Early intervention of transoral laser-assisted marsupialization for adult epiglottic abscess.

Epiglottic abscess is a potentially fatal disease by airway compromise. Emergent airway intervention and admission to an intensive care unit are frequently required for patients with epiglottic abscess. Epiglottic abscess also doubles the duration of hospitalization compared to non-abscess epiglottitis. Abscess drainage, antibiotics administration, and airway monitoring are the mainstays of treatment. Spinal needle aspiration has been introduced to treat epiglottic abscess, which shows no significant additional benefit from a comparative study. Marsupialization has been commonly utilized to treat benign cystic diseases. Early surgical intervention of epiglottic abscess may resolve patient symptoms and secure the airway. Early intervention of transoral laser-assisted marsupialization for epiglottic abscess was a safe, simple, and reliable technique that guaranteed early recovery in 12 cases. Therefore, this article presents the procedures, pros, and cons of this method for treating epiglottic abscess.

Pignat's vertical partial laryngectomy with crico-hyoido-epiglotto-plasty.

PURPOSE: Pignat's partial laryngectomy with crico-hyoido-epiglotto-plasty (CHEPL) is a vertical laryngectomy with resection of the anterior portion of the thyroid cartilage and reconstruction with a wires net and the subhyoid muscles. The aim of this retrospective study was to evaluate and analyze oncologic and functional outcomes in patients affected by laryngeal squamous cell carcinoma and treated with Pignat's partial laryngectomy. METHODS: Seventy patients with cT1-cT3 glottic cancer were surgically treated with Pignat's technique. EXCLUSION CRITERIA: invasion of posterior cricoid arch, more than 3 mm under glottis, of more than one arytenoid, of posterior portion of thyroid cartilage, of the suprahyoid epiglottis. Overall survival, disease free survival, rates of decannulation and enteral feeding were analyzed. RESULTS: 23 (32.9%) pT1, 37 (52.9%) pT2, 5 (7.1%) pT3, 5 (7.1%) pT4a, 64 (91.5%) pN0, 5 (7.1%) pN1, 1 (1.4%) pN2. Adjuvant treatment was administered to 13 patients (18.6%). All patients had tracheotomy. Five year OS and DFS were 81.66 and 77.95%, respectively. A statistically significant DFS difference was observed between early and late stages. Five year local control was 81.16%. Five year larynx preservation rate was 89.16%. Median decannulation time was 12 days. Median duration of enteral nutrition was 16 days. All patients achieved efficient phonation. CONCLUSION: Pignat's partial laryngectomy with CHEPL can represent an alternative to horizontal supracricoid laryngectomy to achieve laryngeal preservation. Good oncologic and functional outcomes are possible as long as indications are followed.

Experience in reconstruction of esophagus, epiglottis, and upper trachea due to caustic injuries in pediatric patients and establishment of algorithm.

BACKGROUND: Unintentional swallowing of corrosive agents cause problems in the pediatric population. Swallowing dysfunction can be seen after injuring the pharynx and/or epiglottis which leads to the obstruction of esophagus. An algorithm was established taking into account the injury to the epiglottis and restoring gastrointestinal continuity with isolated or combine free and or supercharged jejunum flap, or supercharged colon transposition flap. METHODS: Seventeen patients between the ages of 3 and 16 (mean age: 7.7) were treated between 1985 and 2019. Three different procedures were performed based on endoscopic findings; for patients with no or minimal damage to epiglottis, pedicled colon transposition was done in 12 cases. For patients with epiglottic scarring or edema, a two-stage reconstruction was performed. In the first stage, free jejunum flap was implemented to the pharynx to facilitate food passage, followed by a pedicled jejunum in two cases, or a pedicled colon transposition in two cases to provide gastrointestinal continuity. For one patient with severe epiglottic scarring, a free jejunal flap was used as a diversion conduit in the first stage, followed by supercharged colon transposition to restore gastrointestinal continuity. RESULTS: Supercharged intestinal flaps were harvested with 3-4 cm of extra intestinal tissue than the measured thoracic portion in each individual in order to reach the hypopharyngeal region. The size of the free jejunal flaps were 10 cm. Oral feeding was initiated on the eighth postoperative day. Partial loss of the anterior wall of the jejunal flap was seen in one case, in which a free anterolateral thigh-vastus lateralis musculocutaneous flap was used for reconstruction. The mean follow-up time was 5.1 years and there was no stricture in the final outcome. CONCLUSION: A competent epiglottis is essential for proper swallowing reflex. Meticulous microsurgical dissection and performing supercharged intestinal flaps provide a complication-free end result.

Description and evaluation of a novel transoral endoscopic arytenopexy in canine cadavers.

OBJECTIVE: To describe the transoral endoscopic arytenopexy (TEA) and evaluate its effects on the rima glottis area (RGA) and laryngeal epiglottic-glottic seal (LEGS). We hypothesize the TEA will be a feasible surgical technique and the TEA will provide a significant increase in RGA with minimal change to the LEGS. STUDY DESIGN: Canine cadaveric model. ANIMALS: Fifteen medium- to large-breed canine cadavers. METHODS: Endoscopic photos of the larynx were taken with the epiglottis open for baseline RGA measurement and closed for baseline measurement of exposed RGA and LEGS. A custom endoscopic gag port (EGP) facilitated the TEA, performed by suturing the lateral aspect of the left arytenoid soft tissues to adjacent pharyngeal wall across the piriform recess. Endoscopic photos were repeated to measure changes in RGA and LEGS. A computerized planimetric analysis program was used to calculate baseline RGA and LEGS. The RGA was reported in % change from baseline. The LEGS was reported as intact or altered. A nonparametric Wilcoxon signed-rank test was used to compare baseline to post-TEA RGA. RESULTS: The mean baseline RGA was 0.52 ± 0.28 cm3 and mean post-TEA RGA was 0.78 ± 0.37 cm3 (p-value < .0001). The LEGS remained intact post-TEA in all cadavers. CONCLUSIONS: The TEA was technically feasible and resulted in an increase in RGA while maintaining the LEGS. CLINICAL SIGNIFICANCE: The TEA may provide a minimally invasive addition to the established techniques for reducing airway resistance while minimizing the impact on the LEGS.

Surgical approach of laryngofissure combined with epiglottis valley in treating locally-advanced pyriform sinus carcinoma. / å–‰è£‚å¼€è”åˆä¼šåŽŒè°·å ¥è·¯æ‰‹æœ¯æ²»ç–—å±€éƒ¨æ™šæœŸæ¢¨çŠ¶çªç™Œ.

OBJECTIVES: To evaluate feasibility and efficacy of surgical approach of laryngofissure combined with epiglottis valley in treating locally-advanced pyriform sinus carcinoma. METHODS: Clinical data of 216 patients with T3 and T4a pyriform sinus carcinoma, who came from the Department of Otorhinolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University between January 2013 and December 2019, were retrospectively analyzed. Three different types of surgery were used in these patients. Seventy-three patients were performed by approach of laryngofissure combined with epiglottis valley for partial laryngopharyngectomy (Group I); 75 patients were performed by approach of lateral pharynx for piriform fossa resection (Group II); 68 patients were performed by total laryngopharyngectomy (Group III). All patients were treated with radiotherapy and followed up regularly after operation. Kaplan-Meier regression model was used to analyze the overall survival rate. EAT-10 swallowing scale was utilized to evaluate the postoperative swallowing function, while the rate of tracheal tube extubation and the incidence of postoperative complications in each group were compared. RESULTS: There were 76.7% patients with T3 stage in Group I, 100% patients with T3 stage in Group II, and 64.7% patients with T4a stage in Group III. There was significant difference between them (P<0.01). Clinical stage IV patients in the Group I, Group II, and Group III were 74.0%, 54.7%, and 89.7%, respectively, with significant difference (P<0.01). The 3-year overall survival (OS) rate in Group I, Group II, and Group III were 69.9%, 53.3%, and 58.8%, respectively. Patients in the Group I had a better survival outcome than that in the Group II (P<0.05). The median score of EAT-10 swallowing scale was 12.0 in the Group I, 8.0 in Group II, and 5.0 in Group III, with significant difference (P<0.01). There was no significant difference in the rate of tracheal tube extubation and the incidence of complication among the 3 groups (both P>0.05). CONCLUSIONS: Surgical approach of laryngofissure combined with epiglottis valley in the treating locally-advanced piriform sinus carcinoma presents favorable outcome in terms of survival rate and laryngeal function preservation, which deserves to be promoted.

Epiglottopexy with or without aryepiglottic fold division: Comparing outcomes in the treatment of pediatric obstructive sleep apnea.

OBJECTIVE: To determine the success of epiglottopexy with or without aryepiglottic fold division for treatment of patients with obstructive sleep apnea (OSA) with epiglottic obstruction. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary care academic hospital. METHODS: Children with sleep study proven OSA who underwent epiglottopexy with or without aryepiglottic fold division from January 2013 to June 2017 were included. The epiglottis contributed to airway obstruction in all patients. Pre- and post-operative apnea-hypopnea index (AHI) were compared. Age, sex, body mass index (BMI) z-score and post-operative complications were also evaluated. Success was defined by post-operative AHI < 5.0 with resolution of OSA symptoms or AHI ≤ 1.0 events per hour. RESULTS: Twenty-eight children (age 2-17 years) underwent either epiglottopexy with division of aryepiglottic folds (N = 18) or epiglottopexy alone (N = 10). There was no difference in preoperative age, AHI, or BMI between the groups. Post-operative AHI was lower in the group undergoing epiglottopexy alone (AHI 1.50) versus with aryepiglottic fold division (AHI 3.17) (P < 0.05). No difference was found in mean AHI improvement between the two groups. For the entire cohort, success criteria were met by 53.6% of patients for AHI < 5.0 without symptoms and 25.0% of patients for AHI ≤ 1.0, with no difference in surgical success between procedures (P > 0.05). CONCLUSIONS: Children undergoing epiglottopexy with division of aryepiglottic folds for laryngeal collapse were as likely to have improved OSA symptoms as children undergoing epiglottopexy alone.

Robot-assisted epiglottopexy as a method for managing adult obstructive sleep apnea.

INTRODUCTION: Patients who do not tolerate continuous positive airway pressure (CPAP) for treatment of obstructive sleep apnea (OSA) often seek surgical management. A variety of procedures exist to address the nasal passages, oropharynx, hypopharynx, and larynx. Diagnostic studies including drug-induced sleep endoscopy (DISE) are helpful in identifying areas of obstruction. One potential site of obstruction is at the level of the epiglottis. We describe the use of robotic technology to assist with epiglottopexy to manage epiglottic retroflexion as a cause of two patients' OSA. This is the first reported robot-assisted epiglottopexy in the adult otolaryngology literature. METHODS: This is a case series of two patients with OSA who demonstrated epiglottis collapse into the airway during DISE. They were evaluated by polysomnographic testing (PSG), Epworth Sleepiness Scale (ESS), and physical exam. Given their epiglottic collapse seen on DISE, they underwent robot-assisted epiglottopexy. RESULTS: Both patients had moderate to severe OSA preoperatively. They successfully underwent robot-assisted epiglottopexy as a surgical intervention. They tolerated the procedure, and there have been no complications. Each reported improved symptoms, with patient one showing a decrease in total AHI and a substantial decrease in oxygen desaturations at night. The second patient reported a significant decrease in AHI and ESS. CONCLUSION: There are many options for surgical intervention in patients with OSA. Epiglottopexy is one method for addressing collapse of the epiglottis and can be achieved successfully through robot-assisted epiglottopexy in adult patients with OSA. LEVEL OF EVIDENCE: IV.

Swallowing outcomes after pediatric epiglottopexy.

INTRODUCTION: Persistent sleep apnea following tonsillectomy and adenoidectomy in children requires additional evaluation. One of the common areas of persistent upper airway obstruction in these children is the base of the tongue and lingual tonsils as well as epiglottic prolapse. Depending on the site of obstruction on sleep endoscopy or a cine MRI, surgical procedures include base of tongue reduction and lingual tonsillectomy with or without epiglottopexy. OBJECTIVE: To assess the swallowing outcomes in children undergoing epiglottopexy with lingual tonsillectomy. METHODS: A retrospective case series review of children undergoing epiglottopexy with or without lingual tonsillectomy. All patients underwent an epiglottopexy with lingual tonsillectomy using coblation. A detailed evaluation including a sleep study, sleep endoscopy, and thorough swallowing assessment preoperatively as well as postoperatively was performed. RESULTS: Five children underwent epiglottopexy with lingual tonsillectomy for obstructive sleep apnea. Epiglottopexy improved sleep apnea with Apnea Hypopnea Index (AHI) falling significantly from 4.6 to 0.5 (p < 0.05). All patients had a normal swallowing assessment postoperatively with functional endoscopic evaluation of swallowing (FEES) revealing no evidence of aspiration and penetration. CONCLUSION: In our case series epiglottopexy with lingual tonsillectomy is a safe and effective technique, which improves sleep apnea in pediatric patients. It does not affect the swallowing mechanism, and the epiglottis still retains the laryngeal protective role.

Transendoscopic correction of epiglottic entrapment with a silicone-covered laser guide and diode laser in 29 horses.

OBJECTIVE: To describe the use of a silicone-covered laser guide and diode laser for surgical correction of epiglottic entrapment and report postoperative outcomes in horses with epiglottic entrapment. STUDY DESIGN: Retrospective case series. ANIMALS: Thoroughbred and standardbred racehorses (n = 29) with epiglottic entrapment. METHODS: A silicone-covered laser guide was placed endoscopically to direct the diode laser cutting action during transection of the entrapping subepiglottic membrane and to act as a physical barrier between the membrane and the epiglottic cartilage. Postoperative complications and trainer satisfaction were recorded via use of a follow-up questionnaire. Race records were reviewed to determine return to racing and detect differences in the number of starts, wins, or earnings before and after surgery. RESULTS: The entrapping membrane was successfully released in all horses. Mild postoperative complications such as swelling of the surgical site (12 horses) and coughing or mild nasal discharge (5 horses) were recorded during the first few days after surgery. Ninety-six percent of trainers were satisfied with the outcome of the procedure; 93% of horses returned to racing. CONCLUSION: Laser guide-assisted transection of the subepiglottic membrane corrected epiglottic entrapment in standing horses. CLINICAL SIGNIFICANCE: Ease of surgical technique, mild postoperative complications, and a good prognosis to return to racing make this a suitable alternative to the traditional laser procedure.

Racing performance of National Hunt thoroughbred racehorses after treatment of palatal dysfunction with a laryngeal tie-forward procedure and thermocautery of the soft palate with or without aryepiglottic folds resection.

OBJECTIVE: To assess racing performance of National Hunt thoroughbred (NH) racehorses with a definite diagnosis of palatal dysfunction treated with a laryngeal tie-forward procedure (LTF) and soft palate cautery (SPC) with or without transendoscopic laser excision of the aryepiglottic folds (TLEAF) and to determine correlation between performance measures. STUDY DESIGN: Retrospective cohort study. ANIMALS: National Hunt racehorses treated with LTF, SPC ± TLEAF (n = 44) and nonaffected controls (n = 88). METHODS: Performance was evaluated by using Racing Post ratings (RPR), race earnings (RE), and performance index (PIndex). Affected horses were compared with nonaffected horses. The effect of TLEAF and correlations between measures were analyzed. RESULTS: Racing Post rating, RE and PIndex improved by 50%, 26%, and 12% in treated, and by 50%, 39%, and 24% in control horses, respectively, when measurements were evaluated for the median of three presurgical and postsurgical races. Lower postsurgical performance was detected when five postsurgical races were compared with two presurgical races (P ≤ .03). The number of postsurgical earnings rated at zero was greater in treated horses than in control horses (P < .05). Race earnings and RPR correlated more strongly (r = 0.634-0.796) than PIndex and other measures (r = 0.378-0.692). CONCLUSION: Postsurgical performance of NH racehorses with palatal dysfunction after LTF and SPC ± TLEAF was decreased compared with unaffected controls. The negative effect of TLEAF on performance was detected. CLINICAL SIGNIFICANCE: Although LTF is widely performed in NH racehorses, it may not be the most efficient treatment for palatal dysfunction.

Epiglottis shape as a predictor of obstruction level in patients with sleep apnea.

PURPOSE: Despite a broad range of diagnostic methods, identifying the site of obstruction in the upper respiratory tract in patients with obstructive sleep apnea is not always simple and straightforward. With regard to this problem, we present our observations about the specific shape of the epiglottis in patients with obstruction at the level of the tongue base and/or epiglottis. METHODS: One hundred and forty consecutive drug-induced sleep endoscopy (DISE) video recordings of patients with polygraphy-verified obstructive sleep apnea were analyzed by three independent observers. We compared the levels of obstruction using the VOTE classification and the shape of the epiglottis, both as seen during the DISE investigation and in the awake state. We have calculated the interrater reliability for VOTE classification results and epiglottis shape evaluation by three different observers. RESULTS: Out of 140 patients, there were 52 (37.1%) with a flat epiglottis. Within this group, there were only 3 (6%) cases in which obstructions at the tongue base and/or epiglottis level were not found. In the group with normally convex and omega-shaped epiglottis, obstruction at the tongue base level was observed in 28 patients (31.8%); obstruction at the epiglottis level was observed in 5 patients (5.7%); and obstruction at both the epiglottis and tongue base level was observed in 3 patients (3.4%). Interrater reliability for VOTE classification was poor for V (ICC = 0.414) and good for O (ICC = 0.824), T (ICC = 0.775), and E (ICC = 0.852). Additionally, interrater reliability was excellent for epiglottis shape (ICC = 0.912). CONCLUSION: In patients with obstructive sleep apnea, examinations in the awake state and drug-induced sleep endoscopy both showed that in most cases of obstruction at epiglottis and/or tongue base, the epiglottis was flat, i.e., lacking the typical anterior convexity in its upper part. We assume that the change of its shape is a result of degeneration of suspensory apparatus that maintains the shape of the epiglottis and holds it in its position. This could contribute to the better identification of patients with a narrowing at this level, and in turn to better decisions regarding the choice of the most suitable treatment.

Epiglottopexy for the treatment of epiglottic retroversion in 2 horses.

OBJECTIVE: To report an epiglottopexy technique for the treatment of epiglottic retroversion (ER) in 2 horses. STUDY DESIGN: Case report. ANIMALS: A 2-year-old thoroughbred gelding and a 6-year-old standardbred gelding, both with ER. METHODS: Epiglottic retroversion was diagnosed via exercising endoscopic examination in both horses. Epiglottopexy technique was performed in both cases. RESULTS: Both horses returned to previous racing class within 1 year after surgery. Repeat exercising endoscopy of 1 horse 6 months postoperatively revealed resolution of the ER. CONCLUSION: Epiglottopexy should be considered for treatment of ER in the equine athlete. CLINICAL SIGNIFICANCE: Previously reported surgical techniques for ER in the equine athlete have not resulted in horses returning to previous performance level. The technique reported here resulted in both horses achieving athletic status.

Using quarterly earnings to assess racing performance in 66 thoroughbreds after transendoscopic laser surgery for treatment of epiglottic entrapment.

OBJECTIVE: To assess the outcome of transendoscopic laser surgery for the treatment of epiglottic entrapment (EE) and determine the influence of preoperative morphological characteristics on outcomes. STUDY DESIGN: Retrospective cohort study. ANIMALS: Thoroughbred racehorses treated with transendoscopic laser surgery (n = 66) and untreated cohorts (n = 132). METHODS: Medical, surgical, and race records of 66 horses treated with transendoscopic laser surgery were compared with untreated cohorts randomly selected from their last race presurgery. Postsurgery data were collated as number of starts and race winnings for each quarter after the date of surgery. RESULTS: Treated horses performed worse (P = .002) than their untreated cohorts in their last race presurgery. Although treated horses raced fewer times (P < .001) and earned less money (P < .001) in the first quarter after surgery compared with untreated horses, quarterly earnings or starts did not differ between groups after the first quarter. Among variables tested, subepiglottic membrane resection was the only prognostic factor; horses requiring this resection raced fewer times (P = .001) but without a significant difference in earnings. CONCLUSION: Horses treated for EE via transendoscopic laser surgery returned to a performance standard comparable to their untreated cohorts by the second quarter postsurgery. Horses with entrapments requiring resection raced fewer times postoperatively than the untreated cohorts. CLINICAL SIGNIFICANCE: Treated horses can be expected to perform equivocally to that of untreated cohorts in all but the first quarter following surgery except in those cases where resection of the entrapping membranes is required.

Combined Orthodontic and Surgical Treatment in a 8-Years-Old Patient Affected By Severe Obstructive Sleep Apnea: A Case-Report.

An eight-years-old girl showed a restless sleep with snoring and severe apnea episodes, a mandibular retrognathia, mouth breathing, maxillary transverse discrepancy, mandibular transverse discrepancy, moderate crowding and anterior open-bite. The CBCT showed an anterior collapse of the epiglottis. The treatment consisted in a rapid palatal expansion, an epiglottoplasty and a reduction of the tongue base. Polysomnography revealed that apnea-hypopnea index improved from 21,8 episodes/hr at the baseline to 0,6 episodes/hr, average oxygen saturation from 96,5% to 98,1%, oxygen desaturation events from 23,4 episodes/hr to 1/hr.

[Evaluación funcional de deglución-aspiración en pacientes sometidos a laringectomía subtotal supracricoidea con cricohioidoepiglotopexia].

INTRODUCTION: Cardiovascular disease is the main cause of mortality worldwide. In women, its incidence increases at the sixth decade of life, coinciding with postmenopause. Whether this effect is due to menopause-related hormonal changes is not known. OBJECTIVE: To evaluate the differences in cardiovascular risk in pre- and postmenopausal women by means of the Globorisk risk scale, the triglyceride/high-density lipoproteinsHDL cholesterol (Tg/HDL-C) ratio and metabolic syndrome (MS) criteria. METHOD: Cross-sectional study that included 408 women from 40 to 60 years of age; anthropometric measurements and biochemical determinations were performed. The participants were classified as premenopausal and postmenopausal. Cardiovascular risk was assessed using the MS criteria, the Globorisk risk calculator and the Tg/HDL-C ratio. RESULTS: Postmenopausal women showed a significant increase in waist circumference, total cholesterol and triglycerides Tg in comparison with premenopausal women. Significant associations were found between hormonal state and Globorisk-measured cardiovascular risk (OR = 2.50; 95 % CI = 1.67-3.74) and the Tgtriglyceride/HDL-C ratio (OR = 1.66; 95 % CI = 1.09-2.52). CONCLUSION: Cardiovascular risk factors have a higher prevalence in postmenopause. The Globorisk scale and Tg/HDL-C ratio identify cardiovascular risk in postmenopausal women.

INTRODUCCIÓN: La laringectomía subtotal supracricoidea asociada con cricohioidoepiglotopexia es la técnica quirúrgica conservadora más eficiente para preservar las funciones laríngeas de los pacientes con carcinoma localmente avanzado de la laringe. La complicación más temida de esta intervención es la aspiración en el momento de la deglución y la neumonía secundaria; existen diversas formas de evaluar la aspiración y el grado de esta. Presentamos una novedosa forma de identificar incluso pequeñas cantidades de aspiración traqueobronquial. MÉTODO: Se incluyeron pacientes sometidos a laringectomía subtotal y cricohioidoepiglotopexia por cáncer laríngeo; todos evaluados con trago radiactivo posoperatorio. Con base en la sintomatología y resultado del gammagramma se decidió prolongar el tiempo de alimentación por sonda. RESULTADOS: Se incluyeron 37 pacientes, cuatro habían recibido radioterapia; la tasa de aspiración fue de 29.7 %; 50 % de los pacientes que habían recibido radioterapia presentó aspiración y 18 % de los pacientes con aspiración requirió prolongación del tiempo de alimentación por sonda nasogástrica; ninguno necesitó laringectomía total por aspiración que no permitiera la deglución. CONCLUSIONES: La evaluación posoperatoria de pacientes sometidos a laringectomía subtotal con trago radiactivo permite identificar líquido aspirado al árbol bronquial, incluso en cantidades mínimas, y planear el momento para iniciar la deglución.

Outcome of TORS to tongue base and epiglottis in patients with OSA intolerant of conventional treatment.

PURPOSE: Transoral robotic surgery (TORS) of the tongue base with or without epiglottoplasty represents a novel treatment for obstructive sleep apnea (OSA). The objective was to evaluate the clinical efficacy of TORS of the tongue base with or without epiglottoplasty in patients who had not tolerated or complied with conventional treatment (continuous positive airway pressure or oral appliance). METHODS: Four-year prospective case series. The primary outcome measure was the apnea-hypopnea index (AHI) in combination with the Epworth Sleepiness Score (ESS). Mean oxygen saturation levels (SaO2) before and after TORS on respective sleep studies were also recorded. Secondary outcome measures included operative time and complications. Patient reported outcome measures (PROMs) assessed included voice, swallow and quality of life. RESULTS: Fourteen patients underwent TORS for tongue base reduction with ten having additional wedge epiglottoplasty. A 64 % success rate was achieved with a normal post-operative sleep study in 36 % of cases at 6 months. There was a 51 % reduction in the mean AHI (36.3 ± 21.4 to 21.2 ± 24.6, p = 0.02) and a sustained reduction in the mean Epworth Sleepiness Score (p = 0.002). Mean SaO2 significantly increased after surgery compared to pre-operative values (92.9 ± 1.8 to 94.3 ± 2.5, p = 0.005). Quality of life showed a sustained improvement 3 months following surgery (p = 0.01). No major complications occurred. CONCLUSIONS: TORS of the tongue base with or without epiglottoplasty represents a promising treatment option with minimal morbidity for selected patients with OSA. Long-term prospective comparative evaluation is necessary to validate the findings of this study.

Evaluation of growth curves in children after supraglottoplasty.

OBJECTIVES: To determine if monitoring weight growth curves is a sensitive objective parameter for evaluating operative outcomes after supraglottoplasty. STUDY DESIGN: Retrospective chart review. METHODS: An IRB approved retrospective review of patients who underwent supraglottoplasty from 2/28/2012 to 10/20/2014 by the otolaryngology department at a single institution was performed. Variables collected included age, race, sex, preoperative weight percentiles, and weight percentiles at 3 month, 12 month, and 3 year followup intervals. RESULTS: 20 patients met inclusion criteria. 15 (75%) patients were male and 5 (25%) were female. 9 (45%) patients were African American, 8 (40%) were Caucasian, and 3 (15%) were other. Average weight for age at surgery was 29.8 percentile. 6 (30%) had failure to thrive by weight. By 3 months postop average weight had increased by 7.67 percentile (p=0.09, 95% CI -1.62 to 17.0), by 12 months there was an observed increase of 19.1 percentile (p=0.06, 95% CI 0.47-37.8), and by 3 years the average weight had increased by 26.53 percentile (p=0.03, 95% CI 4.47-48.59). By three years postop the average weight had normalized (64.5 percentile). Among those who met preoperative failure to thrive criteria (average 0.11 percentile), weight gain was still dramatic with average weight percentile of 37.5 by 3 years postop. CONCLUSION: Patients undergoing supraglottoplasty are typically underweight for age. Statistically significant weight gain occurs in children after going supraglottoplasty. This intervention can normalize their growth chart growth patterns by 3 years postoperatively, even in children with failure to thrive.