Barbed Pharyngoplasty and Sleep Disordered Breathing

Foreword
Foreword
Preface
Palate Surgery: The Never-Ending Story
Contents
1: Evolution of Palatal Surgery for Sleep-Disordered Breathing
1.1 Introduction
1.2 Historical Evolution
1.3 Conceptual Evolution
1.4 Technical Evolution
1.5 Postoperative Evolution
1.6 Summary
References
2: The New Generation of Palate Surgery for Obstructive Sleep Apnea
2.1 Introduction
2.2 Methodology
2.3 Statistical Method
2.4 Results
2.5 Discussion
2.6 Conclusion
References
3: Barbed Suture Technology
3.1 Introduction
3.2 Technical Features
3.3 Advantages of Barbed Suture Technology in Pharyngeal/Palatal Surgery
3.4 Complications
References
4: Overview of Barbed Suture in Non-ENT Surgery
4.1 Technological Development of Barbed Sutures in Different Surgical Fields
4.2 Current Surgical Applications of Barbed Sutures in Laparoscopic and Robotic Surgery
4.3 Barbed Sutures in Wound Closure and Plastic Surgery
References
5: Overview of Different Barbed Procedures for Sleep Breathing Disorders
References
6: Qualitative Phenotyping by Surrogate Index for the Selection of Patient Candidates for Velo-Pharyngeal Surgery
6.1 Endotypic Traits and UA Surgery
6.1.1 Upper Airway Surgery for OSA Modifies Anatomical Pharyngeal Collapsibility
6.1.2 Clinical Endotypic Trait Analysis Could Predict UA Surgical Outcomes
6.2 Techniques to Measure OSA Endotypes
6.3 Endotype Surrogate Measures for Clinical Application
6.4 Conclusions
References
7: Barbed Surgery Related Anatomy
7.1 Introduction
7.2 Oropharynx
7.2.1 Soft Palate
7.2.2 Palatine Tonsils
7.2.3 Barbed Snore Surgery: Anatomical Consideration
7.2.3.1 Pterygomandibular Raphe
7.2.3.2 Pterygoid Hamulus
7.2.3.3 Palatine Aponeurosis
7.2.3.4 Posterior Nasal Spine
References
8: Surgical Simulation for Barbed Pharyngoplasties
8.1 Background
8.2 Synthetic Models
8.3 Ex Vivo Surgical Model
8.4 Take Home Messages
References
9: New Philosophy in Palate-Oropharynx Procedures
9.1 Two Coaxial Tubes Theory
References
10: Barbed Anterior Pharyngoplasty
10.1 Introduction
10.1.1 Indications and Contraindications
10.1.2 Surgical Technique
10.2 Our Experience
References
11: Barbed Lateral Pharyngoplasty
11.1 Introduction
11.2 Material and Methods
11.2.1 Equipment
11.2.2 Principles
11.2.3 Indications and Contraindications
11.2.4 Surgical Planning
11.2.5 Surgical Technique
11.2.6 Post-operative Care
11.3 Outcomes from the Literature and Personal Experience
11.4 Conclusions
References
12: Circular Pharyngoplasties
12.1 Alianza Technique
12.2 Indications and Contraindications
12.3 Surgical Technique
12.4 Modified Alianza Technique
12.5 Personal Experience
12.6 Conclusions
12.7 Barbed Antero-Lateral Pharyngoplasty (BALPh)
References
13: Barbed Snore Surgery: The Learning Curve
13.1 Introduction
13.2 Study Design
13.2.1 Data Acquisition and Statistical Analysis
13.3 Results
13.4 Discussion
13.5 Conclusion
References
14: Barbed Reposition Pharyngoplasty (BRP)
14.1 Introduction to Barbed Reposition Pharyngoplasty (BRP)
14.2 Barbed Reposition Pharyngoplasty development
14.3 Bio-Engineering Modeling
14.4 Biomechanical Studies
14.5 Diffusion and Popularity
14.6 Conclusion
References
15: Candidates to Barbed Reposition Pharyngoplasty
15.1 Background
15.2 Barbed Reposition Pharyngoplasty for Sleep Apnea
15.2.1 Selection Criteria According to Surrogate Endotypes (PALM Classification) (See Chap. 6 of Bosi et al. for a More Extensive Discussion)
15.2.2 Selection Criteria According to Anatomo-Functional Phenotypes
15.2.2.1 Barbed Reposition Pharyngoplasty for Sleep Apnea
15.2.2.2 Barbed Reposition Pharyngoplasty for Simple Snoring
15.2.3 Selection Criteria According to Drug-Induced Sleep Endoscopy Findings
15.3 Conclusion
References
16: Barbed Reposition Pharyngoplasty (BRP): Surgical Technique
16.1 Barbed Reposition Pharyngoplasty (BRP): Surgical Technique
References
17: Barbed Reposition Pharyngoplasty (BRP): Postoperative Management, Outcomes Evaluation, and Follow-Up
17.1 Postoperative Management of Barbed Reposition Pharyngoplasty
17.2 Outcomes Evaluation and Follow-Up
17.3 Postoperative Pain and Swallowing
17.4 Respiratory Outcomes Evaluation
References
18: Barbed Reposition Pharyngoplasty (BRP): Intraoperative and Postoperative Complications
18.1 Intraoperative and Postoperative Complications
18.1.1 Intraoperative Complications [2–5]
18.1.2 Postoperative Complications [6–10]
18.2 Special Topic: Extrusion and Exposure [6]
References
19: Effectiveness of Barbed Repositioning Pharyngoplasty for the Treatment of Obstructive Sleep Apnea (OSA): Prospective Outcomes, Multicentric Studies and Review of Literature Results
19.1 Effectiveness of Barbed Repositioning Pharyngoplasty for the Treatment of Obstructive Sleep Apnea (OSA): A Prospective Randomized Trial
19.1.1 Trial Design
19.1.1.1 Surgical Technique
19.1.2 Results
19.1.3 Discussion
19.2 Prospective Multicenter Study on Barbed Reposition Pharyngoplasty Standing Alone or as Part of Multilevel Surgery for Sleep
19.2.1 Material and Methods
19.2.1.1 Surgical Technique
19.2.2 Statistical Analysis
19.2.3 Results
19.3 Current Literature Evidence
References
20: Palate Postoperative Problems Score (PPOPS): Tool for the Evaluation of Subjectives Results of Palatal Surgery Techniques
20.1 Introduction
20.2 Definitions
20.3 Discussion
20.4 Results
20.5 Discussion
20.6 Conclusion
References
21: BRP Vs Other Palate Procedures
21.1 Introduction
21.2 BRP Vs. Others
21.3 Discussion
21.4 Summary
21.5 Conclusions
References
22: Long-Term Functional Results of Barbed Reposition Pharyngoplasty Vs. Hyoid Suspension for Obstructive Sleep Apnea Hypopnea Syndrome
References
23: Outcome Predictors for Non-resective Pharyngoplasty in Obstructive Sleep Apnea-Hypopnea Syndrome
23.1 Outcomes in OSA Surgery
23.2 Scoring Systems
23.3 Aims of Palatopharyngeal Surgery
23.4 Outcome Predictors
23.5 Tips and Traps
References
24: Long-Term Complications of Palate Surgery: An Update
24.1 Introduction
24.2 Methods
24.3 Results
24.4 Discussion
24.5 Conclusion
References
25: Barbed Pharyngoplasty in Revision Surgery
25.1 Introduction
25.2 Soft Palate Functional Anatomy
25.2.1 Clinical Examination in Barbed Pharyngoplasty Revision Surgery
25.3 Barbed Pharyngoplasties
25.4 Failure of Conventional Surgeries in OSA Patients
25.5 Failure of Lateral Pharyngoplasty
25.6 Failure of Anterior Palatoplasty
25.7 Conclusions
References
26: Barbed Pharyngoplasties in Multilevel Surgery Including TransOral Robotic Surgery (TORS)
26.1 Introduction
26.2 Historical Background
26.3 Effect of Palate Surgery on TORS Results
26.3.1 Expansion Sphincter Pharyngoplasty (ESP)
26.3.2 Barbed Reposition Pharyngoplasty (BRP)
26.4 Conclusions
References
27: Myofunctional Therapy as a Postoperative Adjuvant Treatment to Single Level Velopharyngeal Surgery
27.1 Introduction
27.2 Myofunctional Assessment
27.3 Pathogenetic Basis, Exercises, and Classifications
27.4 Protocols
27.5 Efficacy
27.6 OMFT and Surgery
27.7 Limitations and Future Perspectives
References
28: Modified BRP and Different Palate Techniques to Treat Oropharyngeal Collapse
28.1 Introduction
28.2 Surgical Technique (Video 28.1)
28.3 Modifications to the Technique Described
28.4 Results
28.5 Indications
28.6 Postoperative Care
28.7 Complications
28.8 Discussion
References
29: Technical Update of Barbed Pharyngoplasty for Retropalatal Obstruction
29.1 Introduction
29.2 The Mechanism of Vectorial Collapse and Obstruction
29.3 Why Barbed Pharyngoplasty?
29.4 Development of Modified Technique
29.5 Advantages of Modified Technique
29.6 Our Experience: Modified Vs Classical Technique
29.7 Preoperative Evaluation
29.8 Surgical Technique
29.9 Modified Barbed Pharyngoplasty in Multilevel Surgery
References
30: Barbed Suspension Pharyngoplasty (BSP)
30.1 Introduction and Indications to the Surgical Technique
30.1.1 Surgical Step
30.2 Results and Conclusions
References
31: A Personalized and Eclectic Use of Barbed Suture to Address Palate Abnormalities in Sleep Apnea Patients
31.1 Introduction
31.2 Patient Selection
31.2.1 Contraindications to Palatal Barbed Surgery
31.3 Surgical Techniques
31.4 Barbed Anterior Palatoplasty (BAPP): Basic Variant
31.4.1 Indications
31.4.2 Considerations
31.5 Tonsils Sparing Antero-Lateral Barbed Pharyngoplasty (TSALBP) (Fig. 31.3)
31.5.1 Indications
31.6 BAPP + BSP (Barbed Suspension Palatoplasty) (Fig. 31.4)
31.6.1 Indications
31.7 BAPP + BRP (Barbed Reposition Palatoplasty) (Fig. 31.5)
31.7.1 Indications
31.8 Muscle Sparing Sphincter Barbed Pharyngoplasty (MSBSP)
31.8.1 Indications
31.8.2 Considerations
31.9 Post-operative Care
31.10 Complications
31.11 Case Series
31.12 Discussion and Conclusion
References
32: Barbed Functional Expansion Pharyngoplasty
32.1 Introduction
32.2 Surgical Technique
32.3 Indications
32.4 Postoperative Care
32.5 Complications
32.6 Surgical Outcomes
32.7 Concluding Remarks
References
33: Simplified Barbed Reposition Pharyngoplasty (sBRP)
33.1 Definition
33.2 Equipments
33.3 Anesthesia and Patient Positioning
33.4 Surgical Procedure and Steps
33.5 Success Rate
33.6 Limits
References
34: Different Barbed Pharyngoplasty Techniques for Retropalatal Collapse in Obstructive Sleep Apnoea Patients: A Systematic Review
34.1 Introduction
34.2 Results
34.2.1 Barbed Pharyngoplasty for Sleep Apnoea
34.2.2 Barbed Pharyngoplasty for Snoring
34.3 Conclusions
References
35: Barbed Pharyngoplasty Experience in Egypt
35.1 Introduction
35.2 Historical Background
35.3 Surgical Technique of CO-BRP
35.4 Postoperative Care
35.5 Outcome Measurement
35.6 Our Experience in Egypt
35.7 Conclusion
References
36: Barbed Pharyngoplasties: Experience in India
36.1 Introduction
36.2 Methodology
36.3 Results
36.4 Discussion
References
37: Barbed Pharyngoplasties Experience in Singapore
37.1 Introduction
37.2 History of Pharyngoplasty in Singapore
37.3 How Barbed Pharyngoplasty Started in Singapore
37.4 Barbed Reposition Pharyngoplasty (BRP) Technique in Singapore
37.5 Future Research
References
38: Barbed Pharyngoplasties Experience in Thailand
38.1 Preoperative Assessment
38.2 Indication
38.3 Contraindication
38.4 Surgical Procedures
38.4.1 Barbed Palatal Suspension
38.4.2 Barbed Reposition Pharyngoplasty
38.4.3 Barbed Anterior Palatoplasty
38.4.4 Modified Barbed Reposition Pharyngoplasty
38.4.5 Barbed Suspension Pharyngoplasty
38.5 Results
38.6 Complications
38.7 Barbed Suture
38.8 Single-Level or Multilevel Surgery
38.9 Conclusion
References
39: Barbed Pharyngoplasties Experience in Spain
39.1 Introduction
39.2 Materials and Methods
39.3 Results
39.4 Discussion
References
40: Barbed Pharyngoplasty Experience in Brazil
40.1 Introduction
40.2 Results
40.3 Complications
40.4 Conclusion
References
41: Barbed Pharyngoplasties Experience in USA
41.1 Introduction
41.2 Survey Results
41.3 Barriers to Adoption
References
42: Fellowship and Training in Barbed Pharyngoplasty
42.1 Introduction
42.2 OSA Fellowships
42.3 Our Experience
42.4 Pre Fellowships Requirement
42.5 What We Learn During the Fellowships
42.6 Proper Patient’s Evaluation
42.7 Surgical Skills
42.8 Applied New Technique After Fellowships and its Difficulties
42.9 Conclusion
References
43: Future Perspectives
43.1 Point #1: Patient Selection
43.2 Point#2: Barbed Suture Technology
43.3 Point#3: Technique
43.4 Point#4: Suture Deployment
43.5 Point#5: Planned Revision BRP
43.6 Point#6: Improved Visualization