OSA Upper Airways Surgery: A Targeted Approach
| Autor: | Claudio Vicini, Giovanni Cammaroto, Marcello Bosi, Stefano Pelucchi, Pierre El Chater, Giulio Romano Filograna-Pignatelli, V. Koka, B. Tucker Woodson, Andrea De Vito, Giannicola Iannella |
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| Rok vydání: | 2021 |
| Předmět: |
Medicine (General)
medicine.medical_specialty Polysomnography medicine.medical_treatment Review 03 medical and health sciences R5-920 0302 clinical medicine Transoral robotic surgery medicine Humans uvulopharyngopalatoplasty Medical history Continuous positive airway pressure 030223 otorhinolaryngology apnea barbed palatoplasty continuous positive airway pressure expansion sphincter palatoplasy mandibular advancement device sleep-disordered breathing transoral robotic surgery upper airway surgery endoscopy humans pharynx polysomnography sleep apnea obstructive Sleep Apnea Obstructive business.industry Apnea Endoscopy General Medicine medicine.disease respiratory tract diseases Surgery Obstructive sleep apnea Palatoplasty Apnea–hypopnea index Pharynx medicine.symptom Airway business 030217 neurology & neurosurgery |
| Zdroj: | Medicina, Vol 57, Iss 690, p 690 (2021) Medicina |
| ISSN: | 1648-9144 |
| DOI: | 10.3390/medicina57070690 |
| Popis: | Obstructive sleep apnea syndrome (OSA) is a multi-factorial disorder, with quite complex endotypes, consisting of anatomical and non-anatomical pathophysiological factors. Continuous positive airway pressure (CPAP) is recognized as the first-line standard treatment for OSA, whereas upper airway (UA) surgery is often recommended for treating OSA patients who have refused or cannot tolerate CPAP. The main results achievable by the surgery are UA expansion, and/or stabilization, and/or removal of the obstructive tissue to different UA levels. The site and pattern of UA collapse identification is of upmost importance in selecting the customized surgical procedure to perform, as well as the identification of the relation between anatomical and non-anatomical factors in each patient. Medical history, sleep studies, clinical examination, UA endoscopy in awake and drug-induced sedation, and imaging help the otorhinolaryngologist in selecting the surgical candidate, identifying OSA patients with mild UA collapsibility or tissue UA obstruction, which allow achievement of the best surgical outcomes. Literature data reported that the latest palatal surgical procedures, such as expansion sphincter palatoplasty or barbed reposition palatoplasty, which achieve soft palatal and lateral pharyngeal wall remodeling and stiffening, improved the Apnea Hypopnea Index, but the outcome analyses are still limited by methodological bias and the limited number of patients’ in each study. Otherwise, the latest literature data have also demonstrated the role of UA surgery in the improvement of non-anatomical factors, confirming that a multidisciplinary and multimodality diagnostic and therapeutical approach to OSA patients could allow the best selection of customized treatment options and outcomes. |
| Databáze: | OpenAIRE |
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