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Sleep Apnea Syndromes: HELP
Articles by Filippo Montevecchi
Based on 24 articles published since 2010
(Why 24 articles?)
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Between 2010 and 2020, Filippo Montevecchi wrote the following 24 articles about Sleep Apnea Syndromes.
 
+ Citations + Abstracts
1 Review Transoral Robotic Surgery for Obstructive Sleep Apnea: Past, Present, and Future. 2019

Vicini, Claudio / Montevecchi, Filippo. ·Otolaryngology-Head and Neck Surgery, University of Ferrara, Via Aldo Moro 8, Ferrara 44124, Italy; Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni - L. Pierantoni Hospital, ASL of Romagna, Via Carlo Forlanini 34, Forlì 47100, Italy. · Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni - L. Pierantoni Hospital, ASL of Romagna, Via Carlo Forlanini 34, Forlì 47100, Italy. Electronic address: filippomontevecchi72@gmail.com. ·Sleep Med Clin · Pubmed #30709535.

ABSTRACT: Nocturnal upper airway collapse often involves the obstruction at the tongue base. Several surgical procedures have been developed in recent years to address this area in continuous positive airway pressure-nonadherent patients and include hyolingual advancement, tongue suture suspension, and various lingual resection techniques. Traditional tongue base resection is generally done either via a transcervical technique or transorally with an endoscope for visualization. Each of these approaches has significant potential limitations. The unsurpassed visualization, dexterity, and control provided by the Da Vinci Surgical System offer many benefits for the surgeon compared with the other technologies.

2 Review Laryngopharyngeal reflux in obstructive sleep apnoea patients: Literature review and meta-analysis. 2018

Magliulo, Giuseppe / Iannella, Giannicola / Polimeni, Antonella / De Vincentiis, Marco / Meccariello, Giuseppe / Gulotta, Giampiero / Pasquariello, Benedetta / Montevecchi, Filippo / De Vito, Andrea / D'Agostino, Giovanni / Gobbi, Riccardo / Cammaroto, Giovanni / Vicini, Claudio. ·Department of 'Organi di Senso', University "Sapienza", Rome, Italy. Electronic address: giuseppemagliuloorl@yahoo.com. · Department of 'Organi di Senso', University "Sapienza", Rome, Italy. · Department of Oral and Maxillo Facial Sciences, University "Sapienza", Rome, Italy. · Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy. · Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy; Department ENT & Audiology, University of Ferrara, Ferrara, Italy. ·Am J Otolaryngol · Pubmed #30224217.

ABSTRACT: PURPOSE: Laryngopharyngeal reflux (LPR) is a frequent condition in Obstructive Sleep Apnoea (OSA) patients and different studies have been published in the last years about this topic. A review of the published literature regarding LPR in OSA patients has been reported. A meta-analysis to evaluate the incidence of LPR in OSA patients and correlate LPR positivity with OSA patients' characteristics has been performed. METHODS: A comprehensive review of the English language literature about LPR in OSA patients was performed using the most important electronic databases (PubMed, EMBASE, the Cochrane Library etc.). A total of 10 papers studying LPR in OSA were assessed and considered eligible for the meta-analysis. RESULTS: The data analysis regarding 870 identified OSA patients showed that 394 patients were LPR +, while 476 were LPR-. The meta-analysis showed no statistical difference regarding the AHI value between LPR + patients and LPR- patients (p = 0,3). Mean BMI was more higher in LPR + patients than in the patients without LPR, showing a significant statistical difference (p = 0.001). CONCLUSION: Current international literature demonstrates a high incidence of LPR (45.2%) in OSA patients. The severity of AHI in OSA patients would not seem to correlate with the presence of laryngopharyngeal reflux. The OSA patients with LPR showed a higher BMI compared with LPR- patients.

3 Review Transoral robotic surgery for the management of obstructive sleep apnea: a systematic review and meta-analysis. 2017

Meccariello, Giuseppe / Cammaroto, Giovanni / Montevecchi, Filippo / Hoff, Paut T / Spector, Matthew E / Negm, Hesham / Shams, Medhat / Bellini, Chiara / Zeccardo, Ermelinda / Vicini, Claudio. ·Otolaryngology and Stomatology Unit, Department of Head-Neck Surgeries, G.B. Morgagni-L.Pierantoni Hospital, Azienda USL della Romagna, via Carlo Forlanini, 34, Forlì, Italy. drmeccariello@gmail.com. · Department of Otorhinolaryngology, University of Messina, Messina, Italy. · Otolaryngology and Stomatology Unit, Department of Head-Neck Surgeries, G.B. Morgagni-L.Pierantoni Hospital, Azienda USL della Romagna, via Carlo Forlanini, 34, Forlì, Italy. · Department of Otolaryngology-Head and Neck Surgery, St Joseph Mercy Health System, Ann Arbor, MI, USA. · Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA. · Department of Otolaryngology, Faculty of Medicine, Cairo University, Cairo, Egypt. · Department of Otolaryngology Head and Neck Surgery, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar. ·Eur Arch Otorhinolaryngol · Pubmed #27221389.

ABSTRACT: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a serious social health problem with significant implications on quality of life. Surgery for OSAHS has been criticized due to a lack of evidence to support its efficacy as well as the heterogeneous reporting of published outcomes. Moreover, the transoral robotic surgery (TORS) in the management of OSAHS is still in a relative infancy. Nevertheless, a review and meta-analysis of the published articles may be helpful. Among 195 articles, eight studies were included in the analysis. The mean of enrolled patients was 102.5 ± 107.9 (range 6-289) comprising a total of 820 cases. The mean age was 49 ± 3.27 and 285 patients underwent a previous sleep apnea surgery. The uvulopalatopharyngoplasty (UPPP) was the most common palatal procedure. The mean rate of failure was 34.4 % (29.5-46.2 %). Complications occurred in 21.3 % of the patients included in the analysis, most of them were classified as minor. Transient dysphagia represented the most common complication (7.2 %) followed by bleeding (4.2 %). TORS for the treatment of OSAHS appears to be a promising and safe procedure for selected patients seeking an alternative to continuous positive airway pressure (CPAP), although further researches are urgently needed.

4 Review Tongue reduction for OSAHS: TORSs vs coblations, technologies vs techniques, apples vs oranges. 2017

Cammaroto, Giovanni / Montevecchi, Filippo / D'Agostino, Giovanni / Zeccardo, Ermelinda / Bellini, Chiara / Galletti, Bruno / Shams, Medhat / Negm, Hesham / Vicini, Claudio. ·Department of Otolaryngology, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy. giovanni.cammaroto@hotmail.com. · ENT and Oral Surgery Unit, Department of Special Surgery, Ospedale Morgagni Pierantoni, Forlì, Italy. · Department of Otolaryngology, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy. · Department of Otolaryngolgy, Head and Neck Surgery, Hamad Medical Corporation, Rumailah Hospital, Doha, Qatar. · Department of Otorhinolaryngology, Faculty of Medicine, University of Cairo, Cairo, Egypt. ·Eur Arch Otorhinolaryngol · Pubmed #27221388.

ABSTRACT: Coblation tongue surgery and Trans-oral robotic surgery (TORS) proved to be the most published therapeutical options for the treatment of patients affected by obstructive sleep apneas (OSAHS). A systematic review of the literature and an analysis of the data are presented. The mean rates of failure were 34.4 and 38.5 %, respectively in TORS and Coblation groups. Complications occurred in 21.3 % of the patients treated with TORS and in 8.4 % of the patients treated with Coblation surgery. TORS seems to give slightly better results, allowing a wider surgical view and a measurable, more consistent removal of lingual tissue. However, the higher rate of minor complication and the significant costs of TORS must also be considered. Moreover, both technologies may be applied to a wide range of surgical techniques, each of them with different effectiveness.

5 Guideline European position paper on drug-induced sedation endoscopy (DISE). 2014

De Vito, Andrea / Carrasco Llatas, Marina / Vanni, Agnoletti / Bosi, Marcello / Braghiroli, Alberto / Campanini, Aldo / de Vries, Nico / Hamans, Evert / Hohenhorst, Winfried / Kotecha, Bhik T / Maurer, Joachim / Montevecchi, Filippo / Piccin, Ottavio / Sorrenti, Giovanni / Vanderveken, Olivier M / Vicini, Claudio. ·Special Surgery Department, Ear-Nose-Throat Unit, Morgagni-Pierantoni Hospital, Via Forlanini 34, 47121, Forlì, Italy. ·Sleep Breath · Pubmed #24859484.

ABSTRACT: BACKGROUND: Although drug-induced sedation endoscopy (DISE) represents the most widespread diagnostic tool for upper airway endoscopic evaluation of snoring and obstructive sleep apnea hypopnea syndrome (OSAHS), many controversies exist about how to perform the sedation, the indications for DISE, and how to report DISE findings. The present position paper reports on a consensus as proposed by a group of European experts in the field of DISE after discussion during a recent dedicated meeting. METHODS: The authors have evaluated all the available evidence reported in the literature and have compared experience among various departments in leading European centers in order to provide a standardization of the DISE procedure and an in-depth insight in the main aspects of this technique. RESULTS: A proposal of the DISE procedure standardization has been achieved with a general agreement concerning the terminology, indications, contraindications, required preliminary examinations, setting, technical equipment required, staffing, local anesthesia and nasal decongestion, patient positioning, basis and special diagnostic maneuvers, and the applied sedation drugs and observation windows. Otherwise, no consensus has been reached on a scoring and classification system. CONCLUSIONS: Although consensus has been reached on several aspects of the DISE procedure, some topics remain open to future research, such as a better analysis of the importance of positional aspects during DISE and a further comparison of the differences in degree, level and pattern of upper airway collapse observed during DISE versus during natural sleep and awake endoscopy. Finally, a universally accepted scoring and classification system is lacking.

6 Article Positional Obstructive Sleep Apnea Syndrome in Elderly Patients. 2020

Iannella, Giannicola / Magliulo, Giuseppe / Lo Iacono, Cristina Anna Maria / Bianchi, Giulia / Polimeni, Antonella / Greco, Antonio / De Vito, Andrea / Meccariello, Giuseppe / Cammaroto, Giovanni / Gobbi, Riccardo / Brunori, Marco / Di Luca, Milena / Montevecchi, Filippo / Pace, Annalisa / Visconti, Irene Claudia / Milella, Claudia / Solito, Carmen / Pelucchi, Stefano / Cerritelli, Luca / Vicini, Claudio. ·Department of 'Organi di Senso', University "Sapienza",Viale dell'Università, 33, 00185 Rome, Italy. · Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy. · Department of Cardiovascular, Respiratory, Nephrologic, Anaesthesiologic and Geriatric Sciences, Sapienza University, Viale dell'Università, 33, 00185 Rome, Italy. · Department ENT & Audiology, University of Ferrara, Via Savonarola, 9, 44121 Ferrara, Italy. · Department of Oral and Maxillo Facial Sciences, University "Sapienza", Viale dell'Università, 33, 00185 Rome, Italy. · Department of ENT, University of Catania, Via S. Sofia, 78, 95125 Catania, Italy. · ENT Unit Villa Serena, Via del Camaldolino, 8, 47121 Forlì, Italy. ·Int J Environ Res Public Health · Pubmed #32050596.

ABSTRACT:

7 Article Long-term complications of palate surgery: A multicenter study of 217 patients. 2019

Pang, Kenny P / Vicini, Claudio / Montevecchi, Filippo / Piccin, Ottavio / Chandra, Sudipta / Yang, Hyung C / Agrawal, Vikas / Chung, Joseph C K / Chan, Yiong H / Pang, Scott B / Pang, Kathleen A / Pang, Edward B / Rotenberg, Brian. ·Asia Sleep Centre, Paragon, Singapore. · G.B. Morgagni-L. Pierantoni Hospital, University of Ferrara and Bologna, Forli, Italy. · Sant'Orsola-Malpighi University Hospital, Bologna, Italy. · Belle Vue Clinic and Hospital, Kolkata, India. · Chonnam National University Hospital, Gwangju, South Korea. · Specialty ENT Hospital, India. · Tuen Mun Hospital, Hong Kong. · Biostatistics Unit, Singapore. · School of Medicine, National University Singapore, Singapore. · School of Medicine, University of Glasgow, Glasgow, United Kingdom. · Western University, London, Ontario, Canada. ·Laryngoscope · Pubmed #31765026.

ABSTRACT: OBJECTIVES/HYPOTHESIS: To investigate long-term complications of newer reconstructive palate surgery techniques. STUDY DESIGN: Retrospective case-series analysis. METHODS: Retrospective six-country clinical study of OSA patients who had nose and palate surgery. RESULTS: There were 217 patients, mean age = 43.9 ± 12.5 years, mean body mass index = 25.9 ± 4.7, mean preoperative apnea-hypopnea index [AHI] = 30.5 ± 19.1, follow-up 41.3 months. A total of 217 palatal procedures were performed, including 50 expansion sphincter pharyngoplasties (ESP), 34 functional expansion pharyngoplasties (FEP), 40 barbed reposition pharyngoplasties (BRP), 64 modified uvulopalatopharyngoplasties (mUPPP), 11 uvulopalatal flap procedures (UPF), nine suspension pharyngoplasties (SP), eight relocation pharyngoplasties (RP), and one z-pharyngoplasty (ZPP). Complications included were constant and/or felt twice per week; dry throat (7.8%), throat lump feeling (11.5%), throat phlegm (10.1%), throat scar feeling (3.7%), and difficulty swallowing (0.5%). Of the 17 patients who had a dry throat complaint, two were constant (one SP, one RP), 15 were occasional (10 mUPPP, three SP, two BRP). Of the 25 patients with the throat lump feeling, four were constant (three RP, one ZPP), 21 were occasional (10 mUPPP, five SP, five UPF, one BRP). Of the 22 patients with the throat phlegm feeling, four were constant (two SP, two RP), 18 were occasional (10 mUPPP, four BRP, two FEP, two SP). Of the eight patients with throat scar feeling, eight were occasional (four SP, two mUPPP, one FEP, one RP), none were constant. One patient had difficulty swallowing (RP procedure). There was no velopharyngeal incompetence, taste disturbance, nor voice change. Highest symptom complaints were mUPPP, SP, and RP, whereas the lowest symptom complaint was ESP. CONCLUSIONS: Newer palatal techniques have shown to have less long-term complications compared to the older ablative techniques. LEVEL OF EVIDENCE: 4 Laryngoscope, 2019.

8 Article Obstructive sleep apnoea syndrome and endothelial function: potential impact of different treatment strategies-meta-analysis of prospective studies. 2019

Cammaroto, Giovanni / Costa, Francesco / Ruiz, Maria Victoria Garcia / Andò, Giuseppe / Vicini, Claudio / Montevecchi, Filippo / Galletti, Claudio / Galletti, Francesco / Valgimigli, Marco. ·Department of Otolaryngology, University of Messina, Messina, Italy. giovanni.cammaroto@hotmail.com. · Department of Otolaryngology, Hospital Morgagni Pierantoni, Forlì, Italy. giovanni.cammaroto@hotmail.com. · Institut Clinic Cardiovascular, Hospital Clinic, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), IDIBAPS, University of Barcelona, Barcelona, Spain. · Department of Clinical and Experimental Medicine, Policlinic "G. Martino", University of Messina, Messina, Italy. · Área del Corazón, Hospital Universitario Virgen de La Victoria, Campus Teatinos s/n, 29010, Málaga, Spain. · Department of Otolaryngology, Hospital Morgagni Pierantoni, Forlì, Italy. · Department of Anaesthesiology, University of Messina, Messina, Italy. · Department of Otolaryngology, University of Messina, Messina, Italy. · Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland. ·Eur Arch Otorhinolaryngol · Pubmed #31197532.

ABSTRACT: PURPOSE: Previous studies have shown an association between obstructive sleep apnoea syndrome (OSAS) and cardiovascular events. Whether this association is mediated by an impairment of endothelial function, which is itself a driver of elevated cardiovascular risk, has yet to be clarified, as it is the eventual protective role of several OSAS treatments. The aim of our meta-analysis is to evaluate the effect of various OSAS treatments on endothelial function calculated by means of flow-mediated dilatation (FMD). METHODS: We conducted a meta-analysis of prospective studies including patients affected by mild to severe OSAS treated with continuous positive airway pressure (CPAP), surgery, oral appliance and medical treatments. FMD was measured before and after treatment RESULTS: After pooling results from different treatment strategies, OSAS treatment showed a positive impact on endothelial function (Mean Difference [MD] = 2.58; 95% CI 1.95-3.20; p < 0.00001). CONCLUSIONS: Our study supports the hypothesis that several modalities of treatment for OSAS positively impact endothelial function. Whether this effect also associates with an improvement of clinical outcomes remains to be ascertained.

9 Article Laryngopharyngeal Reflux Diagnosis in Obstructive Sleep Apnea Patients Using the Pepsin Salivary Test. 2019

Iannella, Giannicola / Vicini, Claudio / Polimeni, Antonella / Greco, Antonio / Gobbi, Riccardo / Montevecchi, Filippo / De Vito, Andrea / Meccariello, Giuseppe / Cammaroto, Giovanni / D'Agostino, Giovanni / Pace, Annalisa / Cascella, Raffaella / Brunori, Marco / Lo Iacono, Cristina Anna Maria / Pelucchi, Stefano / Magliulo, Giuseppe. ·Department of 'Organi di Senso', University "Sapienza", Viale dell'Università 33, 00161 Rome, Italy. giannicola.iannella@uniroma1.it. · Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy. claudio@claudiovicini.com. · Department ENT and Audiology, University of Ferrara, Via Aldo Moro, 8, 44124 Ferrara, Italy. claudio@claudiovicini.com. · Department of Oral and Maxillo Facial Sciences, University "Sapienza", Via Caserta, 6, 00161 Rome, Italy. antonella.polimeni@uniroma1.it. · Department of 'Organi di Senso', University "Sapienza", Viale dell'Università 33, 00161 Rome, Italy. antonio.greco@uniroma1.it. · Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy. dr.riccardogobbi@gmail.com. · Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy. filippomontevecchi72@gmail.com. · Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy. dr.andrea.devito@gmail.com. · Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy. drmeccariello@gmail.com. · Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy. giovanni.cammaroto@hotmail.com. · Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy. giovanni.dagostino77@gmail.com. · Department of 'Organi di Senso', University "Sapienza", Viale dell'Università 33, 00161 Rome, Italy. annalisapace90@gmail.com. · Department of 'Organi di Senso', University "Sapienza", Viale dell'Università 33, 00161 Rome, Italy. raffaellacascella@virgilio.it. · Department of Cardiovascular, Respiratory, Nephrologic, Anaesthesiologic and Geriatric Sciences, Sapienza University, Viale dell'Università 33, 00161 Rome, Italy. marco.brunori@uniroma1.it. · Department of Cardiovascular, Respiratory, Nephrologic, Anaesthesiologic and Geriatric Sciences, Sapienza University, Viale dell'Università 33, 00161 Rome, Italy. cristina.loiacono@uniroma1.it. · Department ENT and Audiology, University of Ferrara, Via Aldo Moro, 8, 44124 Ferrara, Italy. stefano.pelucchi@unife.it. · Department of 'Organi di Senso', University "Sapienza", Viale dell'Università 33, 00161 Rome, Italy. giuseppe.magliulo@uniroma1.it. ·Int J Environ Res Public Health · Pubmed #31185704.

ABSTRACT: BACKGROUND: To investigate the presence of laryngopharyngeal reflux in patients with obstructive sleep apnea (OSA) employing the salivary pepsin concentration method. To compare the results of pepsin concentration with the severity of the pathology. METHODS: Seventy-five OSA patients (44 males, 31 females) were enrolled in the study. For each patient, the AHI (apnea-hypopnea index) and the BMI (body mass index) were initially evaluated. All the patients enrolled were assessed using the reflux symptom index (RSI) and the reflux finding score (RFS) in order to perform a clinical diagnosis of laryngopharyngeal reflux. In all patients a salivary sample was taken to estimate the presence of pepsin and its concentration. RESULTS: The incidence of LPR (laryngopharyngeal reflux) in OSA patients, evaluated using the salivary pepsin concentration test (PEP-test), was found to be 32% of cases. Linear regression testing did not show any correlation between AHI and pepsin concentration in salivary samples ( CONCLUSION: A high number of patients with OSA seem to show positivity for salivary pepsin, correlated to an LPR. There does not appear to be a correlation between the severity of apnea and the grade of salivary pepsin reflux. On the other hand, direct correlation between BMI and the value of pepsin in salivary specimens was observed.

10 Article The aging effect on upper airways collapse of patients with obstructive sleep apnea syndrome. 2018

Vicini, Claudio / De Vito, Andrea / Iannella, Giannicola / Gobbi, Riccardo / Corso, Ruggero Massimo / Montevecchi, Filippo / Polimeni, Antonella / De Vincentiis, Marco / Meccariello, Giuseppe / D'agostino, Giovanni / Cammaroto, Giovanni / Stomeo, Francesco / Magliulo, Giuseppe. ·Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy. · Department ENT and Audiology, University of Ferrara, Ferrara, Italy. · Department of 'Organi di Senso', University "Sapienza", Via Satrico 7, 00183, Rome, Italy. giannicolaiannella@hotmail.it. · Intensive Care Unit, Morgagni-Pierantoni Hospital, Forlì, Italy. · Department of Oral and Maxillo Facial Sciences, University "Sapienza", Rome, Italy. · Department of 'Organi di Senso', University "Sapienza", Via Satrico 7, 00183, Rome, Italy. ·Eur Arch Otorhinolaryngol · Pubmed #30317385.

ABSTRACT: PURPOSE: To evaluate, using drug-induced sleep endoscopy (DISE), sites of upper airway obstruction and pattern of collapse in patients over 65 years old affected by obstructive sleep apnea. To compare sites and pattern of collapse of elderly patients with a group of patients younger than 65 years. METHODS: A group of 55 patients aged over 65 years were enrolled in this prospective study. Fifty patients under 65 years old were collected in the control group. Polysomnographic data and clinical parameters such as the daytime sleepiness, and body mass index were evaluated for both groups of patients. All patients underwent DISE examination with VOTE classification. RESULTS: The AHI value increased with aging whereas elderly patients presented a reduction in daytime sleepiness. Elderly patients showed a higher incidence of total collapse in the velum region compared to younger patients (90.9% vs 70%;); the older patients showed a lower degree of total oropharyngeal lateral wall collapse with respect to younger patients, (20% vs 50%). No difference in tongue base collapse emerged between the two subgroups of patients. CONCLUSION: Elderly patients showed a higher incidence of total collapse in the velum and a lower incidence in the oropharyngeal lateral wall compared to younger patients.

11 Article Trans-Oral Robotic Tongue Reduction for OSA: Does Lingual Anatomy Influence the Surgical Outcome? 2018

Cammaroto, Giovanni / Meccariello, Giuseppe / Costantini, Matteo / Stomeo, Francesco / Hoff, Paul / Montevecchi, Filippo / Vicini, Claudio. ·Department of Otolaryngology, University of Messina, Messina, Italy. · Department of Special Surgery, ENT and Oral Surgery Unit, Ospedale Morgagni Pierantoni, Forlì, Italy. · Department of Pathology, Ospedale Morgagni Pierantoni, Forlì, Italy. · Department of Otolaryngology, University of Ferrara, Ferrara, Italy. · Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan. ·J Clin Sleep Med · Pubmed #30092891.

ABSTRACT: STUDY OBJECTIVES: To evaluate both the influence of the volume of the excised base of tongue (BOT) on the surgical outcome after robotic tongue reduction in patients affected by obstructive sleep apnea (OSA) and the role of the lymphatic or muscular predominance within the removed tissue. METHODS: Fifty-one patients with OSA were included in this study. All patients were treated with a robotic tongue base reduction. Data registered for the analysis were: age, sex, preoperative body mass index, preoperative and postoperative apnea-hypopnea index (AHI), delta AHI (preoperative AHI - postoperative AHI), total volume of the excised BOT, total thickness of excised BOT, isolated lymphatic thickness and soft tissue thickness (including muscular component) of the excised BOT, and lymphatic/soft tissue ratio (lymphatic thickness / soft tissue thickness). RESULTS: A statistically significant reduction of AHI values was seen postoperatively, and a success rate of 74.5% was recorded. However, no significant correlations between delta AHI and tongue volume in cubic centimeters, lymphatic/soft tissue ratio, and total thickness were found. CONCLUSIONS: These findings reinforce the general opinion that OSA is not only influenced by anatomic factors but other phenomena may play a fundamental role in its genesis. A deeper understanding of OSA pathogenesis is needed in order to tailor an individual treatment strategy that could lead to a more effective therapy.

12 Article Evolution of soft palate surgery techniques for obstructive sleep apnea patients: A comparative study for single-level palatal surgeries. 2018

Rashwan, Mohamed S / Montevecchi, Filippo / Cammaroto, Giovanni / Badr El Deen, Mohamed / Iskander, Nagi / El Hennawi, Diaa / El Tabbakh, Mohammed / Meccariello, Giuseppe / Gobbi, Riccardo / Stomeo, Francesco / Vicini, Claudio. ·Faculty of Medicine, Department of Otorhinolaryngology, Suez Canal University Teaching Hospitals, Ismailia, Egypt. · Head and Neck Department - ENT & Oral Surgery Unit, G.B. Morgagni - L. Pierantoni Hospital, Forlì - ASL of Romagna, Italy. · Department of Otorhinolaryngology, University of Messina, Messina, Italy. · ENT & Audiology Department, University of Ferrara, Ferrara, Italy. ·Clin Otolaryngol · Pubmed #29106778.

ABSTRACT: OBJECTIVES: To compare the results of tissue preservation techniques of soft palate surgeries including expansion sphincter pharyngoplasty (ESP) and barbed reposition pharyngoplasty (BRP) for patients suffering from obstructive sleep apnoea (OSA) with the traditional uvulopalatopharyngoplasty (UPPP). DESIGN: Interventional comparative study. SETTING: Morgagni-Pierantoni Hospital. PARTICIPANTS: Seventy-five patients were included in the study, divided into three groups with 25 patients per group: UPPP, ESP or BRP. MAIN OUTCOMES MEASURES: Polysomnography was carried out for all patients pre- and postoperatively; the postoperative results were recorded at least 6 months after surgery. All patients were assessed preoperatively using drug-induced sleep endoscopy. Epworth Sleepiness Scale and body mass index (BMI) were registered for all patients before and after surgery. RESULTS: The mean of pre- and postoperative differences of apnoea-hypopnoea index values was higher in BRP group than ESP: 15.76 ± 14.5 Vs 10.13 ± 5.3; P < .05 and UPPP groups: 15.76 ± 14.5 vs 6.08 ± 5.5; P < .0005. The mean of differences of oxygen desaturation index values was higher in BRP group than UPPP group: 15.09 ± 17.6 vs 7.13 ± 6.8; P < .0005, but not significantly higher than ESP group: 15.09 ± 17.6 vs 6.48 ± 7.9; P > .05. The mean of differences of ESS values was higher in BRP group than ESP group: 5.52 ± 4.1 vs 4.84 ± 3.3; P < .005 and UPPP groups: 5.52 ± 4.1 vs 1.36 ± 1.9; P < .005. Finally, the pre- and postoperative means of differences of lowest oxygen saturation values were not statistically significant among the three groups (P > .05). CONCLUSION: Barbed reposition pharyngoplasty (BRP) can be considered an effective procedure on the basis of the postoperative outcomes. ESP still proves to be a good technique especially when performed by experienced surgeons. Both techniques proved to be superior to UPPP.

13 Article Let's know from our patients: PPOPS score for palate surgery evaluation/a pilot study. 2018

Rashwan, Mohamed S / Montevecchi, Filippo / Firinua, Elisabetta / Dachuri, Sandeep / Obaidat, Hayfa / Gobbi, Riccardo / Cammaroto, Giovanni / Nuzzo, Simona / Vicini, Claudio. ·Department of Otorhinolaryngology, Faculty of medicine, Suez Canal University Teaching Hospitals, Ismailia, Egypt. m_salaheldin@med.suez.edu.eg. · Head and Neck Department, ENT and Oral Surgery Unit, G.B. Morgagni-L. Pierantoni Hospital, Forlì, ASL of Romagna, Romagna, Italy. · Department of Head and Neck Surgery, Otolaryngology Jordanian Royal Medical Services, King Hussein Medical Centre, Amman, Jordan. · Department of Otorhinolaryngology, University of Messina, Messina, Italy. · Biostatistics Unit, G.B. Morgagni-L. Pierantoni Hospital, Forlì, ASL of Romagna, Romagna, Italy. ·Eur Arch Otorhinolaryngol · Pubmed #29094197.

ABSTRACT: AIM: To introduce a questionnaire that can be used to assess the post-operative perception of the patients after palatal surgery. The questionnaire was named: Palate Post-Operative Problems Score (PPOPS). STUDY DESIGN: Pilot study. PATIENTS AND METHODS: The study was performed at Morgagni-Pierantoni hospital, Forli. Forty patients suffering from obstructive sleep apnea (OSA) who performed either expansion sphincter pharyngoplasty (ESP) or barbed reposition pharyngoplasty (BRP) in our hospital were divided into two groups, 20 patients per group. The patients' answers to the PPOPS questionnaire were recorded and their total scores were compared in addition to each item separately. PPOPS questionnaire consists of 12 items scored from 0 to 3 with a total score from 0 to 36. RESULTS: The overall average scores between both groups were similar being 4.05 for the BRP and 4.35 for the ESP with P value 0.4. From the results of the questionnaire, the patients favoured choosing BRP than ESP although some items showed better results among ESP patients and the difference between both techniques is not statistically significant. Every item score was separately compared and described in details later in the results. CONCLUSION: PPOPS questionnaire can be an additional useful tool for the assessment of any kind of palatal surgery through detailed analysis of the patients' perception for their surgery. BRP and ESP are similar procedures in the idea and results.

14 Article Transoral robotic surgery for obstructive sleep apnea syndrome: Principles and technique. 2017

Vicini, Claudio / Montevecchi, Filippo / Gobbi, Riccardo / De Vito, Andrea / Meccariello, Giuseppe. ·Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy. ·World J Otorhinolaryngol Head Neck Surg · Pubmed #29204586.

ABSTRACT: Objective: The present study is a review of transoral robotic surgery (TORS) for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods: The review presents the experience of the robotic center that developed the technique with regards to patient selection, surgical method, and post-operative care. In addition, the review provides results of a systematic review and meta-analysis of the complications and clinical outcomes of TORS when applied in the management of OSAHS. Results: The rate of success, defined as 50% reduction of pre-operative AHI and an overall AHI <20 events/h, is achieved in up to 76.6% of patients with a range between 53.8% and 83.3%. The safety of this approach is reasonable as the main complication (bleeding) affected 4.2% of patients (range 4.2%-5.3%). However, transient dysphagia (7.2%; range 5%-14%) does compromise the quality of life and must be discussed with patients preoperatively. Conclusions: TORS for the treatment of OSAHS appears to be a promising and safe procedure for patients seeking an alternative to traditional therapy. Appropriate patient selection remains an important consideration for successful implementation of this novel surgical approach requiring further research.

15 Article Transoral robotic-assisted tongue base resection in pediatric obstructive sleep apnea syndrome: case presentation, clinical and technical consideration. 2017

Montevecchi, Filippo / Bellini, Chiara / Meccariello, Giuseppe / Hoff, Paul T / Dinelli, Elisa / Dallan, Iacopo / Corso, Ruggero M / Vicini, Claudio. ·Head and Neck Department, ENT and Oral Surgery Unit, G.B. Morgagni, L. Pierantoni Hospital, ASL of Romagna, Forlì, Italy. · Head and Neck Department, ENT and Oral Surgery Unit, Infermi Hospital, ASL of Romagna, Faenza, Italy. · Head and Neck Department, ENT and Oral Surgery Unit, G.B. Morgagni, L. Pierantoni Hospital, ASL of Romagna, Forlì, Italy. drmeccariello@gmail.com. · Head and Neck Department, ENT and Oral Surgery Unit, Infermi Hospital, ASL of Romagna, Faenza, Italy. drmeccariello@gmail.com. · Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA. · Otorhinolaryngology Unit, "S. Camillo" Clinic, Forte dei Marmi, Italy. · Department of Otorhinolaryngology, University of Pisa, Pisa, Italy. · Emergency Department, Anesthesia and Intensive Care Section, "GB Morgagni-L. Pierantoni" Hospital, Forlì, Italy. ·Eur Arch Otorhinolaryngol · Pubmed #27568349.

ABSTRACT: Pediatric obstructive sleep apnea syndrome (OSAS) is primarily caused by adenotonsillar hypertrophy. However, tongue base hypertrophy is increasingly being recognized as a cause, even after adenotonsillectomy. We report three cases of pediatric OSAS successfully treated by transoral robotic reduction of the tongue base. In all children, we were able to achieve improved retrolingual patency while avoiding significant procedure-related morbidity. In conclusion, tongue base reduction by transoral robotic surgery appears to be a feasible solution for the base of tongue obstruction due to lingual tonsil hypertrophy in pediatric patients.

16 Article Diagnostic Accuracy of Obstructive Airway Adult Test for Diagnosis of Obstructive Sleep Apnea. 2015

Gasparini, Giulio / Vicini, Claudio / De Benedetto, Michele / Salamanca, Fabrizio / Sorrenti, Giovanni / Romandini, Mario / Bosi, Marcello / Saponaro, Gianmarco / Foresta, Enrico / Laforì, Andreina / Meccariello, Giuseppe / Bianchi, Alessandro / Toraldo, Domenico Maurizio / Campanini, Aldo / Montevecchi, Filippo / Rizzotto, Grazia / Cervelli, Daniele / Moro, Alessandro / Arigliani, Michele / Gobbi, Riccardo / Pelo, Sandro. ·Maxillo Facial Surgery, Complesso Integrato Columbus, Catholic University Medical School, Rome, Italy. · Special Surgery Department, Ear-Nose-Throat Unit, Morgagni-Pierantoni Hospital, Forlì, Italy. · Department of Otolaryngology Head and Neck Surgery, Hospital Fazzi, Lecce, Italy. · Department of Otolaryngology, S. Pio X Hospital, Milan, Italy. · Department of Otolaryngology Head and Neck Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy. · Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy ; Department of Periodontology, Catholic University of the Sacred Heart, Rome, Italy. · "A. Galateo" Respiratory Rehabilitation Unit, San Cesario di Lecce, Italy. · Department of Neurology, Complesso Integrato Columbus, Rome, Italy. ·Biomed Res Int · Pubmed #26636102.

ABSTRACT: RATIONALE: The gold standard for the diagnosis of Obstructive Sleep Apnea (OSA) is polysomnography, whose access is however reduced by costs and limited availability, so that additional diagnostic tests are needed. OBJECTIVES: To analyze the diagnostic accuracy of the Obstructive Airway Adult Test (OAAT) compared to polysomnography for the diagnosis of OSA in adult patients. METHODS: Ninety patients affected by OSA verified with polysomnography (AHI ≥ 5) and ten healthy patients, randomly selected, were included and all were interviewed by one blind examiner with OAAT questions. MEASUREMENTS AND MAIN RESULTS: The Spearman rho, evaluated to measure the correlation between OAAT and polysomnography, was 0.72 (p < 0.01). The area under the ROC curve (95% CI) was the parameter to evaluate the accuracy of the OAAT: it was 0.91 (0.81-1.00) for the diagnosis of OSA (AHI ≥ 5), 0.90 (0.82-0.98) for moderate OSA (AHI ≥ 15), and 0.84 (0.76-0.92) for severe OSA (AHI ≥ 30). CONCLUSIONS: The OAAT has shown a high correlation with polysomnography and also a high diagnostic accuracy for the diagnosis of OSA. It has also been shown to be able to discriminate among the different degrees of severity of OSA. Additional large studies aiming to validate this questionnaire as a screening or diagnostic test are needed.

17 Article Barbed reposition pharyngoplasty (BRP) for OSAHS: a feasibility, safety, efficacy and teachability pilot study. "We are on the giant's shoulders". 2015

Vicini, Claudio / Hendawy, Ehsan / Campanini, Aldo / Eesa, Mohamed / Bahgat, Ahmed / AlGhamdi, Saleh / Meccariello, Giuseppe / DeVito, Andrea / Montevecchi, Filippo / Mantovani, Mario. ·Department of Special Surgery, ENT and Oral Surgery Unit, G.B. Morgagni-L. Pierantoni Hospital, University of Pavia, Forlì, Italy. ·Eur Arch Otorhinolaryngol · Pubmed #25864183.

ABSTRACT: A new palatal procedure for snoring/obstructive sleep apnea (OSA) is described. The procedure was named as barbed reposition pharyngoplasty (BRP). The technique is described step by step. The new surgical technique was carried out in ten adult OSA patients with mean age of 53.4 ± 12.4 years (average 30-70) with confirmed retropalatal obstruction. In this pilot study; we assessed the feasibility by calculating the number of cases that failed to be operated and converted to other palatal technique during the same surgical setting, safety was assessed by evaluating both intra-operative and post-operative complications, teachability measured by the learning curve of our team members (the time of surgical procedure). In this study, the technique is proved to be feasible in all cases. There were no significant intra-operative or post-operative complications. Objective clinical improvement was confirmed by polysomnography 6 months post-operative with significant decrease in mean AHI from 43.65 ± 26.83 to 13.57 ± 15.41 (P = 0.007), daytime sleepiness assessed by Epworth Sleepiness Scale from 11.6 ± 4.86 to 4.3 ± 2 (P < 0.01), ODI from 44.7 ± 27.3 to 12.9 ± 16.3 (P = 0.004). Operative time decreased over the course of the study with an initial steep ascent in technical skill acquisition followed by more gradual improvement, and a steady decrease in operative time to as short as 20 min. Our preliminary results suggest that BRP technique is feasible, safe and effective in management of OSA patients. Moreover, it is easy to learn even for not experienced surgeons, less time consuming and with no significant complications.

18 Article Swallowing outcome after TORS for sleep apnea: short- and long-term evaluation. 2015

Eesa, Mohamed / Montevecchi, Filippo / Hendawy, Ehsan / D'Agostino, Giovanni / Meccariello, Giuseppe / Vicini, Claudio. ·Department of Otolaryngology, Head-Neck Surgery, University of Zagazig, Zagazig, Egypt, dr.eesaorl@gmail.com. ·Eur Arch Otorhinolaryngol · Pubmed #25557003.

ABSTRACT: The aim of this study was to evaluate outcomes related to swallowing function in patients who underwent transoral robotic surgery (TORS) for sleep apnea on both short- and long-term scales. 78 patients who underwent TORS for sleep apnea between 2011 and 2014 were followed up for an average period of 20 ± 7.12 months (range 7-32 months), then swallowing outcomes determined by MD Anderson Dysphagia Inventory (MDADI) questionnaire, gastrografin fluoroscopy imaging results, nasogastric tube dependence and subjectively by recording the patients' complaints were analyzed and reported. Minimal insignificant short-term impact on swallowing function (4.58 ± 7.03 preoperative MDADI score versus 5.18 ± 8.32 post-operative) (p = 0.56) was registered. Mean time for start of oral feeding was 1.05 ± 0.25 days (average, 1-3). In no case nasogastric tube feeding was required. Only five patients (6 %) showed significant aspiration on gastrografin fluoroscopy examination after 1 week; there was no significant correlation between the volume of tissue removed from both tongue base and epiglottis to the incidence of aspiration as shown by gastrografin fluoroscopy examination (p = 0.72). No long-term swallowing complaint was registered. Patients who underwent TORS tongue base reduction and supraglottoplasty for sleep apnea proved to have a reasonable short-term swallowing outcomes with no long-term sequelae.

19 Article Clinical outcomes and complications associated with TORS for OSAHS: a benchmark for evaluating an emerging surgical technology in a targeted application for benign disease. 2014

Vicini, Claudio / Montevecchi, Filippo / Campanini, Aldo / Dallan, Iacopo / Hoff, Paul T / Spector, Matthew E / Thaler, Erica / Ahn, Jeffrey / Baptista, Peter / Remacle, Marc / Lawson, George / Benazzo, Marco / Canzi, Pietro. ·Morgagni-Pierantoni Hospital, Forlì, Italy. ·ORL J Otorhinolaryngol Relat Spec · Pubmed #24777053.

ABSTRACT: BACKGROUND: The aim of this study was to create benchmarks for evaluating clinical outcomes and complications of transoral robotic surgeries (TORS) in a multicenter setting. METHODS: 243 TORS for obstructive sleep apnea/hypopnea syndrome (OSAHS) operations, carried out between 2008 and 2012, were analyzed at 7 different centers. The average hospitalization was 3.5 days. The mean patient age was 50 ± 12 years, the average BMI at the time of the procedure was 28.53 ± 3.87 and the majority of the patients were men (81%). RESULTS: The mean preoperative and postoperative apnea/hypopnea index was 43.0 ± 22.6 and 17.9 ± 18.4, respectively (p < 0.001). The mean preoperative and postoperative Epworth Sleepiness Scale score was 12.34 ± 5.19 and 5.7 ± 3.49, respectively (p < 0.001). The mean pre- and postoperative lowest O2 saturation was 79.5 ± 8.77 and 83.9 ± 6.38%, respectively (p < 0.001). CONCLUSIONS: Patients undergoing TORS as part of a multilevel approach for the treatment of OSAHS have a reasonable expectation of success with minimal long-term morbidity.

20 Article Combined transoral robotic tongue base surgery and palate surgery in obstructive sleep apnea-hypopnea syndrome: expansion sphincter pharyngoplasty versus uvulopalatopharyngoplasty. 2014

Vicini, Claudio / Montevecchi, Filippo / Pang, Kenny / Bahgat, Ahmed / Dallan, Iacopo / Frassineti, Sabrina / Campanini, Aldo. ·Department of Special Surgery, ENT and Oral Surgery Unit, G.B. Morgagni - L. Pierantoni Hospital, University of Pavia in Forlì, Italy. ·Head Neck · Pubmed #23765905.

ABSTRACT: BACKGROUND: Transoral robotic surgery (TORS) for obstructive sleep apnea-hypopnea syndrome is a relatively young technique principally devised for managing apneas in the tongue base (TB) area and supraglottic larynx. This procedure is included in the so-called "multilevel surgery" often including a palatal and nasal surgery. METHODS: We carried out a retrospective analysis in order to understand in detail the relative impact on apneas of the 2 different procedures carried out in the palate area (expansion sphincter pharyngoplasty and uvulopalatopharyngoplasty). We evaluated 2 groups, each of 12 cases, which were sorted according to the primary selection criteria of statistically comparable preoperative apnea-hypopnea index (AHI), sex, age, body mass index (BMI), and volume of removed TB tissue. RESULTS: Postoperative AHI registered was of 9.9 ± 8.6 SD for the expansion sphincter pharyngoplasty group and 19.8 ± 14.1 SD for the uvulopalatopharyngoplasty group. CONCLUSION: As the palate component of our multilevel procedure, expansion sphincter pharyngoplasty, including conventional nose surgery and robotic surgery, seems to be superior to uvulopalatopharyngoplasty.

21 Article Multilevel radiofrequency ablation for snoring and OSAHS patients therapy: long-term outcomes. 2012

De Vito, Andrea / Frassineti, Sabrina / Panatta, Maria Laura / Montevecchi, Filippo / Canzi, Pietro / Vicini, Claudio. ·Department of Special Surgery, Head and Neck Surgery and Oral Surgery Unit, Morgagni-Pierantoni Hospital, Via Forlanini 34, 47100 Forlì, Italy. andrea_devito@fastwebnet.it ·Eur Arch Otorhinolaryngol · Pubmed #21626124.

ABSTRACT: Our objective is to evaluate the outcomes of the Radio-Frequency (RF) energy for tissue thermo-ablation therapy in sleep-disordered breathing patients and retrospective evaluation of the RF therapy after a 5-year follow-up period, in terms of snoring and apnea reduction. From June 1999 to June 2009, we enrolled patients suffering from simple snoring and patients with obstructive apnea hypopnoea syndrome (OSAHS). A visual analog scale (VAS) questionnaire was used to evaluate the level of snoring and was filled out in short- and long-term periods, whereas in OSAHS patients an unattended polysomnography was performed before and after a minimum of 6 months from the last RF therapy treatment session. The presence of post-operative pain was assessed by means of a specific VAS. Results stated that 187/250 patients finished the RF therapy. In the simple snoring group, mean snoring VAS decreased from 7.48 to 3.7 (P < 0.0001). In the post-operative snoring group, mean snoring VAS decreased from 7.6 to 3.6 (P < 0.0001). In the mild-to-moderate grade OSAHS group, AHI decreased from a mean value of 18.1 to a mean value of 12.9 (P < 0.0001). Furthermore, we recorded a mean post-operative pain VAS of one in each group of patients. Our results suggest an important role of RF therapy in the improvement of snoring solution, but not for a significant AHI reduction. Level of evidence 2c.

22 Article Transoral robotic surgery of the tongue base in obstructive sleep Apnea-Hypopnea syndrome: anatomic considerations and clinical experience. 2012

Vicini, Claudio / Dallan, Iacopo / Canzi, Pietro / Frassineti, Sabrina / Nacci, Andrea / Seccia, Veronica / Panicucci, Erica / Grazia La Pietra, Maria / Montevecchi, Filippo / Tschabitscher, Manfred. ·Department of Special Surgery, Ear, Nose, and Throat, and Oral Surgery Unit, Ospedale Morgagni Pierantoni, University of Pavia in Forlì, Italy. ·Head Neck · Pubmed #21400628.

ABSTRACT: BACKGROUND: The purpose of our work was to describe, through cadaveric dissection, the anatomy of the tongue base with a robotic perspective and to demonstrate the feasibility of this approach in case of tongue base hypertrophy in Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS). METHODS: Forty-four patients with OSAHS underwent tongue base resection in the last 2 years. Twenty patients with a 10-month minimum follow-up were evaluated. The anatomic details of 3 tongue bases dissected from above are illustrated. RESULTS: The cadaveric study shows that no constant landmarks are identifiable, with no significant neurovascular structures present in the midline. Clinically, transoral robotic surgery (TORS) for the tongue base was feasible, with no major complications and satisfaction of the majority of patients. Mean apnea hypopnea index (AHI) improvement was 24.6 ± 22.2 SD, mean Epworth Sleepiness Scale (ESS) improvement was 5.9 ± 4.4 SD. CONCLUSION: Tongue base hypertrophy can be safely and effectively managed by TORS in OSAHS. Our midterm data are encouraging and worthy of further evaluation.

23 Article Transoral robotic geniohyoidpexy as an additional step of transoral robotic tongue base reduction and supraglottoplasty: feasibility in a cadaver model. 2011

Vicini, Claudio / Montevecchi, Filippo / Dallan, Iacopo / Canzi, Pietro / Tenti, Giulia. ·Department of Special Surgery, Otolaryngology - Head and Neck Surgery Division, Oral Surgery Unit, G.B. Morgagni L. Pierantoni Hospital, University of Pavia in Forlì, Forlì, Italy. ·ORL J Otorhinolaryngol Relat Spec · Pubmed #21508654.

ABSTRACT: PURPOSE OF THE STUDY: To evaluate the feasibility of including an additional step of transoral geniohyoidpexy in the transoral robotic tongue base reduction (TBR) and supraglottoplasty (SGP) procedure in order to better reproduce the classic Chabolle operation with expected similar outcomes but possibly with far less invasivity. PROCEDURE: A da Vinci surgical system was used in 2 cadavers. Dissection was carried out via a transoral approach in the same setting of TBR and SGP, after completing the basic tongue base and supraglottic steps. RESULT: A complete geniohyoidpexy was performed transorally. After identification, the hyoid bone body was rapidly dissected free from the suprahyoid muscles near the midline to the inferior border. CONCLUSION: A transoral robotic access to the hyoid bone was demonstrated. The procedure proved to be feasible in the same robotic setting of TBR and SGP.

24 Article Transoral robotic tongue base resection in obstructive sleep apnoea-hypopnoea syndrome: a preliminary report. 2010

Vicini, Claudio / Dallan, Iacopo / Canzi, Pietro / Frassineti, Sabrina / La Pietra, Maria Grazia / Montevecchi, Filippo. ·Department of Special Surgery, ENT and Oral Surgery Unit, Ospedale Morgagni Pietrantoni, University of Pavia, Forlì, Italy. ·ORL J Otorhinolaryngol Relat Spec · Pubmed #20173358.

ABSTRACT: PURPOSE OF THE STUDY: To evaluate the feasibility, tolerability and efficacy of tongue base management by means of transoral robotic surgery (TORS) in patients suffering from the obstructive sleep apnoea-hypopnoea syndrome (OSAHS) primarily related to hypertrophy of the tongue base. PROCEDURE: Seventeen patients with OSAHS principally related to tongue base hypertrophy were managed by means of TORS (Intuitive da Vinci(R)). Patients with a minimum follow-up of 3 months were evaluated. RESULTS: Ten patients [mean preoperative apnoea-hypopnoea index (AHI): 38.3 +/- 23.5 SD] were included in the study. By means of robotic technology, the tongue base and the epiglottis could be managed. The postoperative polysomnographic results were fairly good (mean postoperative AHI: 20.6 +/- 17.3 SD), and the functional results (pain, swallowing and quality of life) are very encouraging; altogether, complications were rare and of minor importance. CONCLUSIONS: Transoral robotic tongue base management in patients with OSAHS primarily related to tongue base hypertrophy is feasible and well tolerable. These preliminary results are encouraging and worthy of further evaluation.