Effectiveness of barbed repositioning pharyngoplasty for the treatment of obstructive sleep apnea (OSA): a prospective randomized trial.

Purpose: The aim of our randomized clinical trial is to produce stronger evidence supporting barbed repositioning pharyngoplasty (BRP) as a therapeutic option for the treatment of obstructive sleep apnea (OSA).

Methods: The trial was a single-center prospective controlled trial with two parallel arms (group A: BRP; group B: observation) and randomization. Baseline and 6-month polygraphy evaluating the apnea hypopnea index (AHI), oxygen desaturation index (ODI), and lowest oxygen saturation (LOS) were performed.

Combined transoral robotic tongue base surgery and palate surgery in obstructive sleep apnea-hypopnea syndrome: expansion sphincter pharyngoplasty versus uvulopalatopharyngoplasty.

Background: Transoral robotic surgery (TORS) for obstructive sleep apnea-hypopnea syndrome is a relatively young technique principally devised for managing apneas in the tongue base (TB) area and supraglottic larynx. This procedure is included in the so-called "multilevel surgery" often including a palatal and nasal surgery.

Methods: We carried out a retrospective analysis in order to understand in detail the relative impact on apneas of the 2 different procedures carried out in the palate area (expansion sphincter pharyngoplasty and uvulopalatopharyngoplasty).

The nose oropharynx hypopharynx and larynx (NOHL) classification: a new system of diagnostic standardized examination for OSAHS patients.

The main pathological event of obstructive sleep apnea hypopnea syndrome (OSAHS) is the apneic collapse of the upper airways (UA). Frequently, UA collapse occurs at the same time at different section levels. Identifying the site and the dynamic pattern of obstruction is mandatory in therapeutical decision-making, and in particular if a surgical therapy option is taken into account.

Multilevel radiofrequency ablation for snoring and OSAHS patients therapy: long-term outcomes.

Our objective is to evaluate the outcomes of the Radio-Frequency (RF) energy for tissue thermo-ablation therapy in sleep-disordered breathing patients and retrospective evaluation of the RF therapy after a 5-year follow-up period, in terms of snoring and apnea reduction. From June 1999 to June 2009, we enrolled patients suffering from simple snoring and patients with obstructive apnea hypopnoea syndrome (OSAHS). A visual analog scale (VAS) questionnaire was used to evaluate the level of snoring and was filled out in short- and long-term periods, whereas in OSAHS patients an unattended polysomnography was performed before and after a minimum of 6 months from the last RF therapy treatment session.

Transoral robotic surgery of the tongue base in obstructive sleep Apnea-Hypopnea syndrome: anatomic considerations and clinical experience.

Background: The purpose of our work was to describe, through cadaveric dissection, the anatomy of the tongue base with a robotic perspective and to demonstrate the feasibility of this approach in case of tongue base hypertrophy in Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS).

Methods: Forty-four patients with OSAHS underwent tongue base resection in the last 2 years. Twenty patients with a 10-month minimum follow-up were evaluated.

Tongue Base Reduction with Thyro-Hyoido-Pexy (TBRTHP) vs. Tongue Base Reduction with Hyo-Epiglottoplasty (TBRHE) in mild-severe OSAHS adult treatment. Preliminary findings from a prospective randomised trial.

In a preliminary prospective randomised study, a series of 5 patients submitted to classic Tongue Base Reduction with Hyo-Epiglottoplasty (TBRHE according to Chabolle et al., 1998) is compared to a series of 7 patients submitted to a modified version of Chabolle's procedure. The changes introduced in the new surgical technique can be summarised as follows: a) lower neck skin incision; b) different neurovascular bundle identification; c) submucosal tongue base muscle resection; d) variation of the caudal hyoid stabilisation, already described by the Authors in 2008 (Tongue Base Reduction with Thyro-Hyoido-Pexy).

Transoral robotic tongue base resection in obstructive sleep apnoea-hypopnoea syndrome: a preliminary report.

Purpose Of The Study: To evaluate the feasibility, tolerability and efficacy of tongue base management by means of transoral robotic surgery (TORS) in patients suffering from the obstructive sleep apnoea-hypopnoea syndrome (OSAHS) primarily related to hypertrophy of the tongue base.

Procedure: Seventeen patients with OSAHS principally related to tongue base hypertrophy were managed by means of TORS (Intuitive da Vinci(R)). Patients with a minimum follow-up of 3 months were evaluated.

Hyoidthyroidpexia as a treatment in multilevel surgery for obstructive sleep apnea.

Conclusion: This type of surgery is effective in patients with obstructive sleep apnea syndrome (OSAS), but may not be effective in obese patients or those with a preoperative apnea hypopnea index (AHI)>35. For these reasons, the careful study and selection of patients is fundamental in the surgical treatment of OSAS.

Objectives: Evaluation of the efficacy of hyoid surgery combined with oropharynx and nose surgery in the treatment of OSAS.

Role of skin-lined tracheotomy in obstructive sleep apnoea syndrome: personal experience.

Permanent tracheotomy was the first surgical procedure proposed for the treatment of severe obstructive sleep apnoea syndrome and is still the only surgical option that ensures, even in very severe cases, complete elimination of apnoea and, in turn, clinical remission. Improved knowledge of the causes of obstructive sleep apnoea syndromes and the increasing therapeutic options (instrumental, medical and surgical) have resulted in cases requiring tracheotomy as the only indispensable therapeutic option becoming more rare. At present, the only indications are in very occasional conditions of life-threatening obstructive sleep apnoea syndromes and in patients on whom continuous positive airway pressure is not tolerated or is not effective (severe deoxygenation or hypercapnia, severe respiratory disorder index, severe obstructive sleep apnoea syndrome-related arrhythmias, severe excessive daytime sleepiness, heart diseases or ischaemic encephalopathy exacerbated by obstructive sleep apnoea syndromes, obstructive pneumopathy exacerbated by obstructive sleep apnoea syndromes, severe obstructive sleep apnoea syndromes with few chances of resolution with other surgical procedures or failure of the latter).

Temporary tracheotomy in the surgical treatment of obstructive sleep apnea syndrome: personal experience.

Aim of the study is a retrospective analysis on the use of temporary tracheotomy in our snoring surgery experience. From September 1996 to April 2002, 1103 snoring surgery procedures have been carried out on various sites of the upper airways in 530 patients (mean age 50 years, 81% males) prevalently related to severe Obstructive Sleep Apnea Syndromes (33%). Of these patients, 472 (89%) were operated upon under general anaesthesia, whereas 58 (11%) received local anaesthesia.

[Sideropenic anemia and celiac disease].

Since the beginning of the use of Antigliadin Antibodies (AGA) in the screening of coeliac disease (CD) we have observed an increasing in the total number of cases diagnosed, in particular of the cases with monosymptomatic and atypical forms. Iron deficiency anemia is one of the more frequent findings that we can find in CD, either in association with other typical coeliac signs, or as an isolated expression of the disease. The first aim of our study was to determine the incidence of iron deficiency anemia in our patients affected by CD at the moment of diagnosis.

[Celiac disease in children with Down's syndrome].

The coexistence of Down's syndrome (DS) and coeliac disease (CD) has been occasionally reported and both diseases are often related to autoimmune disorders. The pathogenetic factor that links CD and DS may be an altered immune system and/or the presence of a common genetic factor. Some epidemiological investigations, performed in patients with CD, showed an increased incidence of DS compared to the natural incidence of this abnormality in the general population.

[Discordance in the onset of celiac disease in monozygotic twins].

Coeliac disease (CD) is a gluten intolerance caused by a combination of genetic and environmental factors such as nutrition and infections. Monozygotic twins appear to have a concordance for CD up to 71%. This paper reports a third case of late onset of CD in monozygotic twin girls.