latest palatal surgical procedures, such as expansion sphincter palatoplasty or barbed reposition palatoplasty, which achieve soft palatal and lateral pharyngeal wall remodeling and stiffening, improved the Apnea Hypopnea Index, but the outcome analyses are still limited by methodological bias and the limited number of patients’ in each study. Otherwise, the latest literature data have also demonstrated the role of UA surgery in the improvement of non-anatomical factors, confirming that a multidisciplinary and multimodality diagnostic and therapeutical approach to OSA patients could allow the best selection of customized treatment options and outcomes.

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Section: Oropharyngeal Surgerymentioning

confidence: 99%

OSA Upper Airways Surgery: A Targeted Approach

et al. 2021

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“…Finally, the myofunctional therapy (MFT) with its active training of the oropharyngeal muscles has been introduced as an OSA treatment modality. The current studies demonstrate a positive effect in reducing sleep apnea, as shown by the post-therapy improvement of polysomnography values and clinical symptoms [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ].…”

mentioning

confidence: 64%

“…There are many surgical procedures proposed for the treatment of OSA. Surgery of the velo-pharyngeal region had a huge evolution going from ablative techniques (UP3 and LAUP) to remodeling techniques of the pharyngeal lateral walls [ 18 , 19 , 20 , 21 ]. In this scenario, barbed reposition pharyngoplasty (BRP), devised by Vicini et al [ 22 ], showed excellent outcomes at short- and long-term follow-up [ 23 , 24 ].…”

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confidence: 99%

Obstructive Sleep Apnea Syndrome: From Symptoms to Treatment

Iannella

Magliulo

Greco

et al. 2022

IJERPH

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Obstructive sleep apnea (OSA) syndrome is a respiratory sleep disorder characterized by partial or complete recurrent episodes of upper airway collapse that occur during the night. The OSA manifests with a reduction (hypopnea) or complete cessation (apnea) of airflow in the upper airways, associated with breathing effort. OSA is a frequent and often underestimated pathology affecting between 2 and 5% of the middle-aged population. Typical nocturnal symptoms are the persistent snoring and awakenings with dyspnea sensation. On the other hand, diurnal symptoms could be sleepiness, headaches, asthenia, neurological disorders, and impaired personal relationships. Surgery of the velo-pharyngeal region had a huge evolution going from ablative techniques (UP3 and LAUP) to remodeling techniques of the pharyngeal lateral walls.

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“…Over time, oropharyngeal surgical methods have advanced from excisional techniques towards the more preservative remodeling of the oropharynx, particularly targeting the lateral walls and conducting expansion of the velopharynx space [ 81 ]. Among the first of the aforementioned methods was transpalatal advancement pharyngoplasty (TPA), a technique introduced by Woodson et al who intended it for patients who underwent unsuccessful UPPP and were found to have lasting velopharyngeal collapse [ 82 ].…”

Section: Surgical Therapy For Obstructive Sleep Apneamentioning

confidence: 99%

Oromaxillofacial Surgery: Both a Treatment and a Possible Cause of Obstructive Sleep Apnea—A Narrative Review

Martinović

Tokic

Puizina-Mladinic

et al. 2023

Life

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Obstructive sleep apnea (OSA) is a chronic, sleep-related breathing disorder. It is characterized by a nocturnal periodic decrease or complete stop in airflow due to partial or total collapse of the oropharyngeal tract. Surgical treatment of OSA is constantly evolving and improving, especially with the implementation of new technologies, and this is needed because of the very heterogeneous reasons for OSA due to the multiple sites of potential airway obstruction. Moreover, all of these surgical methods have advantages and disadvantages; hence, patients should be approached individually, and surgical therapies should be chosen carefully. Furthermore, while it is well-established that oromaxillofacial surgery (OMFS) provides various surgical modalities for treating OSA both in adults and children, a new aspect is emerging regarding the possibility that some of the surgeries from the OMFS domain are also causing OSA. The latest studies are suggesting that surgical treatment in the head and neck region for causes other than OSA could possibly have a major impact on the emergence of newly developed OSA, and this issue is still very scarcely mentioned in the literature. Both oncology, traumatology, and orthognathic surgeries could be potential risk factors for developing OSA. This is an important subject, and this review will focus on both the possibilities of OMFS treatments for OSA and on the OMFS treatments for other causes that could possibly be triggering OSA.

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

Cited by 16 publications

References 28 publications

OSA Upper Airways Surgery: A Targeted Approach

OSA Upper Airways Surgery: A Targeted Approach

Obstructive Sleep Apnea Syndrome: From Symptoms to Treatment

Oromaxillofacial Surgery: Both a Treatment and a Possible Cause of Obstructive Sleep Apnea—A Narrative Review

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