Sabrina Frassineti

Transoral Robotic Tongue Base Resection in Obstructive Sleep Apnoea-Hypopnoea Syndrome: A Preliminary Report

Purpose of the Study:To evaluate the feasibility, tolerability and efficacy of tongue base management by means of transoral robotic surgery (TORS) in patients suffering from the obstructive sleep apnoea-hypopnoea syndrome (OSAHS) primarily related to hypertrophy of the tongue base. Procedure:Seventeen patients with OSAHS principally related to tongue base hypertrophy were managed by means of TORS (Intuitive da Vinci®). Patients with a minimum follow-up of 3 months were evaluated. Results: Ten patients [mean preoperative apnoea-hypopnoea index (AHI): 38.3 ± 23.5 SD] were included in the study. By means of robotic technology, the tongue base and the epiglottis could be managed. The postoperative polysomnographic results were fairly good (mean postoperative AHI: 20.6 ± 17.3 SD), and the functional results (pain, swallowing and quality of life) are very encouraging; altogether, complications were rare and of minor importance. Conclusions: Transoral robotic tongue base management in patients with OSAHS primarily related to tongue base hypertrophy is feasible and well tolerable. These preliminary results are encouraging and worthy of further evaluation.

Transoral robotic surgery of the tongue base in obstructive sleep Apnea‐Hypopnea syndrome: Anatomic considerations and clinical experience

The purpose of our work was to describe, through cadaveric dissection, the anatomy of the tongue base with a robotic perspective and to demonstrate the feasibility of this approach in case of tongue base hypertrophy in Obstructive Sleep Apnea‐Hypopnea Syndrome (OSAHS).

The nose oropharynx hypopharynx and larynx (NOHL) classification: a new system of diagnostic standardized examination for OSAHS patients.

The main pathological event of obstructive sleep apnea hypopnea syndrome (OSAHS) is the apneic collapse of the upper airways (UA). Frequently, UA collapse occurs at the same time at different section levels. Identifying the site and the dynamic pattern of obstruction is mandatory in therapeutical decision-making, and in particular if a surgical therapy option is taken into account. Nowadays, awake fiberoptic nasopharyngeal endoscopy represents the first level diagnostic technique to be performed in such patients, but recently, the drug-induced sleep endoscopy (DISE) has been introduced to overcome the limits of the awake nasopharyngeal endoscopy. Whatever diagnostic tool we decide to use, one of the main problems encountered is the standardization of the description of the sites and dynamic patterns of UA collapses. In this paper, the authors describe the NOHL classification, which could be applied during awake and sleep endoscopy, and allows a simple, quick, and effective evaluation of grade and patterns of UA collapse, suggesting its application, especially in therapeutical decision-making and in the analysis of surgical outcomes.

Combined transoral robotic tongue base surgery and palate surgery in obstructive sleep apnea‐hypopnea syndrome: Expansion sphincter pharyngoplasty versus uvulopalatopharyngoplasty

Transoral robotic surgery (TORS) for obstructive sleep apnea‐hypopnea syndrome is a relatively young technique principally devised for managing apneas in the tongue base (TB) area and supraglottic larynx. This procedure is included in the so‐called “multilevel surgery” often including a palatal and nasal surgery.

Hyoidthyroidpexia as a treatment in multilevel surgery for obstructive sleep apnea

Conclusion. This type of surgery is effective in patients with obstructive sleep apnea syndrome (OSAS), but may not be effective in obese patients or those with a preoperative apnea hypopnea index (AHI)>35. For these reasons, the careful study and selection of patients is fundamental in the surgical treatment of OSAS. Objectives. Evaluation of the efficacy of hyoid surgery combined with oropharynx and nose surgery in the treatment of OSAS. Subjects and methods. A total of 109 OSAS patients underwent hyoidthyroidpexia as a treatment in multilevel surgery. Before surgery all patients were treated with continuous positive airway pressure (CPAP) therapy for at least 6 months and underwent preoperative and postoperative polysomnography. The preoperative examination was composed of upper airways endoscopy, lateral cephalometric radiograph, calculation of body mass index (BMI), and subjective analysis of daytime sleepiness. Results. In all, 67/109 patients (61.5%) with postoperative AHI<20 were defined as ‘responders’, while the other 42 patients (38.5%) were defined as ‘non-responders’. The correlation between preoperative BMI and postoperative AHI revealed that non-responders had a much higher average BMI compared with responders. Moreover, when analyzing median preoperative and postoperative AHI, it emerged that non-responders had a much higher preoperative AHI compared with responders.