Robotic Modification of Epiglottis Trimming in the Treatment of Obstructive Sleep Apnea

Abstract

Objective With the widespread use of drug-induced sleep endoscopy, it has been suggested that epiglottis pathologies are present at high rates in patients with sleep apnea. The aim of our study was to evaluate the efficacy of trimming the curled-inward epiglottis as an updated surgical technique in patients with omega epiglottis. Study Design Retrospective study. Setting Tertiary hospital. Methods Among the 283 patients with epiglottis pathology, 21 with isolated omega-shaped epiglottis (age, 33-53 years) fulfilled the inclusion criteria between May 2016 and April 2019. Drug-induced sleep endoscopy was used to detect epiglottic collapse compressed by the lateral parts during inspiration. An epiglottoplasty technique was applied as single-level sleep surgery in patients with an isolated omega-shaped epiglottis. The medical data were also reviewed. Results The mean pre- and postoperative total apnea-hypopnea index (AHI) scores were 27.89 and 10.58, respectively, and this difference was statistically significant ( P < .001). There was a statistically significant difference between the pre- and postoperative supine AHI scores (27.02 vs 10.48, P < .001). Surgical success, defined as AHI <20 and a decrease in AHI by 50%, was documented in 85.71% of patients (18/21), and 12 patients found complete relief from obstructive sleep apnea symptoms (AHI <5); the cure rate was 38.09% (8/21). Conclusion Trimming the curled-inward epiglottis may represent an excellent option for epiglottis surgery in patients with obstructive sleep apnea by being less invasive than techniques currently in use.

Uncommon anatomical variation of an epiglottis encountered during emergent endotracheal intubation

“…Historically, OSE is associated with pediatric laryngomalacia 1 and, occasionally, adult obstructive sleep apnea. 2 , 3 However, many patients are often asymptomatic. The incidence of OSE found during adult ED intubations is unknown, but it is not a rare finding and should be anticipated by emergency physicians because it can make mask ventilation and ETI difficult.…”

“…An OSE is a unique anatomical variation that features the lateral folds of the epiglottis curling acutely inward toward the posterior hypopharynx, often fully or partially obscuring a normal glottic opening. Historically, OSE is associated with pediatric laryngomalacia 1 and, occasionally, adult obstructive sleep apnea 2,3 . However, many patients are often asymptomatic.…”