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Common head and neck viva topics
Published in Joseph Manjaly, Peter Kullar, Advanced ENT Training, 2019
Surgical options include nasal surgery (septoplasty, inferior turbinate reduction, polypectomy; when significant nasal obstruction may be contributing to the sleep disordered breathing) tonsillectomy, uvulopalatoplasty and more rarely tongue base reduction (robotic surgery has been described). Less commonly performed operations include mandibular advancement, hyoid suspension and more recently, implantable hypoglossal nerve stimulators.
The Surgical Management of Snoring and Obstructive Sleep Apnoea
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Bhik Kotecha, Mohamed Reda Elbadawey
A number of procedures were described in the literature aimed at dilating the hypopharynageal airway, including genioglossus advancement, tongue base suspension suture, hyoid suspension, maxillomandibular advancement and laser midline glossectomy. Most of the reports describing these procedures are pilot studies with no standardized comparison of other techniques used in the treatment of OSA. The reported success rate of some of these procedures approaches 60% in the short term. These procedures are associated with relatively high complication rates, such as swallowing problems, taste change, tongue oedema, tooth numbness and mandibular fractures. The midline laser glossectomy was associated with a high incidence of post-operative bleeding.117
Evidence-Based Approach to Therapy
Published in Mark A. Richardson, Norman R. Friedman, Clinician’s Guide to Pediatric Sleep Disorders, 2016
Nira A. Goldstein, Richard M. Rosenfeld
Cohen and Burstein (97–99) have published several case series describing their use of skeletal expansion combined with soft-tissue reduction in their children with craniofacial syndromes or cerebral palsy and refractory obstructive sleep apnea. In addition to T&A and UPPP, soft-tissue procedures included septoplasty and turbinectomy, tongue reduction, and tongue hyoid suspension. Skeletal expansion procedures included mandibular advancement, costochondral grafts, mandibular distraction, temporomandibular joint arthroplasty, and Le Fort procedures. Tracheotomy was avoided in 90% of their patients, whereas 80% of their tracheotomized children were successfully decannulated. Supplemental oxygen therapy or CPAP was still required by 8% of the patients. The mean apnea–hypopnea index decreased from 25.9 to 4.4 after surgery, whereas the mean lowest oxygen saturation increased from 61% to 92%. Based on a few published case series, tracheotomy is considered curative in complicated children with refractory OSA and severe upper airway obstruction (100,101).
Z-palatopharyngoplasty combined with 70-degree endoscopy-assisted coblator partial medial glossectomy on severe obstructive sleep apnea
Published in Acta Oto-Laryngologica, 2019
Huaihong Chen, Jiangping Wang, Xiaoxing Huang, Yuanshou Huang, Juan Lu, Xiangping Li
Upper airway collapse is at the core of OSA pathogenesis. The uvulopalatopharyngoplasty (UPPP) surgical technique is widely used across the world, with an effectiveness of about 40–50%. Z-palatopharyngoplasty (ZPPP) was originally developed for OSA patients lacking tonsils or with pharyngeal obstruction. The clinical efficacy and safety of ZPPP has been previously confirmed in other studies [2]. It has been proposed that multi-level surgical strategy for all obstruction planes may significantly improve the OSA surgical outcome [1]. The surgical principle is based on the reduction or suspension technique of tongue tissue. The most commonly used surgical techniques for management of tongue plane collapse include radiofrequency ablation of the tongue base (RFBOT), genioglossus advancement hyoid myotomy, hyoid suspension, lingual midline resection, and hypoglossal nerve stimulation among others [3]. The hyoid suspension technique generally requires specialized surgical instruments and equipment. A large amount of research is currently focused on identifying different tongue base resection techniques. The purpose of this study was to evaluate the safety and efficacy of combined ZPPP with 70-degree endoscopy-assisted midline partial glossectomy for the surgical treatment of patients with severe OSA.
The effect of obstructive sleep apnea surgery on laryngopharyngeal reflux with obstructive sleep apnea
Published in Acta Oto-Laryngologica, 2020
Ruiyi Yue, Dengxiang Xing, Jie Qin, Haibo Lu, Chun Liu, Shuhua Li, Dahai Wu
All the 45 patients underwent multilevel OSA surgery such as tonsillectomy, uvulopalatopharyngoplasty (UPPP), hyoid suspension, midline glossectomy, and so on. According to PSG, sleep endoscopy and pharyngeal computed tomography (CT), the main obstruction sites of the upper airway were comprehensively judged. Patients with velopharyngeal obstruction alone were performed UPPP and tonsillectomy. Patients with lingual hypertrophy underwent midline glossectomy combined with UPPP and tonsillectomy. Patients with glossocoma received hyoid suspension combined with UPPP and tonsillectomy.