PMID- 34300335 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210729 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 10 IP - 14 DP - 2021 Jul 18 TI - Combined Transoral Robotic Tongue Base Surgery and Palate Surgery in Obstructive Sleep Apnea Syndrome: Modified Uvulopalatopharyngoplasty versus Barbed Reposition Pharyngoplasty. LID - 10.3390/jcm10143169 [doi] LID - 3169 AB - BACKGROUND: Successful surgery outcomes are limited to moderate to severe obstructive sleep apnea (OSA) syndrome. Multilevel collapse at retropalatal and retroglossal areas is often found during the drug-induced sleep endoscopy (DISE). Therefore, multilevel surgery is considered for these patients. The aim of our study was to survey surgical outcomes by modified uvulopalatoplasty (UPPP) plus transoral robotic surgery tongue base reduction (TORSTBR) versus barbed repositioning pharyngoplasty (BRP) plus TORSTBR. METHODS: The retrospective cohort study was performed at a tertiary referral center. We collected moderate to severe OSA patients who were not tolerant to positive pressure assistant PAP from September 2016 to September 2019; pre-operative-operative Muller tests all showed retropalatal and retroglossal collapse; pre-operative Friedman Tongue Position (FTP) > III, with the tonsils grade at grade II minimum, with simultaneous velum (V > 1) and tongue base (T > 1), collapsed by drug-induced sleep endoscopy (DISE) under the VOTE grading system. The UPPP plus TORSTBR (n = 31) and BRP plus TORSTBR (n = 31) techniques were offered. We compare the outcomes using an Epworth sleepiness scale (ESS) questionnaire, and measure the patients' apnea-hypopnea index (AHI), lowest O(2) saturation, cumulative time spent below 90% (CT90), and arousal index (AI) by polysomnography six months after surgery; we also measure their length of hospital stay and complications between these two groups. RESULTS: Comparing BRP plus TORSTBR with UPPP plus TORSTBR, the surgical success rate is 67.74% and 38.71%, respectively. The significantly higher surgical success rate in the BRP plus TORSTBR group was noted. The surgical time is shorter in the BRP plus TORSTBR group. The complication rate is not significant in pain, bleeding, dysgeusia, dysphagia, globus sensation, and prolonged suture stay, even though the BRP plus TORSTBR rendered a higher percentage of globus sensation during swallowing and a more prevalent requirement of suture removal one month after surgery. The length of hospital stay is not significantly different between the two groups. CONCLUSION: In conclusion, BRP plus TORSTBR is a considerable therapy for moderate to severe OSA patients with DISE showing a multi-level collapse in velum and tongue base area. The BRP technique might offer a better anterior-posterior suspension vector for palate level obstruction. FAU - Tsou, Yung-An AU - Tsou YA AD - Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung 40402, Taiwan. AD - School of Medicine, China Medical University, Taichung 40402, Taiwan. AD - Department of Audiology and Speech-Language Pathology, Asia University, Taichung 41354, Taiwan. FAU - Hsu, Chun-Chieh AU - Hsu CC AD - Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung 40402, Taiwan. FAU - Shih, Liang-Chun AU - Shih LC AD - Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung 40402, Taiwan. AD - Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan. FAU - Lin, Tze-Chieh AU - Lin TC AD - Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung 40402, Taiwan. FAU - Chiu, Chien-Jen AU - Chiu CJ AD - Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung 40402, Taiwan. FAU - Tien, Vincent Hui-Chi AU - Tien VH AD - Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung 40402, Taiwan. AD - Department of Audiology and Speech-Language Pathology, Asia University, Taichung 41354, Taiwan. FAU - Tsai, Ming-Hsui AU - Tsai MH AD - Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung 40402, Taiwan. AD - School of Medicine, China Medical University, Taichung 40402, Taiwan. AD - Department of Audiology and Speech-Language Pathology, Asia University, Taichung 41354, Taiwan. FAU - Chang, Wen-Dien AU - Chang WD AUID- ORCID: 0000-0001-5546-5874 AD - Department of Sport Performance, National Taiwan University of Sport, Taichung 404401, Taiwan. LA - eng PT - Journal Article DEP - 20210718 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC8306291 OTO - NOTNLM OT - barbed repositioning pharyngoplasty OT - obstructive sleep apnea OT - transoral robotic surgery tongue base reduction OT - uvulopalatoplasty COIS- The authors declare no conflict of interests regarding the publication of this paper. EDAT- 2021/07/25 06:00 MHDA- 2021/07/25 06:01 PMCR- 2021/07/18 CRDT- 2021/07/24 01:07 PHST- 2021/06/24 00:00 [received] PHST- 2021/07/13 00:00 [revised] PHST- 2021/07/15 00:00 [accepted] PHST- 2021/07/24 01:07 [entrez] PHST- 2021/07/25 06:00 [pubmed] PHST- 2021/07/25 06:01 [medline] PHST- 2021/07/18 00:00 [pmc-release] AID - jcm10143169 [pii] AID - jcm-10-03169 [pii] AID - 10.3390/jcm10143169 [doi] PST - epublish SO - J Clin Med. 2021 Jul 18;10(14):3169. doi: 10.3390/jcm10143169.