Comparing Upper Airway Stimulation to Transoral Robotic Base of Tongue Resection for Treatment of Obstructive Sleep Apnea.

OBJECTIVES: Transoral robotic surgery (TORS) and upper airway stimulation (UAS) are modalities for treating tongue base obstruction contributing to obstructive sleep apnea (OSA). We aim to compare patients with OSA undergoing TORS to those undergoing UAS. METHODS: We retrospectively reviewed patients treated with TORS and UAS using the senior authors' surgical database. We evaluated demographic, preoperative polysomnography (PSG), postoperative PSG, complication, hospital length of stay, and hospital readmission data to compare the two cohorts. RESULTS: Seventy-six patients underwent UAS. This included 50 men and 26 women. The mean age and body mass index were 61.92 and 29.38. The mean pre- versus postoperative apnea hypopnea index (AHI) and O2 nadir were 36.64 versus 7.20 and 80.27% versus 88.77%, respectfully. The rate of surgical success and postoperative AHI less than 15 and 5 were 86.84%, 89.47%, and 59.21. All patients underwent ambulatory surgery, and no one was readmitted. Twenty-four patients underwent TORS. This included 20 men and four women with a mean age and body mass index BMI of 46.42 and 29.63. The mean pre- versus postoperative AHI and O2 nadir were 35.70 versus 20.05 and 80.50% versus 84.10%, respectfully. The rate of surgical success and postoperative AHI less than 15 and 5 were 54.17%, 50.00%, and 20.83%. The mean length of stay was 1.33 days, and four patients were readmitted. We found significant differences in age, postoperative AHI and O2 nadir, surgical success and postoperative AHI less than 15 and 5, length of stay, and rate of readmission. CONCLUSIONS: UAS is successful in treating OSA showing improved outcomes, length of stay, and readmission compared to TORS. LEVEL OF EVIDENCE: 3 Laryngoscope, 129:1010-1013, 2019.

Synovial Sarcoma of the Tongue: Report of a Case.

This report outlines the workup and management of a 55-year-old woman with a synovial sarcoma of the lateral border of the tongue that was initially diagnosed as a glomus tumor. A review was performed of the literature on synovial sarcomas of the oral cavity and current National Comprehensive Cancer Network guidelines. Synovial sarcomas of the tongue are rare neoplasms, with variable morphologic microscopic types and immunohistochemical profiles. Fluorescence in situ hybridization analysis of the known gene translocation also can be used in diagnosis. According to the literature, resection of the tumor is the current treatment of choice; however, owing to the rarity of this entity, diagnosis and management prove challenging for the oral and maxillofacial surgeon.

[Comparative effectiveness of maxillomandibular advancement surgery versus mandibular advancement device for patients with moderate or severe obstructive sleep area]. / Ostéotomie d'avancée maxillo-mandibulaire ou orthèse d'avancée mandibulaire dans le traitement des syndromes d'apnées obstructives du sommeil modérés à sévères : comparaison d'efficacité et recherche de critères prédictifs d'efficacité

INTRODUCTION: Currently, positive airway pressure is the gold standard treatment of obstructive sleep apnea (OSA). Unfortunely, adherence rates are poor. Alternative therapies are mandibular advancement device (MAD) and maxillomandibular advancement (MMA). PATIENTS: This retrospective study compared both treatment effectiveness on patients with moderate and severe OSA from January 2005 to September 2012, and carried out predictive factor of effectiveness. We defined therapeutic success as an apnea hypopnea index (AHI) less than 15 per hour and at least a 50% reduction of the initial index. The difference in effectiveness has been studied using regression logistic adjusted on MAD versus MMA propensity score. RESULTS: This study included 198 patients. 37 were treated by MMA, and 161 with MAD. MMA treatment was significantly more efficient than MAD treatment with an odds ratio of 3.22; CI95% 1.31Γ7.82 (p = 0.011). Younger age and lower initial AHI were predictive of increased success. There was no significant interaction between the treatment and morphologic patient factors. CONCLUSION: In our sample of patients, MMA surgery was significantly more efficient than MAD treatment for the patients with moderate or severe OSA. No morphologic characteristic was identified to determine which patients would benefit most from MAD versus MMA surgery.

Total glossectomy with preservation of the larynx: oncological and functional results.

Our aim was to analyse the overall and disease-free survival (DFS), time to recovery of oral feeding, and morbidity, in a consecutive series of patients who had total glossectomy with preservation of the larynx for advanced cancer of the tongue at the European institute of Oncology (Milan). From June 2002 to April 2011, 37 patients who were treated for advanced cancer of the tongue had total glossectomy, bilateral neck dissection, and preservation of the larynx. Various flaps were used for reconstruction. Overall and disease-free survival were assessed from the day of operation to the latest outpatient examination. Postoperative morbidity and rehabilitation of feeding were also assessed. Six patients had major complications, four of whom had a second operation for necrosis of the flap. Actuarial five-year overall survival (OS) and disease-free survival were 54% and 47%. Twenty-four patients (65%) were operated on as their first treatment, and had 79% five-year overall survival and 61% 5-year disease-free survival. Twenty-six patients were eventually able to feed orally postoperatively. Although this retrospective study include a limited number of patients, the results support the validity of total glossectomy as a safe procedure for advanced cancer of the tongue. Pretreated patient were previously treated with surgery, radiotherapy or chemoradiotherapy with curative purposes. Nevertheless, the long period required for recovery of oral feeding indicates that total glossectomy should be reserved for highly motivated patients.

Measurement of anaphylatoxin activity during surgery.

We studied whether or not anaphylatoxins (ATs) are related to stress-related surgery by examining AT measurement in 51 patients undergoing operation. C3a plasma levels in patients who underwent the Caldwell-Luc operation increased from a pre-surgery concentration of 129 +/- 19 (mean +/- SD) ng/ml to 293 +/- 91 ng/ml during surgery under local anesthesia. However, pre- and post-surgery values were almost the same. No significant change occurred in the C5a plasma concentration at any time in patients undergoing the Caldwell-Luc operation, tonsillectomy or partial glossectomy. The mechanism underlying elevation in C3a during surgery is discussed.