Paker Miki, Duek Irit, Awwad Faten, Benyamini Limor, Meshyeev Tsipi, Gil Ziv, Cohen Jacob T
Department of Otolaryngology-Head and Neck Surgery, Head and Neck Center, Rambam Health Care Campus, Haifa, Israel.
the Rappaport Institute of Medicine and Research, Technion-Israel Institute of Technology, Haifa, Israel.
Laryngoscope. 2019 Feb;129(2):422-428. doi: 10.1002/lary.27364. Epub 2018 Nov 15.
OBJECTIVES/HYPOTHESIS: This study aimed to evaluate the long-term swallowing performance following transoral robotic surgery (TORS) to the base of tongue (BOT) in the treatment of obstructive sleep apnea (OSA).
Retrospective and prospective cohort study.
Data analysis of 39 patients who underwent BOT reduction via TORS to treat OSA at our center from September 2013 to April 2016. Long-term swallowing functions were assessed using subjective self-evaluated swallowing disturbances questionnaire (SDQ) and objective fiberoptic endoscopic evaluation of swallowing (FEES).
Seven patients underwent TORS BOT reduction alone, whereas 32 had also uvulopalatoplasty ± tonsillectomy, with a surgical success rate of 71.4%. Mean time for swallowing evaluation was 27.4 ± 9.43 months. Twenty-five patients completed the SDQ with an average score of 9.26 ± 10.05. In 32%, the SDQ was positive for dysphagia. In 10 out of 14 patients who underwent FEES, swallowing problems were noticed. The most common pathological findings were food residue in the vallecula followed by early spillage of food into the hypopharynx, penetration of solid food and liquid on the vocal folds surface, and aspiration.
BOT reduction via TORS has a negative effect on long-term swallowing function. A self-assessment questionnaire can help detect patients who suffer from swallowing impairment. Postoperative objective swallowing tests are essential not only in the immediate postoperative period but also during late routine follow-up. Proper patient selection and detailed information about surgery and possible late-swallowing effect are important factors before scheduling BOT reduction via TORS for OSA treatment.
4 Laryngoscope, 129:422-428, 2019.
目的/假设：本研究旨在评估经口机器人手术（TORS）治疗舌根（BOT）阻塞性睡眠呼吸暂停（OSA）后的长期吞咽功能。
回顾性和前瞻性队列研究。
对2013年9月至2016年4月在本中心接受TORS治疗OSA并进行BOT缩小术的39例患者进行数据分析。使用主观自我评估吞咽障碍问卷（SDQ）和客观纤维喉镜吞咽功能评估（FEES）对长期吞咽功能进行评估。
7例患者仅接受了TORS BOT缩小术，而32例还进行了悬雍垂腭咽成形术±扁桃体切除术，手术成功率为71.4%。吞咽评估的平均时间为27.4±9.43个月。25例患者完成了SDQ，平均得分为9.26±10.05。32%的患者SDQ显示吞咽困难呈阳性。在接受FEES的14例患者中，有10例发现吞咽问题。最常见的病理表现是会厌谷有食物残留，其次是食物过早溢入下咽、固体食物和液体渗透到声带表面以及误吸。
通过TORS进行BOT缩小术对长期吞咽功能有负面影响。自我评估问卷有助于检测吞咽功能受损的患者。术后客观吞咽测试不仅在术后即刻至关重要，在后期常规随访期间也必不可少。在安排通过TORS进行BOT缩小术治疗OSA之前，正确选择患者以及提供有关手术和可能的后期吞咽影响的详细信息是重要因素。
4《喉镜》，129:422 - 428，2019年。
