Surgical Treatment of Obstructive Sleep Apnea:
Epiglottic Surgery
Abstract Introduction and objective: Among the possible causes of OSA, although rare, are alterations of the epiglottis. The objective of this work is to highlight its importance and insist on its active diagnosis, since in well-selected cases it can be treated surgically.Synthesis: The importance of the epiglottis as a cause of OSA, its exploration and possible surgical alternatives are detailed.Conclusions: The epiglottis is an anatomical structure that generally goes unnoticed as a cause of OSA in adults and that can cause even severe OSA.It must be studied in an active way. Its involvement in OSA is likely not to be revealed during awake examination and DISE may be required to appreciate how it collapses during inspiration in the sleeping patient.Some surgical techniques are described as it is a good choice in many properly selected patients.
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Torre C, Camacho M, Liu SY, Huon LK, Capasso R. Epiglottis collapse in adult obstructive sleep apnea: A systematic review. Laryngoscope. 2016 Feb;126(2):515-23. doi: 10.1002/lary.25589.
Lugo Saldaña R, Chávez Viveros R. Epiglotectomia parcial con técnica de radiofrecuencia o cauterio monopolar y epiglotopexia. En Lugo Saldaña R, Saldivar Ponce K ed.Manual de procedimientos quirúrgicos en ronquido y apnea obstructiva del sueño.Amolca.2022.
Ravesloot MJ, DeVries N.One hundred consecutive patients undergoing drug- induced sleep endoscopy: results and evaluation. Laryngoscope. 2011;121(12): 2710–2716.
Friedman M, Jacobowitz O. Sleep apnea and snoring, surgical and non-surgical therapy. 2ªed.Elsevier.2020
Kwon OE, Jung SY, Al-Dilaijan K, Min JY, Lee KH, Kim SW. Is epiglottis surgery necessary for obstructive sleep apnea patients with epiglottis obstruction? Laryngoscope. 2019 Nov;129(11):2658-2662. doi: 10.1002/lary.27808.
Verse T, Montevecchi F.Larynx and trachea.In Verse T, de Vries N,ed. Current concepts of Sleep apnea surgery. 1st Edition. Stuttgart: Thieme; 2019.pg:222-226
Sung CM, Kim HC, Yang HC. The clinical characteristics of patients with an isolate epiglottic collapse. Auris Nasus Larynx. 2020 Jun;47(3):450-457. doi: 10.1016/j.anl.2019.10.009. Epub 2019 Nov 14. PMID: 31733977.
Genta PR, Sands SA, Butler JP, et al. Airflow shape is associated with the pharyngeal structure causing OSA. Chest. 2017;152(3):537–546.
Jeong SH, Man Sung C, Lim SC, Yang HC. Partial epiglottectomy improves residual apnea-hypopnea index in patients with epiglottis collapse. J Clin Sleep Med. 2020 Sep 15;16(9):1607-1610. doi: 10.5664/jcsm.8640. PMID: 32620192.
Azarbarzin A, Marques M, Sands SA, Op de Beeck S, Genta PR, Taranto-Montemurro L, de Melo CM, Messineo L, Vanderveken OM, White DP, Wellman A. Predicting epiglottic collapse in patients with obstructive sleep apnoea. Eur Respir J. 2017 Sep 20;50(3):1700345. doi: 10.1183/13993003.00345-2017. PMID: 28931660; PMCID: PMC5915305.
Vonk PE, Ravesloot MJL, Kasius KM, van Maanen JP, de Vries N. Floppy epiglottis during drug-induced sleep endoscopy: an almost complete resolution by adopting the lateral posture. Sleep Breath. 2020 Mar;24(1):103-109. doi: 10.1007/s11325-019-01847-x.
O'Connor Reina C, Plaza Mayor G, Ignacio-Garcia JM, Baptista Jardin P, Garcia-Iriarte MT, et al. Floppy Closing Door Epiglottis Treated Successfully with an Mhealth Application Based on Myofunctional Therapy: A Case Report. Case Rep Otolaryngol. 2019 Jul 1; 2019:4157898. doi: 10.1155/2019/4157898
Askar SM, Quriba AS, Hassan EM, Awad AM. Positional Awake Endoscopy Versus DISE in Assessment of OSA: A Comparative Study. Laryngoscope. 2020 Sep;130(9):2269-2274. doi: 10.1002/lary.28391.
Catalfumo FJ, Golz A, Westerman ST, Gilbert LM, Joachims HZ, Goldenberg D. The epiglottis and obstructive sleep apnoea syndrome. J Laryngol Otol. 1998 Oct;112(10):940-3. doi: 10.1017/s0022215100142136.
Oomen KP, Modi VK. Epiglottopexy with and without lingual tonsillectomy. Laryngoscope. 2014 Apr;124(4):1019-22. doi: 10.1002/lary.24279. Epub 2013 Jul 12. PMID: 23794262.
Sandu k, Monnier P, Reinhard A, Gorostidi F. Endoscopic epiglottopexy using Lichtenberger’s needle carrier to avoid breakdown of repair. Eur Arch Otorhinolaryngol (2015) 272:3385–3390 DOI 10.1007/s00405-015-3707-5
Vicini C, Montevecchi F. Multilevel surgery for obstructive sleep apnea-hypopnea syndrome (OSAHS). En Plaza G, Baptista P, O´Connor C, editores. Sleep-disordered breathing. Diagnosis and treatment. Barcelona. CRS. Amplifon. 2017. pg 425-440.
Vicini C, Montevecchi F, Tenti G, Dallan I, Huntley T. Robotic surgery for OSAHS: Transoral robotic tongue base reduction and supraglottoplasty for OSAHS. En Pang K, Rotemberg B, Tucker Woodson B. Advanced surgical techniques in snoring and obstructive sleep apnea. San Diego. Plural Publishing. 2013. pg 277-283.
Golz A, Goldenberg D, Westerman ST et al. Laser partial epiglottidectomy as a treatment for obstructive sleep apnea and laryngomalacia. Ann Otol Rhinol Laryngol. 2000; 109(12 Pt1):1140-1145
Lugo Saldaña R, Chávez Viveros R. Epiglotectomia parcial con técnica de radiofrecuencia o cauterio monopolar y epiglotopexia. En Lugo Saldaña R, Saldivar Ponce K ed.Manual de procedimientos quirúrgicos en ronquido y apnea obstructiva del sueño.Amolca.2022.
Ravesloot MJ, DeVries N.One hundred consecutive patients undergoing drug- induced sleep endoscopy: results and evaluation. Laryngoscope. 2011;121(12): 2710–2716.
Friedman M, Jacobowitz O. Sleep apnea and snoring, surgical and non-surgical therapy. 2ªed.Elsevier.2020
Kwon OE, Jung SY, Al-Dilaijan K, Min JY, Lee KH, Kim SW. Is epiglottis surgery necessary for obstructive sleep apnea patients with epiglottis obstruction? Laryngoscope. 2019 Nov;129(11):2658-2662. doi: 10.1002/lary.27808.
Verse T, Montevecchi F.Larynx and trachea.In Verse T, de Vries N,ed. Current concepts of Sleep apnea surgery. 1st Edition. Stuttgart: Thieme; 2019.pg:222-226
Sung CM, Kim HC, Yang HC. The clinical characteristics of patients with an isolate epiglottic collapse. Auris Nasus Larynx. 2020 Jun;47(3):450-457. doi: 10.1016/j.anl.2019.10.009. Epub 2019 Nov 14. PMID: 31733977.
Genta PR, Sands SA, Butler JP, et al. Airflow shape is associated with the pharyngeal structure causing OSA. Chest. 2017;152(3):537–546.
Jeong SH, Man Sung C, Lim SC, Yang HC. Partial epiglottectomy improves residual apnea-hypopnea index in patients with epiglottis collapse. J Clin Sleep Med. 2020 Sep 15;16(9):1607-1610. doi: 10.5664/jcsm.8640. PMID: 32620192.
Azarbarzin A, Marques M, Sands SA, Op de Beeck S, Genta PR, Taranto-Montemurro L, de Melo CM, Messineo L, Vanderveken OM, White DP, Wellman A. Predicting epiglottic collapse in patients with obstructive sleep apnoea. Eur Respir J. 2017 Sep 20;50(3):1700345. doi: 10.1183/13993003.00345-2017. PMID: 28931660; PMCID: PMC5915305.
Vonk PE, Ravesloot MJL, Kasius KM, van Maanen JP, de Vries N. Floppy epiglottis during drug-induced sleep endoscopy: an almost complete resolution by adopting the lateral posture. Sleep Breath. 2020 Mar;24(1):103-109. doi: 10.1007/s11325-019-01847-x.
O'Connor Reina C, Plaza Mayor G, Ignacio-Garcia JM, Baptista Jardin P, Garcia-Iriarte MT, et al. Floppy Closing Door Epiglottis Treated Successfully with an Mhealth Application Based on Myofunctional Therapy: A Case Report. Case Rep Otolaryngol. 2019 Jul 1; 2019:4157898. doi: 10.1155/2019/4157898
Askar SM, Quriba AS, Hassan EM, Awad AM. Positional Awake Endoscopy Versus DISE in Assessment of OSA: A Comparative Study. Laryngoscope. 2020 Sep;130(9):2269-2274. doi: 10.1002/lary.28391.
Catalfumo FJ, Golz A, Westerman ST, Gilbert LM, Joachims HZ, Goldenberg D. The epiglottis and obstructive sleep apnoea syndrome. J Laryngol Otol. 1998 Oct;112(10):940-3. doi: 10.1017/s0022215100142136.
Oomen KP, Modi VK. Epiglottopexy with and without lingual tonsillectomy. Laryngoscope. 2014 Apr;124(4):1019-22. doi: 10.1002/lary.24279. Epub 2013 Jul 12. PMID: 23794262.
Sandu k, Monnier P, Reinhard A, Gorostidi F. Endoscopic epiglottopexy using Lichtenberger’s needle carrier to avoid breakdown of repair. Eur Arch Otorhinolaryngol (2015) 272:3385–3390 DOI 10.1007/s00405-015-3707-5
Vicini C, Montevecchi F. Multilevel surgery for obstructive sleep apnea-hypopnea syndrome (OSAHS). En Plaza G, Baptista P, O´Connor C, editores. Sleep-disordered breathing. Diagnosis and treatment. Barcelona. CRS. Amplifon. 2017. pg 425-440.
Vicini C, Montevecchi F, Tenti G, Dallan I, Huntley T. Robotic surgery for OSAHS: Transoral robotic tongue base reduction and supraglottoplasty for OSAHS. En Pang K, Rotemberg B, Tucker Woodson B. Advanced surgical techniques in snoring and obstructive sleep apnea. San Diego. Plural Publishing. 2013. pg 277-283.
Golz A, Goldenberg D, Westerman ST et al. Laser partial epiglottidectomy as a treatment for obstructive sleep apnea and laryngomalacia. Ann Otol Rhinol Laryngol. 2000; 109(12 Pt1):1140-1145
Marco-Garrido, A., Arroyo-Domingo, M., Martínez-Alonso, J. A., O’Connor-Reina, C., Plaza-Mayor, G., Carrasco-Llatas, M., Martínez-Ruiz-de-Apodaca, P., & Baptista-Jardín, P. (2023). Surgical Treatment of Obstructive Sleep Apnea:: Epiglottic Surgery. Revista ORL, e30978. https://doi.org/10.14201/orl.30978
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