Postoperative Pain and Wound Healing After Coblation-Assisted Barbed Anterior Pharyngoplasty (CABAPh): An Observational Study

Abstract

Despite the numerous progresses in the palatal surgery, one of the critical aspect of snoring and OSA surgery is the postoperative pain. Over the last decades several surgical palatal procedures have been proposed. Our aim was to evaluate the tolerability of the coblation-assisted barbed anterior pharyngoplasty (CABAPh) in terms of postoperative pain and wound healing, compared with bipolar assisted barbed anterior pharyngoplasty (BAPh). An observational study on 20 patients with simple snoring was conducted. The outcomes measured to assessing pain were a 10 cm visual analog scale (VAS) and the dose of paracetamol + codeine administrated postoperatively. The wound healing was evaluated using a 3-point scale. The other parameters indicative of both pain and surgical repair were food intake and weight loss postoperatively. The mean overall pain (VAS scale) was significantly less in the CABAPh group (M 3.7; CI 3.34–4.06) compared with the BAPh (M 4.73; CI 4.28–5.19) with a P = 0.003. The mean wound healing after 4 weeks was significantly less in CABAPh group (M 2.7; CI 3.12–2.28) compared with the BAPh (M 2.1; CI 2.45–1.75) with a P = 0.02. There were no statistically significant difference with regard to food intake (P = 0.09) and weight loss (P = 0.94). The CABAPh was able to achieve a greater pain reduction and a faster wound healing compared with bipolar forceps.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

References

  1. 1.

    Casale M, Pappacena M, Rinaldi V, Bressi F, Baptista P, Salvinelli F (2009) Obstructive sleep apnea syndrome: from phenotype to genetic basis. Curr Genomics 10(2):119–126

    CAS  Article  Google Scholar 

  2. 2.

    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):48–53

    CAS  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Vicini C, De Vito A, Benazzo M et al (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

    Article  Google Scholar 

  4. 4.

    Kezirian EJ, Hohenhorst W, de Vries N (2011) Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 268(8):1233–1236

    Article  Google Scholar 

  5. 5.

    Fujita S, Conway W, Zorick F, Roth T (1981) Surgical correction of anatomic azbnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 89(6):923–934

    CAS  Article  Google Scholar 

  6. 6.

    Woodson BT, Robinson S, Lim HJ (2005) Transpalatal advancement pharyngoplasty outcomes compared with uvulopalatopharygoplasty. Otolaryngol Head Neck Surg 133(2):211–217

    Article  Google Scholar 

  7. 7.

    Ellis PD (1994) Laser palatoplasty for snoring due to palatal flutter: a further report. Clin Otolaryngol Allied Sci 19(4):350–351

    CAS  Article  Google Scholar 

  8. 8.

    Mair EA, Day RH (2000) Cautery-assisted palatal stiffening operation. Otolaryngol Head Neck Surg 122(4):547–556

    CAS  PubMed  Google Scholar 

  9. 9.

    Wassmuth Z, Mair E, Loube D, Leonard D (2000) Cautery-assisted palatal stiffening operation for the treatment of obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg 123(1 Pt 1):55–60

    CAS  Article  Google Scholar 

  10. 10.

    Pang KP, Terris DJ (2007) Modified cautery-assisted palatal stiffening operation: new method for treating snoring and mild obstructive sleep apnea. Otolaryngol Head Neck Surg 136(5):823–826

    Article  Google Scholar 

  11. 11.

    Binar M, Karakoc O (2018) Anterior palatoplasty for obstructive sleep apnea: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 158(3):443–449

    Article  Google Scholar 

  12. 12.

    Pang KP, Pang EB, Pang KA, Rotenberg B (2018) Anterior palatoplasty in the treatment of obstructive sleep apnoea - a systemic review. Acta Otorhinolaryngol Ital 38(1):1–6

    CAS  PubMed  Google Scholar 

  13. 13.

    Marzetti A, Tedaldi M, Passali FM (2013) Preliminary findings from our experience in anterior palatoplasty for the treatment of obstructive sleep apnea. Clin Exp Otorhinolaryngol 6(1):18–22

    Article  Google Scholar 

  14. 14.

    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

    CAS  PubMed  PubMed Central  Google Scholar 

  15. 15.

    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

    Article  Google Scholar 

  16. 16.

    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

    Article  Google Scholar 

  17. 17.

    Belloso A, Morar P, Tahery J, Saravanan K, Nigam A, Timms MS (2006) Randomized-controlled study comparing post-operative pain between coblation palatoplasty and laser palatoplasty. Clin Otolaryngol 31(2):138–143

    CAS  Article  Google Scholar 

  18. 18.

    Salamanca F, Costantini F, Mantovani M et al (2014) Barbed anterior pharyngoplasty: an evolution of anterior palatoplasty. Acta Otorhinolaryngol Ital 34(6):434–438

    CAS  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Mantovani M, Rinaldi V, Salamanca F et al (2015) Should we stop performing uvulopalatopharyngoplasty? Indian J Otolaryngol Head Neck Surg 67(Suppl 1):161–162

    Article  Google Scholar 

  20. 20.

    Walker RP, Grigg-Damberger MM, Gopalsami C (1997) Uvulopalatopharyngoplasty versus laser-assisted uvulopalatoplasty for the treatment of obstructive sleep apnea. Laryngoscope 107(1):76–82

    CAS  Article  Google Scholar 

  21. 21.

    Osman EZ, Osborne JE, Hill PD, Lee BW, Hammad Z (2000) Uvulopalatopharyngoplasty versus laser assisted uvulopalatoplasty for the treatment of snoring: an objective randomised clinical trial. Clin Otolaryngol Allied Sci 25(4):305–310

    CAS  Article  Google Scholar 

  22. 22.

    Ugur KS, Kurtaran H, Ark N, Kizilbulut G, Yuksel A, Gunduz M (2013) Comparing anterior palatoplasty and modified uvulopalatopharyngoplasty for primary snoring patients: preliminary results. B-ENT 9(4):285–291

    CAS  PubMed  Google Scholar 

  23. 23.

    Pynnonen M, Brinkmeier JV, Thorne MC, Chong LY, Burton MJ (2017) Coblation versus other surgical techniques for tonsillectomy. Cochrane Database Syst Rev 8:CD004619

    PubMed  Google Scholar 

  24. 24.

    Wiltshire D, Cronin M, Lintern N et al (2018) The debate continues: a prospective, randomised, single-blind study comparing Coblation and bipolar tonsillectomy techniques. J Laryngol Otol 132(3):240–245

    CAS  Article  Google Scholar 

  25. 25.

    Mitic S, Tvinnereim M, Lie E, Saltyte BJ (2007) A pilot randomized controlled trial of coblation tonsillectomy versus dissection tonsillectomy with bipolar diathermy haemostasis. Clin Otolaryngol 32(4):261–267

    CAS  Article  Google Scholar 

  26. 26.

    Glade RS, Pearson SE, Zalzal GH, Choi SS (2006) Coblation adenotonsillectomy: an improvement over electrocautery technique? Otolaryngol Head Neck Surg 134(5):852–855

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Andrea Costantino.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Rinaldi, V., Costantino, A., Moffa, A. et al. Postoperative Pain and Wound Healing After Coblation-Assisted Barbed Anterior Pharyngoplasty (CABAPh): An Observational Study. Indian J Otolaryngol Head Neck Surg 71, 1157–1162 (2019). https://doi.org/10.1007/s12070-018-01577-8

Download citation

Keywords

  • Coblator
  • Anterior pharyngoplasty
  • Pain
  • Wound healing
  • Barbed