Robo-Cob technique; transoral endoscopic coblation tongue base resection in obstructive sleep apnea patients.

BACKGROUND: Another transoral tongue base surgical procedure for obstructive sleep apnea (OSA) is described. The procedure was named as the "Robo-Cob" technique because it is similar to transoral robotic surgery (TORS) but using a coblation technology to manage tongue base hypertrophy in patients with OSA especially in countries where TORS is not an available option for such benign conditions. METHODS: The technique is described step by step. The new surgical technique was carried out in 25 adult OSA patients with mean age of 41.36 ± 8.72 years (average 23-56) with confirmed tongue base hypertrophy by preoperative drug-induced sleep endoscopy (DISE). Coblation was used to resect, not ablate, the tongue base with similar technique as described in TORS. RESULTS: The Robo-Cob technique is proved to be feasible and effective in all cases either alone or when combined with other procedures in multilevel surgery settings. There were no significant intraoperative or postoperative complications. No tracheostomy was done in any patient. Objective clinical improvement was confirmed by polysomnography 3 months postoperatively with significant decrease in mean AHI from 33.84 ± 10.54 to 11.52 ± 5.42 (P < 0.005). Moreover, this technique provided tongue base tissue specimen that allowed measurement of its volume that ranged from 10 to 22 cc (mean 14.96 ± 3.62 cc) to monitor extent of tissue resection. CONCLUSION: The added value of using coblation in resection, not ablation, is being quicker, and being able to provide tissue specimen to measure its volume to judge resection limits.

Assessment of the New L Pharyngeal Flap for Velopharyngeal Insufficiency.

OBJECTIVE: To assess the results of the new L pharyngeal flap for treatment of velopharyngeal insufficiency (VPI). METHODS: This study included 60 patients who were diagnosed as persistent VPI (for > 1 year without response to speech therapy for 6 months at least). L-shaped superiorly based pharyngeal flap was tailored from oropharynx and inserted into the soft palate through a transverse full-thickness palatal incision 1 cm from the hard palate, then the distal horizontal part of the flap was spread 1 cm anteroposterior direction and 1 cm horizontally into the soft palate. Prior to and after surgery, patients were assessed by oral examination, video nasoendoscopy, and speech evaluation. RESULTS: Postoperative speech assessment showed significant improvement in nasoendoscopic closure, speech assessment, and nasometric assessments. Grade 4 velopharyngeal valve closure (complete closure) could be achieved in 59 (98.3%) patients at 6 months postoperatively. No patients showed dehiscence (partial or total) of the flap and no obstructive sleep apnea was reported. CONCLUSION: The newly designed L pharyngeal flap was proved to be highly effective, reliable, and safe in treating patients with persistent VPI with easy applicability and without significant complication.

Hemostatic Options for Transoral Robotic Surgery of the Pharynx and Base of Tongue.

Surgery with transoral robotic surgery (TORS) offers significant advantages compared with traditional open surgical approaches and potentially minimizes the long-term side effects of organ preservation therapy with chemoradiation. Angled telescopes and wristed instruments allow visualization and access to areas of the pharynx that are difficult to reach with line-of-sight instrumentation. Although the application of TORS in head and neck surgery has expanded considerably, there are still only limited data available on the postoperative complications and their management. As further data become available, it is likely that further risk factors and treatment strategies will become available.

Eagle's syndrome, a rare cause of neck pain.

Eagle's syndrome (ES) sometimes called styloid or stylohyoid syndrome is defined as the symptomatic elongation of the styloid process or mineralisation of the stylohyoid ligament. The symptoms related to this condition can be confused with those attributed to a wide variety of facial neuralgias. We report a 34-year-old male patient who presented with a recurrent neck pain and dysphagia. He was diagnosed to have an elongated styloid process. An intraoral transtonsillar shortening of the styloid process was done. We discuss the clinical presentation, diagnosis and treatment of ES as well as a review of the literature.