Various combinations of velopharyngeal and hypopharyngeal surgical procedures for treatment of obstructive sleep apnea: Single-stage, multilevel surgery

Bınar, Murat; Karakoç, Ömer; Akçam, Timur; Asik, Burak; Gerek, Mustafa

doi:10.1016/j.amjoto.2017.06.003

Cited by 2 publications

(1 citation statement)

References 43 publications

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“…This lack of compliance has been demonstrated in many studies and is linked to the mild forms of pathology which experience lesser benefits from CPAP treatment. Our success rate is similar to those in other reports which analyzed the efficacy of multilevel single‐stage surgery with various combinations of oropharyngeal and hypopharyngeal procedures; in these papers, the success rate varied from 56% to 66.4% . Unlike the subjects in those papers, our patients have also undergone septoplasty during the same multilevel surgery, and these data confirm the marginal role of nasal surgery in the correction of apneas.…”

Section: Discussionsupporting

confidence: 89%

Outcomes in single‐stage multilevel surgery for obstructive sleep apnea: Transoral robotic surgery, expansion sphincter pharyngoplasty and septoplasty

Cambi

Chiri

Santis

et al. 2019

Robotics Computer Surgery

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Background: Many patients with obstructive sleep apnea syndrome (OSAS) have multiple obstructive sites simultaneously such as the oropharynx, hypopharynx, and larynx. Multilevel surgery is starting to be widely performed by ENT surgeons and accepted by patients.Methods: Twenty consecutive patients with moderate or severe OSAS were treated with single-stage multilevel surgery. They underwent transoral robotic surgery for tongue base reduction or epiglottoplasty, expansion sphincter pharyngoplasty, and septoplasty. Results:The average length of hospitalization was 5.2 ± 0.9 days. No serious complications were observed. At the postoperative control with polysomnography, the apnea-hypopnea index (AHI) had decreased by at least 50% in 90% of patients;improvements were observed in all sleep parameters. Conclusion:Single-stage multilevel surgery has proven to be effective in treating patients with moderate to severe OSAS, without experiencing persistent complaints.Despite multiple levels of obstruction being operated in a single stage, airway safety was maintained in all patients. K E Y W O R D S expansion sphincter pharyngoplasty, multilevel surgery, OSAS, TORS 1 | INTRODUCTION Obstructive sleep apnea syndrome (OSAS) is characterized by recurring events of partial or complete upper airway collapse during sleep.It is related to increased risk of cardiovascular diseases and causes daytime sleepiness altering the quality of life. To eliminate the collapsing points in the airway, continuous positive airway pressure (CPAP) is the first-choice treatment and the first option that is recommended to the patient. Nevertheless, a significant number of patients refuse CPAP treatment, and in this case, surgical treatment becomes an alternative along with weight loss, orthodontic, and positional therapy.Most OSAS patients have multilevel obstructions at sites including the oropharynx, hypopharynx, and larynx, so the best surgical management must be multilevel. 1

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Section: Discussionsupporting

confidence: 89%

Outcomes in single‐stage multilevel surgery for obstructive sleep apnea: Transoral robotic surgery, expansion sphincter pharyngoplasty and septoplasty

Cambi

Chiri

Santis

et al. 2019

Robotics Computer Surgery

View full text Add to dashboard Cite

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Pharyngeal Manometry and Upper Airway Collapse During Drug-Induced Sleep Endoscopy

Harkins,

Tangutur,

Keenan

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceDrug-induced sleep endoscopy (DISE) is used to guide therapeutic management of obstructive sleep apnea (OSA), depending on the levels and patterns of pharyngeal collapse. However, the collapsibility of specific pharyngeal sites remains unknown.ObjectiveTo assess collapse sites in patients with OSA undergoing DISE and whether number and location are associated with differences in airway collapsibility; and to quantify differences in collapsibility between primary and secondary sites in multilevel collapse.Design, Setting, and ParticipantsThis cohort study assessed adult patients (≥18 years) with OSA undergoing DISE with manometry and positive airway pressure (PAP) titration at a tertiary care center from November 2021 to November 2023. Patients with an AHI score greater than 5 were included; those with less than 1 apnea event during DISE or incorrect catheter placement were excluded. Data were analyzed from September 28, 2022, to March 31, 2024.ExposureDISE with manometry and PAP titration.Main Outcomes and MeasuresActive pharyngeal critical pressure (Pcrit-A) and pharyngeal opening pressure (PhOP) were used to quantify airway collapsibility, adjusted for covariates (age, sex, race, and body mass index [BMI]).ResultsOf 94 screened, 66 patients (mean [SD] age, 57.4 [14.3] years; BMI, 29.2 [3.9]; 51 [77.3%] males) with a mean (SD) apnea-hypopnea index (AHI) of 31.6 (19.0) were included in the analysis. Forty-seven patients (71.2%) had multilevel collapse, 10 (15.2%) had single-level nasopalatal collapse, and 9 (13.6%) had single-level infrapalatal collapse. Groups did not differ in demographic characteristics or established measures of OSA severity. The single-level nasopalatal group had substantially elevated levels of airway collapsibility (Pcrit-A and PhOP covariate adjusted mean, 2.4; 95% CI, 1.1 to 3.8; and 8.2; 95% CI, 6.4 to 9.9 cmH2O) compared to the single-level infrapalatal group (−0.9; 95% CI, −2.4 to 0.5 cmH2O; and 4.9; 95% CI, 3.0 to 6.8 cmH2O, respectively) and similar to the level among the multilevel group (1.3; 95% CI, 0.7 to 2.0; and 8.5; 95% CI, 7.7 to 9.3 cmH2O). The multilevel group had more negative inspiratory pressure (−24.2; 95% CI, −28.1 to −20.2 cmH2O) compared to the single-level nasopalatal group (−9.8; 95% CI, −18.3 to −1.28 cmH2O). In patients with multilevel collapse, airway collapsibility was significantly higher at the primary nasopalatal compared to secondary infrapalatal site (mean difference, 13.7; 95% CI, 11.3 to 16.1 cmH2O).Conclusions and RelevanceThe findings of this cohort study suggest that intervention should target the primary site of pharyngeal collapse, and secondary sites only if they are nearly as collapsible as the primary site. Future work is needed to precisely define the difference in primary and secondary collapsibility that necessitates multilevel treatment.

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Various combinations of velopharyngeal and hypopharyngeal surgical procedures for treatment of obstructive sleep apnea: Single-stage, multilevel surgery

Cited by 2 publications

References 43 publications

Outcomes in single‐stage multilevel surgery for obstructive sleep apnea: Transoral robotic surgery, expansion sphincter pharyngoplasty and septoplasty

Outcomes in single‐stage multilevel surgery for obstructive sleep apnea: Transoral robotic surgery, expansion sphincter pharyngoplasty and septoplasty

Pharyngeal Manometry and Upper Airway Collapse During Drug-Induced Sleep Endoscopy

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