Abstract
Introduction
Oropharyngeal surgery for Obstructive Sleep Apnea (OSA) has evolved from a radical excision of “redundant” soft tissue for the enlargment of the airway to a minimally invasive reconstruction to fulfill both preservation of pharyngeal function and improvement of sleep apnea. Recently, Alianza surgical technique has been successfully introduced as a new, non-resective procedure aimed to treat concentric pharyngeal collapse at the velum using Barbed Sutures. The aim of this study was to show the effectiveness and safety of Alianza technique as standalone surgical treatment in selected patients with moderate-severe OSA and concentric pharyngeal collapse that refused or did not tolerate Continuous Positive Airway Pressure therapy.
Materials and methods
Effectiveness of the surgical procedure was assessed by means of the Epworth Sleepiness Scale (ESS), Home Sleep Test, and a 0–10 snoring VAS.
Results
At the end of our selection process, 26 patients were enrolled, with a mean age of 52.7 ± 9.2 years, that undergone Alianza tecnique. There was a statistically significant reduction in mean post-operative apnea–hypopnea indexes (34.1 ± 11.5–16.3 ± 10.3; p <0.01), mean oxygen desaturation index (29.0 ± 14.5–13.1 ± 9.2; p < 0.01), and mean ESS scores (12.1 ± 5.8 and 5.8 ± 4.4; p < 0.01).There was also a significant decrease in mean post-operative snoring VAS scores (7.85 ± 1.23 vs 3.2 ± 1.7, p < 0.01). There were no major complications.
Conclusions
Our preliminary results suggest that Alianza technique is a safe and repeatable surgery. Further studies on a larger scale are needed to confirm these encouraging data supporting the role of Alianza alone or in OSA multilevel surgery in selected OSA patients.
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References
Chiu FH, Chen CY, Lee JC, Hsu YS (2021) Effect of modified uvulopalatopharyngoplasty without tonsillectomy on obstructive sleep apnea: polysomnographic outcome and correlation with drug-induced sleep endoscopy. Nat Sci Sleep 13:11–19. https://doi.org/10.2147/NSS.S286203
Michael F, Ofer J (2018) Sleep apnea and snoring 2nd edition surgical and non-surgical therapy. Elsevier, Amsterdam
Li H-Y et al (2019) Intrapharyngeal surgery with integrated treatment for obstructive sleep apnea. Biomed J 42(2):84. https://doi.org/10.1016/J.BJ.2019.02.002
Mantovani M, Minetti A, Torretta S, Pincherle A, Tassone G, Pignataro L (2013) The ‘Barbed Roman Blinds’ technique: a step forward. Acta Otorhinolaryngol Ital 33(2):128
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 Cranio-Maxillofacial Surg 45(11):1794–1800. https://doi.org/10.1016/j.jcms.2017.08.007
Yalamanchali S, Farajian V, Hamilton C, Pott TR, Samuelson CG, Friedman M (2013) Diagnosis of obstructive sleep apnea by peripheral arterial tonometry: meta-analysis. JAMA Otolaryngol Head Neck Surg 139(12):1343–1350. https://doi.org/10.1001/JAMAOTO.2013.5338
Moffa A et al (2020) Different barbed pharyngoplasty techniques for retropalatal collapse in obstructive sleep apnea patients: a systematic review. Sleep Breath 24(3):1115–1127. https://doi.org/10.1007/s11325-020-02088-z
Casale M, Moffa A, Pignataro L, Rinaldi V (2021) Palatopharyngeus muscle in pharyngoplasty surgery for OSAS: cut or not to cut? Eur Arch Otorhinolaryngol 278(7):2657–2658. https://doi.org/10.1007/S00405-021-06761-1
Gulotta G et al (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
Friedman M, Salapatas AM, Bonzelaar LB (2017) Updated friedman staging system for obstructive sleep apnea. Adv Otorhinolaryngol 80:41–48. https://doi.org/10.1159/000470859
Vicini C 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/s00405-015-3628-3
de Apodaca PM, Llatas MC, Gras MV, Galofre JD (2020) Improving surgical results in velopharyngeal surgery: our experience in the last decade. Acta Otorrinolaringol Esp 71(4):197–203. https://doi.org/10.1016/J.OTORRI.2019.06.001
Sundman J, Browaldh N, Fehrm J, Friberg D (2021) Eight-year follow-up of modified uvulopalatopharyngoplasty in patients with obstructive sleep apnea. Laryngoscope 131(1):E307–E313. https://doi.org/10.1002/LARY.28960
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This article is part of the Topical Collection on sleep apnea syndrome. Guest editors: Manuele Casale, Rinaldi Vittorio.
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Casale, M., Moffa, A., Giorgi, L. et al. No-cutting remodelling intra-pharyngeal surgery can avoid CPAP in selected OSA patients: myth or reality?. Eur Arch Otorhinolaryngol 279, 5039–5045 (2022). https://doi.org/10.1007/s00405-022-07261-6
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DOI: https://doi.org/10.1007/s00405-022-07261-6