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European Archives of Oto-Rhino-Laryngology

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25-05-2023 | Sleep Apnea | Review Article

Barbed palatal surgery: single stage or multilevel setting—a systematic review by the Young Otolaryngologists of the Italian Society of Otolaryngology

Authors: Cerritelli Luca, Capasso Pasquale, Tripodi Caterina, Moffa Antonio, Leone Federico, Pace Annalisa, Albertini Riccardo, Mannelli Giuditta, Russo Gennaro, Cammaroto Giovanni

Published in: European Archives of Oto-Rhino-Laryngology | Issue 9/2023

Abstract

Purpose

This systematic review aims to compare the efficacy and safety of multilevel and single level surgery, including barbed pharyngoplasties, in the treatment of obstructive sleep apnea (OSA).

Methods

The study followed PRISMA guidelines and searched PubMed/MEDLINE, Google Scholar, and Ovid databases for studies evaluating the effect of barbed pharyngoplasties on adults with OSA. Prospective and retrospective cohort studies were included with pre- and post-treatment comparisons of sleep tests and self-reported clinical outcomes. Exclusion criteria were non-English studies, case reports, reviews, conference abstracts, letters, and pediatric studies. Successful surgery was classified using Sher’s criteria.

Results

The study selected a total of 1014 patients from 26 studies, 24 of which were longitudinal studies with 10 retrospective trials and 14 prospective studies. The average age of the patients was 46.9 years, with an average Body Mass Index (BMI) of 25.6 kg/m². Most of the patients were male (84.6%). The study included only palatal surgical techniques with barbed sutures, and patients who underwent cardio-respiratory monitoring and Drug Induced Sleep Endoscopy (DISE) before surgery. Mean Apnea Hypopnea Index (AHI) preoperative was 32.9/h, AHI postoperative was 11.9/h, and mean reduction of AHI was 62.3%. The most commonly adopted palatoplasty was Barbed Repositioning Pharyngoplasty (BRP) in 16 out of 26 studies, followed by its subsequent modifications in 3 studies.

Conclusions

Barbed pharyngoplasties appear to be effective both on objective measurement and subjective scores. DISE represents a fundamental tool to assess uni-level or multilevel obstruction. When retro-palatal collapse is present, barbed pharyngoplasty appears to be effective. Barbed pharyngoplasties maintain their good results both in single level or multilevel surgery. Randomized clinical controlled trials with multi-center cooperation and long-term study are necessary.

American Academy of Sleep Medicine (2017) International classification of sleep disorders, 3rd edn. American Academy of Sleep Medicine, Darien

Vitiello MV, Boehlecke B (2015) Barriers to continuous positive airway pressure use in adults with obstructive sleep apnea. Sleep Med Clin 10(3):259–268

Chan A, Remmers JE (2019) Surgical management of obstructive sleep apnea. Chest 156(4):826–836

Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. https://doi.org/10.1371/journal.pmed.1000097CrossRefPubMedPubMedCentral

Sher AE (2002) Upper airway surgery for obstructive sleep apnea. Sleep Med Rev 6:195–212CrossRefPubMed

De Apodaca PM, Llatas MC, Gras MV, Galofre JD (2020) Improving surgical results in velopharyngeal surgery: our experience in the last decade. Acta Otorrinolaringol (English Edition) 71(4):197–203CrossRef

De Vito A, Carrasco Llatas M, Ravesloot MJ, Kotecha B, De Vries N, Hamans E, Maurer J, Bosi M, Blumen M, Heiser C, Herzog M, Montevecchi F, Corso RM, Braghiroli A, Gobbi R, Vroegop A, Vonk PE, Hohenhorst W, Piccin O, Sorrenti G, Vanderveken OM, Vicini C (2018) European position paper on drug-induced sleep endoscopy: 2017 Update. Clin Otolaryngol 43(6):1541–1552. https://doi.org/10.1111/coa.13213. (Epub 2018 Sep 30 PMID: 30133943)CrossRefPubMed

Riley RW, Powell NB, Guilleminault C (1993) Obstructive sleep apnea syndrome: a surgical protocol for dynamic upper airway reconstruction. J Oral Maxillofac Surg 51(7):742–747. https://doi.org/10.1016/s0278-2391(10)80412-4. (Discussion 748-9 PMID: 8509912)CrossRefPubMed

Lin HC, Weaver EM, Lin HS, Friedman M (2017) Multilevel obstructive sleep apnea surgery. Adv Otorhinolaryngol 80:109–115. https://doi.org/10.1159/000470879. (Epub 2017 Jul 17. PMID: 28738374)CrossRefPubMed

10.

Friedman M, Ibrahim H, Lee G, Joseph NJ (2003) Combined uvulopalatopharyngoplasty and radiofrequency tongue base reduction for treatment of obstructive sleep apnea/hypopnea syndrome. Oto- laryngol Head Neck Surg 129:611–621CrossRef

11.

Liu SY, Riley RW, Yu MS (2020) Surgical algorithm for obstructive sleep apnea: an update. Clin Exp Otorhinolaryngol 13(3):215–224. https://doi.org/10.21053/ceo.2020.01053. (Epub 2020 Jul 1. PMID: 32631040; PMCID: PMC7435437)CrossRefPubMedPubMedCentral

12.

Vanderveken OM (2018) Drug-induced sleep endoscopy (DISE) as a guide towards upper airway behaviour and treatment outcome: the quest for a vigorous standardization of DISE. Sleep Breath 22(4):897–899. https://doi.org/10.1007/s11325-018-1743-2. (Epub 2018 Oct 18 PMID: 30338440)CrossRefPubMed

13.

Riley RW, Powell NB, Guilleminault C (1993) Obstructive sleep apnea syndrome: a review of 306 consecutively treated sur- gical patients. Otolaryngol Head Neck Surg 108:117–125CrossRefPubMed

14.

Abdullah VJ, van Hasselt CA (2005) Video sleep nasendoscopy. In: Terris DJ, Goode RL (eds) Surgical management of sleep apnea and snoring. Taylor and Francis, Boca Raton, pp 143–154CrossRef

15.

Vroegop AV, Vanderveken OM, Boudewyns AN et al (2014) Drug-induced sleep endoscopy in sleep-disordered breathing: report on 1249 cases. Laryn- goscope 124:797–802CrossRef

16.

Tang JA, Salapatas AM, Bonzelaar LB, Friedman M (2017) Long-term incidence of velopharyngeal insufficiency and other sequelae following uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 156(4):606–610. https://doi.org/10.1177/0194599816688646. (Epub 2017 Jan 24 PMID: 28116979)CrossRefPubMed

17.

Friberg D, Sundman J, Browaldh N (2019) Long-term evaluation of satisfaction and side effects after modified uvulopalatopharyngoplasty. Laryngoscope 2019:12

18.

Pinto V, Piccin O (2018) Making pharyngoplasty simple and safe: when plastic surgery meets sleep surgery. Plast Reconstr Surg 142(6):987e–988e. https://doi.org/10.1097/PRS.0000000000005036CrossRefPubMed

19.

Kamami YV (1994) Outpatient treatment of sleep apnea syndrome with CO 2 laser, LAUP: laser-assisted UPPP results on 46 patients. J Clin Laser Med Surg 12(4):215–219. https://doi.org/10.1089/clm.1994.12.215. (PMID: 10172096)CrossRefPubMed

20.

Volner K, Dunn B, Chang ET, Song SA, Liu SY, Brietzke SE, O’Connor P, Camacho M (2017) Transpalatal advancement pharyngoplasty for obstructive sleep apnea: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 274(3):1197–1203. https://doi.org/10.1007/s00405-016-4121-3. (Epub 2016 Jun 11 PMID: 27289234)CrossRefPubMed

21.

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.2007.03.014CrossRefPubMed

22.

Pang KP, Pang EB, Win MT, Pang KA, Woodson BT (2016) Expansion sphincter pharyngoplasty for the treatment of OSA: a systemic review and meta-analysis. Eur Arch Otorhinolaryngol 273(9):2329–2333. https://doi.org/10.1007/s00405-015-3831-2CrossRefPubMed

23.

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.23911CrossRefPubMed

24.

Casale M, Moffa A, Giorgi L et al (2022) No-cutting remodelling intra-pharyngeal surgery can avoid CPAP in selected OSA patients: myth or reality? Eur Arch Otorhinolaryngol 279(10):5039–5045. https://doi.org/10.1007/s00405-022-07261-6CrossRefPubMed

25.

Vicini C, Hendawy E, Campanini A et al (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/s00405-015-3628-3CrossRefPubMed

26.

Gulotta G, Iannella G, Meccariello G, Cammaroto G, Visconti IC, de Vincentiis M, Greco A, Pelucchi S, Magliulo G, Ruoppolo G, Maniaci A, Cocuzza S, La Mantia I, De Vito A, Abita P, Vicini C (2021) Barbed suture extrusion and exposure in palatoplasty for OSA: what does it mean? Am J Otolaryngol 42(4):102994. https://doi.org/10.1016/j.amjoto.2021.102994. (Epub 2021 Feb 20. PMID: 33639448)CrossRefPubMed

27.

Moffa A, Giorgi L, Cassano M, Lugo R, Baptista P, Casale M (2022) Complications and side effects after barbed pharyngoplasty: a systematic review. Sleep Breath. https://doi.org/10.1007/s11325-022-02585-3. (Epub ahead of print. PMID: 35217931)CrossRefPubMed

28.

Pang KP, Vicini C, Montevecchi F et al (2020) Long-term complications of palate surgery: a multicenter study of 217 patients. Laryngoscope 130(9):2281–2284. https://doi.org/10.1002/lary.28432CrossRefPubMed

29.

Iannella G, Vallicelli B, Magliulo G et al (2020) Long-term subjective outcomes of barbed reposition pharyngoplasty for obstructive sleep apnea syndrome treatment. Int J Environ Res Public Health 17(5):1542. https://doi.org/10.3390/ijerph17051542. (Published 2020 Feb 27)CrossRefPubMedPubMedCentral

30.

Mantovani M, Carioli D, Torretta S, Rinaldi V, Ibba T, Pignataro L (2017) Barbed snore surgery for concentric collapse at the velum: the Alianza technique. J Craniomaxillofac Surg 45(11):1794–1800. https://doi.org/10.1016/j.jcms.2017.08.007CrossRefPubMed

31.

Baptista PM, Diaz Zufiaurre N, Garaycochea O et al (2022) TORS as part of multilevel surgery in OSA: the importance of careful patient selection and outcomes. J Clin Med 11(4):990. https://doi.org/10.3390/jcm11040990. (Published 2022 Feb 14)CrossRefPubMedPubMedCentral

32.

Thaler ER, Rassekh CH, Lee JM, Weinstein GS, O’Malley BW Jr (2016) Outcomes for multilevel surgery for sleep apnea: obstructive sleep apnea, transoral robotic surgery, and uvulopalatopharyngoplasty. Laryngoscope 126(1):266–269. https://doi.org/10.1002/lary.25353. (Epub 2015 Jul 7 PMID: 26153069)CrossRefPubMed

33.

Ravesloot MJ, de Vries N (2011) One hundred consecutive patients undergoing drug- induced sleep endoscopy: results and evaluation. Laryngoscope 121:2710–2716CrossRefPubMed

34.

Saenwandee P, Neruntarat C, Saengthong P et al (2022) Barbed pharyngoplasty for obstructive sleep apnea: a meta-analysis. Am J Otolaryngol 43(2):103306–103307. https://doi.org/10.1016/j.amjoto.2021.103306CrossRefPubMed

35.

Mantovani M, Rinaldi V, Torretta S, Carioli D, Salamanca F, Pignataro L (2016) Barbed Roman blinds technique for the treatment of obstructive sleep apnea: how we do it? Eur Arch Otorhinolaryngol 273(2):517–523. https://doi.org/10.1007/s00405-015-3726-2. (Epub 2015 Jul 21 PMID: 26194006)CrossRefPubMed

36.

Vicini C, Meccariello G, Montevecchi F et al (2020) Effectiveness of barbed repositioning pharyngoplasty for the treatment of obstructive sleep apnea (OSA): a prospective randomized trial. Sleep Breath 24(2):687–694. https://doi.org/10.1007/s11325-019-01956-7CrossRefPubMed

37.

Iannella G, Magliulo G, Cammaroto G et al (2022) Effectiveness of drug-induced sleep endoscopy in improving outcomes of barbed pharyngoplasty for obstructive sleep apnea surgery: a prospective randomized trial. Sleep Breath 26(4):1621–1632. https://doi.org/10.1007/s11325-021-02528-4CrossRefPubMed

38.

Friedman M, Ibrahim H, Bass L (2002) Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg 127(1):13–21. https://doi.org/10.1067/mhn.2002.126477CrossRefPubMed

39.

Tsou YA, Hsu CC, Shih LC, Lin TC, Chiu CJ, Tien VH, Tsai MH, Chang WD (2021) Combined transoral robotic tongue base surgery and palate surgery in obstructive sleep apnea syndrome: modified uvulopalatopharyngoplasty versus barbed reposition pharyngoplasty. J Clin Med 10(14):3169. https://doi.org/10.3390/jcm10143169.PMID:34300335;PMCID:PMC8306291CrossRefPubMedPubMedCentral

40.

Matarredona-Quiles S, Carrasco-Llatas M, Apodaca PM, Ortega-Beltrá N, Dalmau-Galofre J (2022) Is there a relationship between tonsil volume and the success of pharyngeal surgery among adult patients with obstructive sleep apnea? Braz J Otorhinolaryngol. https://doi.org/10.1016/j.bjorl.2021.12.002CrossRefPubMedPubMedCentral

Title: Barbed palatal surgery: single stage or multilevel setting—a systematic review by the Young Otolaryngologists of the Italian Society of Otolaryngology
Authors: Cerritelli Luca
Capasso Pasquale
Tripodi Caterina
Moffa Antonio
Leone Federico
Pace Annalisa
Albertini Riccardo
Mannelli Giuditta
Russo Gennaro
Cammaroto Giovanni
Publication date: 25-05-2023
Publisher: Springer Berlin Heidelberg
Keywords: Sleep Apnea
Pharyngoplasty
Snoring
Published in: European Archives of Oto-Rhino-Laryngology / Issue 9/2023
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-023-08018-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Barbed palatal surgery: single stage or multilevel setting—a systematic review by the Young Otolaryngologists of the Italian Society of Otolaryngology

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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