Barbed Pharyngoplasty and Sleep Disordered Breathing

Foreword
Foreword
Preface
	Palate Surgery: The Never-Ending Story
Contents
1: Evolution of Palatal Surgery for Sleep-Disordered Breathing
	1.1	 Introduction
	1.2	 Historical Evolution
	1.3	 Conceptual Evolution
	1.4	 Technical Evolution
	1.5	 Postoperative Evolution
	1.6	 Summary
	References
2: The New Generation of Palate Surgery for Obstructive Sleep Apnea
	2.1	 Introduction
	2.2	 Methodology
	2.3	 Statistical Method
	2.4	 Results
	2.5	 Discussion
	2.6	 Conclusion
	References
3: Barbed Suture Technology
	3.1	 Introduction
	3.2	 Technical Features
	3.3	 Advantages of Barbed Suture Technology in Pharyngeal/Palatal Surgery
	3.4	 Complications
	References
4: Overview of Barbed Suture in Non-ENT Surgery
	4.1	 Technological Development of Barbed Sutures in Different Surgical Fields
	4.2	 Current Surgical Applications of Barbed Sutures in Laparoscopic and Robotic Surgery
	4.3	 Barbed Sutures in Wound Closure and Plastic Surgery
	References
5: Overview of Different Barbed Procedures for Sleep Breathing Disorders
	References
6: Qualitative Phenotyping by Surrogate Index for the Selection of Patient Candidates for Velo-Pharyngeal Surgery
	6.1	 Endotypic Traits and UA Surgery
		6.1.1	 Upper Airway Surgery for OSA Modifies Anatomical Pharyngeal Collapsibility
		6.1.2	 Clinical Endotypic Trait Analysis Could Predict UA Surgical Outcomes
	6.2	 Techniques to Measure OSA Endotypes
	6.3	 Endotype Surrogate Measures for Clinical Application
	6.4	 Conclusions
	References
7: Barbed Surgery Related Anatomy
	7.1	 Introduction
	7.2	 Oropharynx
		7.2.1	 Soft Palate
		7.2.2	 Palatine Tonsils
		7.2.3	 Barbed Snore Surgery: Anatomical Consideration
			7.2.3.1	 Pterygomandibular Raphe
			7.2.3.2	 Pterygoid Hamulus
			7.2.3.3	 Palatine Aponeurosis
			7.2.3.4	 Posterior Nasal Spine
	References
8: Surgical Simulation for Barbed Pharyngoplasties
	8.1	 Background
	8.2	 Synthetic Models
	8.3	 Ex Vivo Surgical Model
	8.4	 Take Home Messages
	References
9: New Philosophy in Palate-Oropharynx Procedures
	9.1	 Two Coaxial Tubes Theory
	References
10: Barbed Anterior Pharyngoplasty
	10.1	 Introduction
		10.1.1	 Indications and Contraindications
		10.1.2	 Surgical Technique
	10.2	 Our Experience
	References
11: Barbed Lateral Pharyngoplasty
	11.1	 Introduction
	11.2	 Material and Methods
		11.2.1	 Equipment
		11.2.2	 Principles
		11.2.3	 Indications and Contraindications
		11.2.4	 Surgical Planning
		11.2.5	 Surgical Technique
		11.2.6	 Post-operative Care
	11.3	 Outcomes from the Literature and Personal Experience
	11.4	 Conclusions
	References
12: Circular Pharyngoplasties
	12.1	 Alianza Technique
	12.2	 Indications and Contraindications
	12.3	 Surgical Technique
	12.4	 Modified Alianza Technique
	12.5	 Personal Experience
	12.6	 Conclusions
	12.7	 Barbed Antero-Lateral Pharyngoplasty (BALPh)
	References
13: Barbed Snore Surgery: The Learning Curve
	13.1	 Introduction
	13.2	 Study Design
		13.2.1	 Data Acquisition and Statistical Analysis
	13.3	 Results
	13.4	 Discussion
	13.5	 Conclusion
	References
14: Barbed Reposition Pharyngoplasty (BRP)
	14.1	 Introduction to Barbed Reposition Pharyngoplasty (BRP)
	14.2	 Barbed Reposition Pharyngoplasty development
	14.3	 Bio-Engineering Modeling
	14.4	 Biomechanical Studies
	14.5	 Diffusion and Popularity
	14.6	 Conclusion
	References
15: Candidates to Barbed Reposition Pharyngoplasty
	15.1	 Background
	15.2	 Barbed Reposition Pharyngoplasty for Sleep Apnea
		15.2.1	 Selection Criteria According to Surrogate Endotypes (PALM Classification) (See Chap. 6 of Bosi et al. for a More Extensive Discussion)
		15.2.2	 Selection Criteria According to Anatomo-Functional Phenotypes
			15.2.2.1	 Barbed Reposition Pharyngoplasty for Sleep Apnea
			15.2.2.2	 Barbed Reposition Pharyngoplasty for Simple Snoring
		15.2.3	 Selection Criteria According to Drug-Induced Sleep Endoscopy Findings
	15.3	 Conclusion
	References
16: Barbed Reposition Pharyngoplasty (BRP): Surgical Technique
	16.1	 Barbed Reposition Pharyngoplasty (BRP): Surgical Technique
	References
17: Barbed Reposition Pharyngoplasty (BRP): Postoperative Management, Outcomes Evaluation, and Follow-Up
	17.1	 Postoperative Management of Barbed Reposition Pharyngoplasty
	17.2	 Outcomes Evaluation and Follow-Up
	17.3	 Postoperative Pain and Swallowing
	17.4	 Respiratory Outcomes Evaluation
	References
18: Barbed Reposition Pharyngoplasty (BRP): Intraoperative and Postoperative Complications
	18.1	 Intraoperative and Postoperative Complications
		18.1.1	 Intraoperative Complications [2–5]
		18.1.2	 Postoperative Complications [6–10]
	18.2	 Special Topic: Extrusion and Exposure [6]
	References
19: Effectiveness of Barbed Repositioning Pharyngoplasty for the Treatment of Obstructive Sleep Apnea (OSA): Prospective Outcomes, Multicentric Studies and Review of Literature Results
	19.1	 Effectiveness of Barbed Repositioning Pharyngoplasty for the Treatment of Obstructive Sleep Apnea (OSA): A Prospective Randomized Trial
		19.1.1	 Trial Design
			19.1.1.1	 Surgical Technique
		19.1.2	 Results
		19.1.3	 Discussion
	19.2	 Prospective Multicenter Study on Barbed Reposition Pharyngoplasty Standing Alone or as Part of Multilevel Surgery for Sleep
		19.2.1	 Material and Methods
			19.2.1.1	 Surgical Technique
		19.2.2	 Statistical Analysis
		19.2.3	 Results
	19.3	 Current Literature Evidence
	References
20: Palate Postoperative Problems Score (PPOPS): Tool for the Evaluation of Subjectives Results of Palatal Surgery Techniques
	20.1	 Introduction
	20.2	 Definitions
	20.3	 Discussion
	20.4	 Results
	20.5	 Discussion
	20.6	 Conclusion
	References
21: BRP Vs Other Palate Procedures
	21.1	 Introduction
	21.2	 BRP Vs. Others
	21.3	 Discussion
	21.4	 Summary
	21.5	 Conclusions
	References
22: Long-Term Functional Results of Barbed Reposition Pharyngoplasty Vs. Hyoid Suspension for Obstructive Sleep Apnea Hypopnea Syndrome
	References
23: Outcome Predictors for Non-resective Pharyngoplasty in Obstructive Sleep Apnea-Hypopnea Syndrome
	23.1	 Outcomes in OSA Surgery
	23.2	 Scoring Systems
	23.3	 Aims of Palatopharyngeal Surgery
	23.4	 Outcome Predictors
	23.5	 Tips and Traps
	References
24: Long-Term Complications of Palate Surgery: An Update
	24.1	 Introduction
	24.2	 Methods
	24.3	 Results
	24.4	 Discussion
	24.5	 Conclusion
	References
25: Barbed Pharyngoplasty in Revision Surgery
	25.1	 Introduction
	25.2	 Soft Palate Functional Anatomy
		25.2.1	 Clinical Examination in Barbed Pharyngoplasty Revision Surgery
	25.3	 Barbed Pharyngoplasties
	25.4	 Failure of Conventional Surgeries in OSA Patients
	25.5	 Failure of Lateral Pharyngoplasty
	25.6	 Failure of Anterior Palatoplasty
	25.7	 Conclusions
	References
26: Barbed Pharyngoplasties in Multilevel Surgery Including TransOral Robotic Surgery (TORS)
	26.1	 Introduction
	26.2	 Historical Background
	26.3	 Effect of Palate Surgery on TORS Results
		26.3.1	 Expansion Sphincter Pharyngoplasty (ESP)
		26.3.2	 Barbed Reposition Pharyngoplasty (BRP)
	26.4	 Conclusions
	References
27: Myofunctional Therapy as a Postoperative Adjuvant Treatment to Single Level Velopharyngeal Surgery
	27.1	 Introduction
	27.2	 Myofunctional Assessment
	27.3	 Pathogenetic Basis, Exercises, and Classifications
	27.4	 Protocols
	27.5	 Efficacy
	27.6	 OMFT and Surgery
	27.7	 Limitations and Future Perspectives
	References
28: Modified BRP and Different Palate Techniques to Treat Oropharyngeal Collapse
	28.1	 Introduction
	28.2	 Surgical Technique (Video 28.1)
	28.3	 Modifications to the Technique Described
	28.4	 Results
	28.5	 Indications
	28.6	 Postoperative Care
	28.7	 Complications
	28.8	 Discussion
	References
29: Technical Update of Barbed Pharyngoplasty for Retropalatal Obstruction
	29.1	 Introduction
	29.2	 The Mechanism of Vectorial Collapse and Obstruction
	29.3	 Why Barbed Pharyngoplasty?
	29.4	 Development of Modified Technique
	29.5	 Advantages of Modified Technique
	29.6	 Our Experience: Modified Vs Classical Technique
	29.7	 Preoperative Evaluation
	29.8	 Surgical Technique
	29.9	 Modified Barbed Pharyngoplasty in Multilevel Surgery
	References
30: Barbed Suspension Pharyngoplasty (BSP)
	30.1	 Introduction and Indications to the Surgical Technique
		30.1.1	 Surgical Step
	30.2	 Results and Conclusions
	References
31: A Personalized and Eclectic Use of Barbed Suture to Address Palate Abnormalities in Sleep Apnea Patients
	31.1	 Introduction
	31.2	 Patient Selection
		31.2.1	Contraindications to Palatal Barbed Surgery
	31.3	 Surgical Techniques
	31.4	 Barbed Anterior Palatoplasty (BAPP): Basic Variant
		31.4.1	 Indications
		31.4.2	 Considerations
	31.5	 Tonsils Sparing Antero-Lateral Barbed Pharyngoplasty (TSALBP) (Fig. 31.3)
		31.5.1	 Indications
	31.6	 BAPP + BSP (Barbed Suspension Palatoplasty) (Fig. 31.4)
		31.6.1	 Indications
	31.7	 BAPP + BRP (Barbed Reposition Palatoplasty) (Fig. 31.5)
		31.7.1	 Indications
	31.8	 Muscle Sparing Sphincter Barbed Pharyngoplasty (MSBSP)
		31.8.1	 Indications
		31.8.2	 Considerations
	31.9	 Post-operative Care
	31.10	 Complications
	31.11	 Case Series
	31.12	 Discussion and Conclusion
	References
32: Barbed Functional Expansion Pharyngoplasty
	32.1	 Introduction
	32.2	 Surgical Technique
	32.3	 Indications
	32.4	 Postoperative Care
	32.5	 Complications
	32.6	 Surgical Outcomes
	32.7	 Concluding Remarks
	References
33: Simplified Barbed Reposition Pharyngoplasty (sBRP)
	33.1	 Definition
	33.2	 Equipments
	33.3	 Anesthesia and Patient Positioning
	33.4	 Surgical Procedure and Steps
	33.5	 Success Rate
	33.6	 Limits
	References
34: Different Barbed Pharyngoplasty Techniques for Retropalatal Collapse in Obstructive Sleep Apnoea Patients: A Systematic Review
	34.1	 Introduction
	34.2	 Results
		34.2.1	 Barbed Pharyngoplasty for Sleep Apnoea
		34.2.2	 Barbed Pharyngoplasty for Snoring
	34.3	 Conclusions
	References
35: Barbed Pharyngoplasty Experience in Egypt
	35.1	 Introduction
	35.2	 Historical Background
	35.3	 Surgical Technique of CO-BRP
	35.4	 Postoperative Care
	35.5	 Outcome Measurement
	35.6	 Our Experience in Egypt
	35.7	 Conclusion
	References
36: Barbed Pharyngoplasties: Experience in India
	36.1	 Introduction
	36.2	 Methodology
	36.3	 Results
	36.4	 Discussion
	References
37: Barbed Pharyngoplasties Experience in Singapore
	37.1	 Introduction
	37.2	 History of Pharyngoplasty in Singapore
	37.3	 How Barbed Pharyngoplasty Started in Singapore
	37.4	 Barbed Reposition Pharyngoplasty (BRP) Technique in Singapore
	37.5	 Future Research
	References
38: Barbed Pharyngoplasties Experience in Thailand
	38.1	 Preoperative Assessment
	38.2	 Indication
	38.3	 Contraindication
	38.4	 Surgical Procedures
		38.4.1	 Barbed Palatal Suspension
		38.4.2	 Barbed Reposition Pharyngoplasty
		38.4.3	 Barbed Anterior Palatoplasty
		38.4.4	 Modified Barbed Reposition Pharyngoplasty
		38.4.5	 Barbed Suspension Pharyngoplasty
	38.5	 Results
	38.6	 Complications
	38.7	 Barbed Suture
	38.8	 Single-Level or Multilevel Surgery
	38.9	 Conclusion
	References
39: Barbed Pharyngoplasties Experience in Spain
	39.1	 Introduction
	39.2	 Materials and Methods
	39.3	 Results
	39.4	 Discussion
	References
40: Barbed Pharyngoplasty Experience in Brazil
	40.1	 Introduction
	40.2	 Results
	40.3	 Complications
	40.4	 Conclusion
	References
41: Barbed Pharyngoplasties Experience in USA
	41.1	 Introduction
	41.2	 Survey Results
	41.3	 Barriers to Adoption
	References
42: Fellowship and Training in Barbed Pharyngoplasty
	42.1	 Introduction
	42.2	 OSA Fellowships
	42.3	 Our Experience
	42.4	 Pre Fellowships Requirement
	42.5	 What We Learn During the Fellowships
	42.6	 Proper Patient’s Evaluation
	42.7	 Surgical Skills
	42.8	 Applied New Technique After Fellowships and its Difficulties
	42.9	 Conclusion
	References
43: Future Perspectives
	43.1	 Point #1: Patient Selection
	43.2	 Point#2: Barbed Suture Technology
	43.3	 Point#3: Technique
	43.4	 Point#4: Suture Deployment
	43.5	 Point#5: Planned Revision BRP
	43.6	 Point#6: Improved Visualization