Transoral robotic styloidectomy for Eagle syndrome: A systematic review.

OBJECTIVES: The aim of the study is to conduct a systematic review of the existing literature on styloidectomy performed through transoral robotic surgery (TORS) in Eagle syndrome (ES). DESIGN AND SETTING: Two independent reviewers (RC and AC) conducted a systematic review of PubMed and Embase databases, seeking articles on TORS performed for ES treatment. The search was conducted in July 2023. The review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PARTICIPANTS: The review included a total of 17 adult patients, comprising 12 females and 5 males, with an average age of 52.2 years, all diagnosed with ES. MAIN OUTCOME MEASURES: For each patient, we assessed the overall length of the styloid process, the affected side, total intervention duration, hospitalization duration, pre and postoperative Visual Analogue Scale (VAS) scores, and the presence of minor and major complications. RESULTS: We identified 4 articles describing 17 instances of TORS as a surgical treatment for ES in the literature, totaling 18 styloidectomies. The mean age of the patients was 52.2 years, with 12 females and 5 males. The average operation time, inclusive of the docking phase, was 68.8 minutes. Sixteen patients (94.1% of the total) experienced complete symptom disappearance or near-complete resolution after surgery. One patient (5.9%) showed improvement categorized as 'non-meaningful.' Only one case of minor complication was reported among the 17 procedures (5.9%).

Sleep position and obstructive sleep apnea (OSA): Do we know how we sleep? A new explorative sleeping questionnaire.

PURPOSE: Positional obstructive sleep apnea (POSA) has been defined as a difference of 50% or more in Apnea-Hypopnea Index (AHI) between supine and non-supine position. Sleep position is fundamental in the evaluation of obstructive sleep apnea syndrome (OSAS) severity but most tools used in the diagnosis of OSAS are not free from potential bias in the evaluation of usual sleep positions. The aim of this investigation was to evaluate a novel sleep questionnaire with the purpose of exploring sleep habits and evaluating if sleep assessment can identify the usual body position assumed for sleep. MATERIALS AND METHODS: The questionnaire was administered to patients recruited from October to November 2018. Questions concerned sleeping positions and conditions that could influence sleeping positions. Patients who had previously undergone polysomnography (PSG) were asked how they slept during the study night. Whenever present during the examination, the patient's bed partner was also asked about the patient's usual body positions during sleep. RESULTS: Of 315 patients (211 men) enrolled, 35% were affected by OSAS and 69% of patients with OSAS had POSA. POSA was more prevalent among men (75%) compared to women (43%). The new questionnaire provided a discordant result from PSG recordings about sleeping positions and revealed a difference between usual sleeping position and the position during PSG recording. Reported sleep quality was much worse on PSG than at home suggesting that the "first night effect" is real and may lead to over-estimation of POSA cases. CONCLUSIONS: Information about sleeping positions is fundamental to the assessment of OSAS severity. Knowledge gained from the new questionnaire as described may represent a valuable addendum to develop a more detailed polygraphic report. Such a tool may be used in practice with the aim of better identifying patients with true positional OSAS. Such patients may benefit from targeted positional therapy.

Barbed Repositioning Pharyngoplasty: Tips and Tricks.

The barbed repositioning pharyngoplasty surgical technique is becoming more widely used for patients with obstructive sleep apnea due to its safety, effectiveness, and rapidity, as evidenced by multicenter studies and Meta-analyses. In order to achieve uniform surgical outcomes, avoid errors that could worsen outcomes, and enable adequate data comparison, a standardized procedure is required to overcome surgeon-related variability. The aim of this paper is to provide practical tips and tricks based on our surgical practice that can make the surgeon's work easier and aid in achieving desired outcomes.

The Role of Transoral Robotic Surgery in the Era of Hypoglossal Nerve Stimulation.

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder characterized by repeated collapses of the upper airway walls, leading to a complete or partial reduction of airflow [...].

Can sleeping position be correctly identified by OSAS studies?

OBJECTIVE: Positional Obstructive Sleep Apnoea Syndrome (POSAS) is a sub-type of Obstructive Sleep Apnoea Syndrome (OSAS) in which obstructive apnoeas occur mainly in the supine sleeping position. In clinical practice, information on sleep posture is generally gathered by polysomnographic exam (PSG). The current trend in positional therapies consists of position trainers which help to avoid the supine position. The aim of this study is to detect the reliability of different devices on assessing sleeping position, comparing the data with objective evaluation by an infra-red camera. METHODS: We compared the positional results of 4 healthy volunteers obtained from a type III PSG and with a neck-worn sleep position trainer (Night Shift - NS). RESULTS: Data showed that NS is a good tool to assess the position of the trunk, with high rate of agreement with PSG, but in some conditions there are limitations, especially in detecting the real head and neck position and low accordance between NS data and information recorded by infra-red camera. CONCLUSIONS: Our study confirmed that more information about body position during sleep is needed, underling the necessity of developing new technologies that are able to better identify reciprocal body positions.

Leukoplakia in the Oral Cavity and Oral Microbiota: A Comprehensive Review.

We reviewed the current published literature on the impact of oral microbiota on oral cavity leukoplakia (OLK), aiming at clarifying its role in disease transformation. The analysis unveiled that bacterial richness and diversity in the oral cavity tend to be decreased in OLK compared to healthy controls, with a reduction in the prevalent commensals, such as Streptococci, and elevation of anaerobes. Moreover, Fusobacterium nucleatum, Porphyromonas gingivalis and Prevotella intermedia are recurrent findings, and they already have been linked to periodontal disease. These microbial community changes may also represent a marker for the transition from OLK to oral squamous cell carcinoma. Unfortunately, the reviewed studies present several limitations, making an objective comparison difficult. To overcome these biases, longitudinal studies are necessary.

Alternative Applications of Trans-Oral Robotic Surgery (TORS): A Systematic Review.

BACKGROUND: The role of robotic surgery in the field of oncology has been widely described, in particular for the tumours of the oropharynx and larynx, but its efficacy for benign pathology is inconsistent. METHODS: An exhaustive review of the English literature on trans-oral robotic surgery (TORS) for benign conditions was performed using PubMed electronic database. RESULTS: The research was performed in March 2019 and yielded more than eight hundred articles, with 103 meeting the inclusion criteria and considered in the present study. CONCLUSIONS: The application of TORS for the treatment of obstructive sleep apnoea syndrome seems to be particularly well documented. Additionally, there exists a special interest in its use where high precision in limited anatomic space is required. There are still different structural and economic limitations for the application of TORS, however, the progressive technologic innovations and the increasing adoption of robotic surgery seem to encourage the uptake of this technique.

Manipulation of Lateral Pharyngeal Wall Muscles in Sleep Surgery: A Review of the Literature.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) occurs due to upper airway obstruction resulting from anatomical and functional abnormalities. Upper airway collapsibility, particularly those involving the lateral pharyngeal wall (LPW), is known to be one of the main factors contributing to the pathogenesis of OSAS, leading the authors of the present study to propose different strategies in order to stiffen the pharyngeal walls to try to restore normal airflow. METHODS: An exhaustive review of the English literature on lateral pharyngeal wall surgery for the treatment of OSAS was performed using the PubMed electronic database. RESULTS: The research was performed in April 2020 and yielded approximately 2000 articles. However, considering the inclusion criteria, only 17 studies were included in the present study. CONCLUSIONS: The analyzed surgical techniques propose different parts of LPW on which to focus and a variable degree of invasivity. Despite the very promising results, no gold standard for the treatment of pharyngeal wall collapsibility has been proposed. However, thanks to progressive technological innovations and increasingly precise data analysis, the role of LPW surgery seems to be crucial in the treatment of OSAS patients.

Acquired Nasopharyngeal Stenosis Correction Using a Modified Palatal Flaps Technique in Obstructive Sleep Apnea (OSA) Patients.

Background: Acquired nasopharyngeal stenosis is a rare and heterogeneous pathological condition that has different causes, generally resulting as a complication of a pharyngeal surgery, especially in patients affected by obstructive sleep apnea (OSA). Different approaches have been proposed for the treatment of nasopharyngeal stenosis but a unique and standardized management has not yet been presented. The aim of our paper is to evaluate the efficacy of our surgical technique, describing its steps and results with the aim to consider it as a possible solution for the treatment of this condition. Methods: This is a retrospective cohort study. Eight patients (mean age 27.25 years old (yo), range 8-67 yo; Male/Female ratio 4/4; mean body mass index (BMI) 26.1) affected by OSA (mean apnea hypopnea index (AHI) before OSA surgery was 22.1) and acquired nasopharyngeal stenosis as a consequence of different pharyngeal surgeries were treated with our modified approach in the Department of Otolaryngology, Morgagni Pierantoni Hospital, Forlì, Italy. Resolution of stenosis and complication rate were the main outcome measures. Results: Complete resolution of the stenosis was achieved in all cases and no complications were recorded at three weeks, six months, and 2 years follow-up. Conclusions: Our technique appears to be a promising method for the management of nasopharyngeal stenosis in OSA patients. However, further studies comparing different techniques and reporting on larger series and longer follow up time are needed to prove the efficacy of the proposed technique.