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. To test the differences among groups of Student's t test, the role of each factor (univariate analysis) and their independent effect (multivariate analysis) was explored using logistic regression model as appropriate. Linear regression was also conducted. RESULTS: A significant reduction of AHI, ODI, LOS, and Epworth Sleepiness Scale (ESS) values was recorded in the BRP group. BRP showed to be more effective than observation. Logistic regression showed that preoperative AHI is related significantly to postoperative AHI within the BRP group. A linear regression showed that higher baseline AHI predicts more significant postoperative absolute AHI reduction. CONCLUSIONS: BRP appears to be a promising technique and might be included within the surgical armamentarium of a sleep surgeon. Patients affected by severe OSA may benefit from this surgery with more significant reduction of AHI values.

Manejo de la vía aérea a través de faringostoma cervical por radionecrosis / Management of the airway through cervical faringostoma by radionecrosis

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Nuestra técnica de colgajo miocutáneo de pectoral mayor para reconstrucción de defectos cervicales / Our technique of pectoralis major myocutaneous flap for reconstruction of cervical defects

Introducción y Objetivos. Las técnicas actuales para reconstrucción de cabeza y cuello se basan principalmente en colgajos libres, fasciocutáneos o viscerales según el defecto. La evolución de la microcirugía ha relegado a un segundo plano a los colgajos pediculados. El colgajo miocutáneo pediculado de pectoral mayor ha sido uno de los más empleados hasta que se ha extendido el uso de los colgajos libres. Las desventajas que presenta, tales como su volumen o sus secuelas funcionales y estéticas, son responsables de su desuso actual. Presentamos una modificación de la técnica clásica del pectoral mayor para minimizar sus desventajas. Material y Método. Hacemos una descripción técnica de la modificación desarrollada por Márquez-Cañada del colgajo de pectoral mayor para reconstrucción de defectos cervicales y un estudio descriptivo sobre un grupo de pacientes sometidos a la misma. Resultados. Recogimos 6 casos, 5 varones y 1 mujer (edad media de 52.5 años), en los que se empleó la técnica descrita. El defecto más frecuente (66.7%) fue el faringostoma secundario a laringuectomía total y vaciamiento cervical por carcinoma epidermoide de laringe. Tiempo medio entre intervenciones quirúrgicas de 5 semanas. En 2 casos hubo como complicación serohematoma en zona donante tras el primer tiempo quirúrgico, No hubo pérdida de injertos ni necrosis, fístulas o estenosis secundarias. Resultado estético aceptable; los pacientes conservaron movilidad completa del brazo. Conclusiones. Observamos una reducción en el número de complicaciones respecto del uso del pectoral mayor clásico y los colgajos libres Creemos que la modificación técnica que presentamos, por su reproducibilidad y su baja tasa de complicaciones, podría emplearse en reconstrucción de cuello como colgajo de elección en pacientes de alto riesgo, no candidatos a técnicas microquirúrgicas (AU)

Background and Objective. Current techniques for head and neck reconstruction are mainly based on free flaps, fasciocutaneous or visceral according to the defect. The evolution of microsurgery has relegated to the background the pedicled flaps. The pedicled myocutaneous pectoralis major flap has been one of the most employed until the generalization of free flaps. Their disadvantages such as bulky or functional and aesthetic sequelae, are responsible for its current disuse. We present a modification to the classic technique of pectoralis major flap to reduce its disadvantages. Methods. We make a technical description of the modification developed by Márquez-Cañada of the pectoralis major flap for cervical defects reconstruction and a descriptive study on a group of patients submitted to it. Results. We collected 6 cases, 5 males and 1 females (mean age 52.5 years), in which the described technique was used. The most frequent defect (66.7%) was the pharyngostoma secondary to total laryngectomy and cervical emptying secondary a epidermoid carcinoma of the larynx. Mean time between surgeries was 5-week. In 2 cases, there was serohematoma in the donor site after the first surgical time. There was no loss of grafts or necrosis, fistulas or secondary stenoses. Acceptable esthetic result; patients maintained complete arm mobility. Conclusions. We observed a reduction in the number of complications with respect to the use of the classic pectoralis and free flaps. We believe that the technical modification that we present, due to its reproducibility and its low complication rate, could be used in neck reconstruction as a flap of choice in patients of high risk, not candidates for microsurgical techniques (AU)

National Database Analysis of Single-Level versus Multilevel Sleep Surgery.

Objective Recent evidence suggests that multilevel sleep surgery improves outcomes when compared with palate surgery alone for most patients. The study objective was to compare demographic and outcomes data for palate surgery (uvulopalatopharyngoplasty [UPPP]) alone versus multilevel surgery through a national insurance claims database. Study Design Retrospective cohort study. Setting National insurance claims database. Subjects and Methods An adult cohort undergoing single-level UPPP versus UPPP with nasal and/or tongue/hypopharyngeal surgery was identified in the Truven Health Analytics MarketScan Research Databases for the years 2010 through 2012. Demographic and outcomes data were assessed at short-term (≤14 days), intermediate (15-60 days), and long-term (61-183 days) intervals via a multivariate regression model adjusted for age, sex, geographic region, insurance type, and the Charlson-Deyo comorbidity score. The primary long-term complication considered was positive airway pressure (PAP) equipment supply, implying possible treatment failure. Results The cohort included 14,633 patients: 7559 (51.6%), UPPP alone; 5219 (35.7%), UPPP + nasal surgery; 1164 (7.95%), UPPP + tongue/hypopharyngeal surgery; and 691 (4.7%), UPPP + nasal + tongue/hypopharyngeal surgery. Demographic data were similar among the groups. UPPP alone had lower rates of postoperative bleeding than UPPP + tongue/hypopharyngeal surgery (4.31% vs 6.19%, P = .004). Multivariate modeling indicated that the addition of either nasal surgery (odds ratio = 1.21, 95% CI = 1.10-1.34, P < .001) or tongue/hypopharyngeal surgery (odds ratio = 1.15, 95% CI = 1.00-1.32, P = .048) to UPPP was associated with increased odds of postoperative continuous positive airway pressure. Conclusions UPPP alone is currently the predominant form of sleep surgery in the United States. Multilevel surgery had greater odds of postoperative bleeding and positive airway pressure equipment supply than UPPP alone. Dedicated studies formally evaluating single- versus multilevel sleep surgery and the impact of possible surgeon/patient selection bias should be a priority.

Pharyngotomy for a swallowed denture.

The introduction of inhalation anaesthesia, first by the use of ether in 1845 and then of chloroform in the following year, saw an explosion in the range and extent of major surgical procedures as patients were spared the agonies of the surgeon's knife. A good example of this was the operation of pharyngotomy - opening the cervical oesophagus through a lateral incision of the neck - to remove an impacted foreign body. One cannot imagine a surgeon being able to do this without the benefit of an anaesthetic! Edward Cock, a surgeon at Guy's Hospital, performed this operation successfully on two occasions; the second was reported in detail in the Guy's Hospital Reports 1868, Volume 28.

Pharyngostomy.

A retrospective analysis of a prospective observational study of a cohort of patients who required prolonged foregut/midgut decompression/intraluminal stenting and/or enteral nutritional support was conducted. Those patients were intolerant of protracted nasogastric intubation. They also manifested hostile peritoneal cavities and therefore were not candidates for a laparoendoscopic gastrostomy or jejunostomy. Accordingly, they underwent insertion of a pharyngogastric or pharyngojejunal tube. With patients properly positioned and anesthetized and with attention to the anatomy of the superior carotid cervical triangle, those pharyngostomies and cannulations were performed safely and efficiently. The tubes remained indefinitely or were changed/removed ad libitum. Morbidity was nil and no mortality attributable to the procedure was observed. Pharyngostomy should be part of the armamentarium of all general surgeons.

A novel surgical method of managing a high output pharyngostome.

Pharyngocutaneous fistulas following large oncological surgical resection of the upper aerodigestive tract are common and typically heal over a number of weeks. A pharyngostome is a surgically created non-healing opening into the pharynx, which is far less common and often difficult to manage.

A novel surgical method of managing a high output pharyngostome.

Pharyngocutaneous fistulas following large oncological surgical resection of the upper aerodigestive tract are common and typically heal over a number of weeks. A pharyngostome is a surgically created non-healing opening into the pharynx, which is far less common and often difficult to manage.

Colgajo antebraquial radial en cabeza y cuello: nuestra experiencia / Free radial forearm flap in head and neck: our experience

Introducción: La cirugía oncológica conlleva a importantes defectos y secuelas, así como alteraciones funcionales y cosméticas notables. En este aspecto, la cirugía reconstructiva tiene un papel esencial, permitiendo mayor radicalidad en la exéresis y disminución de las morbilidades funcionales y cosméticas asociadas. El objetivo de este estudio es presentar y evaluar la experiencia y resultados de la Unidad de Microcirugía Reconstructiva del Servicio de Otorrinolaringología de nuestro centro. Métodos: Estudio retrospectivo de procedimientos realizado entre los años 2006-2012. Resultados: Un total de 36 casos fueron revisados. El tumor primario se localizó en la mayoría de los casos en orofaringe (58%). En 5 casos se realizó el procedimiento para reconstrucción y cierre de fístulas (4 faringostomas y una fístula traqueoesofágica). El fracaso por necrosis total fue del 16% (6/39). No se produjo mortalidad asociada. Las complicaciones postoperatorias más frecuentes fueron: dehiscencia de sutura en 5 pacientes y faringostoma (fístula) en 5 casos. La radioterapia previa influyó de forma significativa en el aumento de la incidencia global de las complicaciones (p < 0,05). Conclusiones: Actualmente, la cirugía reconstructiva juega un papel fundamental en la cirugía oncológica de cabeza y cuello. El colgajo radial es un método seguro y fiable para la reconstrucción de la mayoría de defectos en la esfera otorrinolaringológica. Asumir este tipo de intervención ofrece una mayor autonomía y seguridad en la cirugía oncológica (AU)

Introduction: Oncologic surgery leads to important defects and sequelae, as well as notable cosmetic and functional alterations. In this aspect reconstructive surgery has an essential role, allowing more radical excision and lower associated functional and cosmetic morbidities. The aim of this study was to present and evaluate the experience and results of the reconstructive microsurgery unit in our centre's ENT department. Methods: Retrospective study of procedures performed between 2006 and 2012. Results: A total of 36 cases were reviewed. The primary tumour was found in the oropharynx (58%) in the majority of cases. In 5 cases the procedure was performed for reconstruction and fistula closure (4 pharyngostoma and 1 tracheoesophageal fistula). Failure from total necrosis was 16% (6/36). No associated mortality has been reported. The most common postoperative complications were wound dehiscence in 5 patients and pharyngostoma (fistula) in 5 cases. Prior radiotherapy significantly influenced the increase in the overall incidence of complications (P<0.05). Conclusions: Reconstructive surgery currently plays an important role in surgery for head and neck cancer. The radial forearm flap is a safe, reliable method for reconstruction of most defects in the ENT field. This type of intervention provides greater autonomy and safety in surgical oncology (AU)