Advertisement

Barbed suspension pharyngoplasty for treatment of lateral pharyngeal wall and palatal collapse in patients affected by OSAHS

  • Marco Barbieri
  • Francesco MissaleEmail author
  • Fabiola Incandela
  • Marco Fragale
  • Andrea Barbieri
  • Valeria Roustan
  • Frank Rikki Canevari
  • Giorgio Peretti
Miscellaneous
  • 13 Downloads

Abstract

Purpose

The aim of this study is to analyze the efficacy of a new modified pharyngoplasty technique with barbed sutures: barbed suspension pharyngoplasty (BSP).

Methods

We enrolled patients affected by obstructive sleep apnea–hypopnea syndrome (OSAHS), having the main site of obstruction at the palatal and lateral pharyngeal walls, who refused or failed to tolerate CPAP therapy and underwent non-resective pharyngoplasty with barbed sutures between January 2014 and October 2017. Two surgical techniques with barbed sutures were used: barbed reposition pharyngoplasty (BRP) and BSP; the main characteristics of the latter are a double passage of the needle, each side, through the soft palate.

Results

Forty-two patients met the study inclusion criteria and were included in the analysis. Twenty-two patients underwent BRP and 20 BSP. Patients treated with both BRP and BSP achieved significant improvement in polysomnographic parameters: AHI, ODI, t90%, and daily sleepiness tested by the ESS questionnaire (p < 0.001). There were no significant differences between groups considering gender, age, or severity of OSAHS (p > 0.05). Outcomes were also comparable (p = 0.10) in the two groups; patients who underwent BSP had successful treatment in 100% of cases, compared to 86% with BRP, with a cure rate of 40% vs. 18%.

Conclusions

BSP is a novel surgical technique that is effective in treating oropharyngeal collapse and can be tailored for patients with high collapsibility of the soft palate who might benefit from the palatal stiffness given by multiple passages of the suture inside it.

Keywords

Sleep apnea OSA Pharyngoplasty Barbed Surgery Outcome 

Notes

Funding

None of the authors have any commercial interest in the subject of this study or received any financial or material support for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The research did not involve any animal models; the research involved human participants in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards; and informed consent was obtained from all individual participants included in the study. Ethical review and approval was not required for this study in accordance with the national and institutional requirements (Ethics committee IRCCS Ospedale Policlinico San Martino, Genoa). However, all patients preoperatively signed a consent form for disclosure of privacy in managing personal data for scientific purposes.

Supplementary material

Supplementary file1 (MOV 37446 kb)

References

  1. 1.
    Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, Hamilton GS, Dharmage SC (2017) Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 34:70–81.  https://doi.org/10.1016/j.smrv.2016.07.002 CrossRefGoogle Scholar
  2. 2.
    Eichler C, Sommer JU, Stuck BA, Hormann K, Maurer JT (2013) Does drug-induced sleep endoscopy change the treatment concept of patients with snoring and obstructive sleep apnea? Sleep Breath 17(1):63–68.  https://doi.org/10.1007/s11325-012-0647-9 CrossRefGoogle Scholar
  3. 3.
    Vroegop AV, Vanderveken OM, Boudewyns AN, Scholman J, Saldien V, Wouters K, Braem MJ, Van de Heyning PH, Hamans E (2014) Drug-induced sleep endoscopy in sleep-disordered breathing: report on 1249 cases. Laryngoscope 124(3):797–802.  https://doi.org/10.1002/lary.24479 CrossRefGoogle Scholar
  4. 4.
    Sethukumar P, Kotecha B (2018) Tailoring surgical interventions to treat obstructive sleep apnoea: one size does not fit all. Breathe (Sheff) 14(3):e84–e93.  https://doi.org/10.1183/20734735.020118 CrossRefGoogle Scholar
  5. 5.
    Sorrenti G, Piccin O (2013) Functional expansion pharyngoplasty in the treatment of obstructive sleep apnea. Laryngoscope 123(11):2905–2908.  https://doi.org/10.1002/lary.23911 CrossRefGoogle Scholar
  6. 6.
    Schwab RJ, Pack AI, Gupta KB, Metzger LJ, Oh E, Getsy JE, Hoffman EA, Gefter WB (1996) Upper airway and soft tissue structural changes induced by CPAP in normal subjects. Am J Respir Crit Care Med 154(4 Pt 1):1106–1116.  https://doi.org/10.1164/ajrccm.154.4.8887615 CrossRefGoogle Scholar
  7. 7.
    Cahali MB (2003) Lateral pharyngoplasty: a new treatment for obstructive sleep apnea hypopnea syndrome. Laryngoscope 113(11):1961–1968CrossRefGoogle Scholar
  8. 8.
    Pang KP, Woodson BT (2007) Expansion sphincter pharyngoplasty: a new technique for the treatment of obstructive sleep apnea. Otolaryngol Head Neck Surg 137(1):110–114.  https://doi.org/10.1016/j.otohns.2007.03.014 CrossRefGoogle Scholar
  9. 9.
    Woodson BT, Wooten MR (1994) Manometric and endoscopic localization of airway obstruction after uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 111(1):38–43.  https://doi.org/10.1177/019459989411100109 CrossRefGoogle Scholar
  10. 10.
    Vicini C, Hendawy E, Campanini A, Eesa M, Bahgat A, AlGhamdi S, Meccariello G, DeVito A, Montevecchi F, Mantovani M (2015) Barbed reposition pharyngoplasty (BRP) for OSAHS: a feasibility, safety, efficacy and teachability pilot study. "We are on the giant's shoulders". Eur Arch Otorhinolaryngol 272(10):3065–3070.  https://doi.org/10.1007/s00405-015-3628-3 CrossRefGoogle Scholar
  11. 11.
    Mantovani M, Minetti A, Torretta S, Pincherle A, Tassone G, Pignataro L (2012) The velo-uvulo-pharyngeal lift or "roman blinds" technique for treatment of snoring: a preliminary report. Acta Otorhinolaryngol Ital 32(1):48–53Google Scholar
  12. 12.
    Vignatelli L, Plazzi G, Barbato A, Ferini-Strambi L, Manni R, Pompei F, D'Alessandro R, Ginsen (2003) Italian version of the Epworth sleepiness scale: external validity. Neurol Sci 23(6):295–300.  https://doi.org/10.1007/s100720300004 CrossRefGoogle Scholar
  13. 13.
    Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545CrossRefGoogle Scholar
  14. 14.
    Vicini C, De Vito A, Benazzo M, Frassineti S, Campanini A, Frasconi P, Mira E (2012) The nose oropharynx hypopharynx and larynx (NOHL) classification: a new system of diagnostic standardized examination for OSAHS patients. Eur Arch Otorhinolaryngol 269(4):1297–1300.  https://doi.org/10.1007/s00405-012-1965-z CrossRefGoogle Scholar
  15. 15.
    Montevecchi F, Meccariello G, Firinu E, Rashwan MS, Arigliani M, De Benedetto M, Palumbo A, Bahgat Y, Bahgat A, Lugo Saldana R, Marzetti A, Pignataro L, Mantovani M, Rinaldi V, Carrasco M, Freire F, Delgado I, Salamanca F, Bianchi A, Onerci M, Agostini P, Romano L, Benazzo M, Baptista P, Salzano F, Dallan I, Nuzzo S, Vicini C (2017) Prospective multicentre study on barbed reposition pharyngoplasty standing alone or as a part of multilevel surgery for sleep apnoea. Clin Otolaryngol.  https://doi.org/10.1111/coa.13001 Google Scholar
  16. 16.
    Rashwan MS, Montevecchi F, Cammaroto G, Badr El Deen M, Iskander N, El Hennawi D, El Tabbakh M, Meccariello G, Gobbi R, Stomeo F, Vicini C (2017) Evolution of soft palate surgery techniques for obstructive sleep apnea patients: a comparative study for single-level palatal surgeries. Clin Otolaryngol.  https://doi.org/10.1111/coa.13027 Google Scholar
  17. 17.
    Pianta L, Bertazzoni G, Morello R, Perotti P, Nicolai P (2018) Barbed expansion sphincter pharyngoplasty for the treatment of oropharyngeal collapse in obstructive sleep apnoea syndrome: a retrospective study on 17 patients. Clin Otolaryngol 43(2):696–700.  https://doi.org/10.1111/coa.13008 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.IRCCS Ospedale Policlinico San MartinoGenoaItaly
  2. 2.Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of GenoaGenoaItaly
  3. 3.Department of Otorhinolaryngology, Maxillofacial and Thyroid SurgeryFondazione IRCCS, National Cancer Institute of Milan, University of MilanMilanItaly
  4. 4.Department of OtorhinolaryngologyOspedale Santa Maria Delle CrociRavennaItaly

Personalised recommendations