Operative Techniques in Otolaryngology - Head and Neck Surgery RSS feed: Current Issue. This large-size, atlas-format journal presents detailed illustrations of new surgical procedures and techniques in otology, rhinology, laryngology, reconstructive head and neck surgery, and facial plastic surgery. Feature articles in each issue are related to a central theme by anatomic area or disease process. The journal will also often contain articles on complications, diagnosis, treatment or rehabilitation. New techniques that are non-operative are also featured. http://www.optecoto.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Operative Techniques in Otolaryngology - Head and Neck Surgery1043-1810231March 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.optecoto.com/article/PIIS104318101200005X/abstract?rss=yesMasthead10.1016/S1043-1810(12)00005-XOperative Techniques in Otolaryngology - Head and Neck Surgery 23, 1 (2012)2012-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2012-03-01231S1043-1810(11)X0006-4IFCIFChttp://www.optecoto.com/article/PIIS1043181012000061/abstract?rss=yesEditorial Board10.1016/S1043-1810(12)00006-1Operative Techniques in Otolaryngology - Head and Neck Surgery 23, 1 (2012)2012-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2012-03-01231S1043-1810(11)X0006-4iihttp://www.optecoto.com/article/PIIS1043181012000073/abstract?rss=yesContents10.1016/S1043-1810(12)00007-3Operative Techniques in Otolaryngology - Head and Neck Surgery 23, 1 (2012)2012-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2012-03-01231S1043-1810(11)X0006-4iiiiihttp://www.optecoto.com/article/PIIS1043181012000103/abstract?rss=yesFuture and recent issues10.1016/S1043-1810(12)00010-3Operative Techniques in Otolaryngology - Head and Neck Surgery 23, 1 (2012)2012-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2012-03-01231S1043-1810(11)X0006-4ivivhttp://www.optecoto.com/article/PIIS1043181012000115/abstract?rss=yesInformation for authors10.1016/S1043-1810(12)00011-5Operative Techniques in Otolaryngology - Head and Neck Surgery 23, 1 (2012)2012-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2012-03-01231S1043-1810(11)X0006-4vvihttp://www.optecoto.com/article/PIIS1043181011000960/abstract?rss=yesAlthough the prevalence of obstructive sleep apnea has been increasing, this common disorder remains difficult to manage by medical and surgical specialists. Continuous positive airway pressure therapy is readily available in many forms but despite its availability and efficacy, continuous positive airway pressure is not accepted or regularly used by many patients. Alternative treatments including surgery, oral appliances, and expiratory positive airway pressure devices thus play an important role in the management of obstructive sleep apnea. In this era of personalized medicine, effective therapy must be fitted to the patient to achieve a successful outcome.IntroductionOfer Jacobowitz10.1016/j.otot.2011.10.001Operative Techniques in Otolaryngology - Head and Neck Surgery 23, 1 (2012)2012-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2012-03-01231S1043-1810(11)X0006-411http://www.optecoto.com/article/PIIS104318101100090X/abstract?rss=yesSamuel Hugh Warburton Robinson was recognized worldwide as a leading airway-reconstruction surgeon for obstructive sleep apnea and a pioneer of new surgical techniques now used internationally where there is need for surgical treatment of sleep apnea.Sam Robinson—a dedicationSuren Krishnan, John-Charles Hodge, Andrew Foreman10.1016/j.otot.2011.09.003Operative Techniques in Otolaryngology - Head and Neck Surgery 23, 1 (2012)2012-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2012-03-01231S1043-1810(11)X0006-422http://www.optecoto.com/article/PIIS1043181012000036/abstract?rss=yes Multiple palatopharyngoplasty techniques are available for reconstruction of the upper pharyngeal airway. To select appropriate procedures, the surgeon requires classification methods, but traditional staging systems only describe levels of obstruction and do not relate sufficient anatomical detail to specify an intervention. A method of awake, upper airway evaluation is described, which allows the surgeon to direct specific surgical procedures to particular luminal shapes and anatomical structures. Expansion sphincter pharyngoplasty is a procedure for treatment of lateral pharyngeal stenosis, where rotation of the palatopharyngeus muscle is performed to widen the pharynx and advance the soft palate anteriorly. Palatal advancement pharyngoplasty is a technique for treatment of posterior retro-palatal obstruction which results in anterior palatal advancement. Surgical techniques and management are described. Expansion sphincter pharyngoplasty and palatal advancement pharyngoplasty: airway evaluation and surgical techniquesB. Tucker Woodson, Matthew Sitton, Ofer Jacobowitz10.1016/j.otot.2012.01.002Operative Techniques in Otolaryngology - Head and Neck Surgery 23, 1 (2012)2012-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2012-03-01231S1043-1810(11)X0006-4310http://www.optecoto.com/article/PIIS1043181011000352/abstract?rss=yesDrug-induced sleep endoscopy (DISE) offers an unique evaluation of the upper airway. After pharmacologic induction of unconscious sedation, it is possible to evaluate endoscopically the structures contributing to upper airway obstruction in sleep disordered breathing. The authors describe DISE techniques and the VOTE classification system for reporting of DISE findings. The VOTE classification focuses on the primary structures that contribute to upper airway obstruction and represents a common language to describe the patterns of obstruction during DISE. The latter can facilitate the scientific evaluation of DISE, including its role in directing treatment.Drug-induced sleep endoscopy in adults with sleep-disordered breathing: Technique and the VOTE Classification systemW. Hohenhorst, M.J.L. Ravesloot, E.J. Kezirian, N. de Vries10.1016/j.otot.2011.06.001Operative Techniques in Otolaryngology - Head and Neck Surgery 23, 1 (2012)2012-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2012-03-01231S1043-1810(11)X0006-41118http://www.optecoto.com/article/PIIS104318101100039X/abstract?rss=yes It has become more apparent in recent years that increasing numbers of children continue to have obstructive sleep apnea despite previous removal of the tonsils and adenoids. This occurs not only in children in “at-risk” populations, such as those with Down syndrome and obesity, but also in otherwise “normal” children. Sleep cine magnetic resonance imaging (MRI) provides a high-resolution examination of the airway during sleep without ionizing radiation exposure and allows for identification of site or sites of residual airway obstruction. This technique is particularly helpful since the diagnostic examination performed in awake adults for sleep apnea is not often possible in the pediatric population. The technique of sleep cine MRI and examples of its use are presented. Sample patient scenarios are used to illustrate how it can assist with treatment planning. Anesthesia use during the cine MRI is discussed. Sleep cine magnetic resonance imaging—A dynamic evaluation of the airwaySally R. Shott10.1016/j.otot.2011.06.005Operative Techniques in Otolaryngology - Head and Neck Surgery 23, 1 (2012)2012-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2012-03-01231S1043-1810(11)X0006-41924http://www.optecoto.com/article/PIIS1043181011000364/abstract?rss=yes The mechanism of obstructive sleep apnea (OSA) is usually multifactorial and the obstruction in the upper airway is very likely to be multilevel. Relocation pharyngoplasty (RP) is an innovative and multilevel surgical technique to remodel the narrow pharynx by advancing the soft palate and splinting the lateral pharyngeal wall in an attempt to both enlarge pharyngeal airway lumen and lessen pharyngeal collapse. We present the reader with some detailed illustrations of our surgical technique that can be used in selected OSA patients. Relocation pharyngoplastyHsueh-Yu Li, Li-Ang Lee10.1016/j.otot.2011.06.002Operative Techniques in Otolaryngology - Head and Neck Surgery 23, 1 (2012)2012-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2012-03-01231S1043-1810(11)X0006-42529http://www.optecoto.com/article/PIIS1043181011000388/abstract?rss=yes Surgical correction of palatal obstruction is frequently needed as part of the multilevel treatment of moderate and severe obstructive sleep apnea/hypopnea syndrome. The classic uvulopalatopharyngoplasty technique described by Fujita has limited success rates. Uvulopalatopharyngoplasty has been modified in the form of Z-palatoplasty. Although this technique was first described for patients without tonsils, it has been further modified to include tonsillectomy along with pharyngoplasty. We describe the author's technique and experience with this new modification. Modification of Z-palatoplasty technique and review of five-year experienceMichael Friedman, Meghan Wilson, Kanwar Kelley10.1016/j.otot.2011.06.004Operative Techniques in Otolaryngology - Head and Neck Surgery 23, 1 (2012)2012-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2012-03-01231S1043-1810(11)X0006-43035http://www.optecoto.com/article/PIIS1043181011000972/abstract?rss=yes Obstructive Sleep Apnea (OSA) is a chronic illness with the risks of secondary cardio-vascular and neuro-cognitive morbidities. Continuous Positive Airways Pressure (CPAP) is the accepted first line treatment for OSA. Patients who fail treatment with CPAP and other conservative measures, should be considered for surgery after discussion in a multi-disciplinary clinic for sleep disordered breathing. A structured approach to Surgery for OSA has been clearly defined and accepted by the American Academy of Sleep Medicine (1). The aim of surgery is to address the collapsibility of structures of the upper airway. The tongue base can contribute to OSA. The following techniques which aim to reduce the volume of the tongue base are described: 1) External Submucosal Glossectomy 2) Percutaneous Submucosal Glossectomy 3) Intraoral Submucosal Endoscopic Assisted Linguaplasty (SMILE) 4) Intraoral Submucosal Midline Glossectomy 5) Intraoral Submucosal Linguaplasty Conventional tongue base volumetric reduction for obstructive sleep apneaSamuel Robinson, Suren Krishnan, John-Charles Hodge, Andrew Foreman10.1016/j.otot.2011.10.002Operative Techniques in Otolaryngology - Head and Neck Surgery 23, 1 (2012)2012-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2012-03-01231S1043-1810(11)X0006-43644http://www.optecoto.com/article/PIIS1043181011000443/abstract?rss=yes A transoral robotic version of Chabolle's tongue base reduction with hyoid epiglottoplasty for obstructive sleep apnea syndrome is described. The main tongue base and supraglottic surgical steps are pointed out, as well as the indications and potential complications. The advantages and limits of this minimally invasive approach are discussed. Transoral robotic surgery: Tongue base reduction and supraglottoplasty for obstructive sleep apneaClaudio Vicini, Filippo Montevecchi, Giulia Tenti, Pietro Canzi, Iacopo Dallan, Tod C. Huntley10.1016/j.otot.2011.07.003Operative Techniques in Otolaryngology - Head and Neck Surgery 23, 1 (2012)2012-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2012-03-01231S1043-1810(11)X0006-44547http://www.optecoto.com/article/PIIS1043181011001357/abstract?rss=yes A structured approach to Surgery for OSA has been clearly defined and accepted by the American Academy of Sleep Medicine. The aim of surgery is to address the collapsibility of structures of the upper airway. The da Vinci Robot (Intuitive Surgical, Sunnyvale, California, USA) has been validated and now approved by the Food and Drug Administration as an adjunct to transoral surgery. Trans Oral Robotic Surgery (TORS) has been proved to be useful in resection of oropharyngeal malignancy and some benign tumours of the parapharyngeal space. This is due to the excellent visual and instrument access, as well as the loss of tremor. The application of TORS for a variety of surgical procedures for sleep apnea is described. Robot-assisted, volumetric tongue base reduction and pharyngeal surgery for obstructive sleep apneaSamuel Robinson, Suren Krishnan, John-Charles Hodge, Andrew Foreman10.1016/j.otot.2011.10.004Operative Techniques in Otolaryngology - Head and Neck Surgery 23, 1 (2012)2012-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2012-03-01231S1043-1810(11)X0006-44855http://www.optecoto.com/article/PIIS1043181011000431/abstract?rss=yes Hyoid advancement to the mandible was first described in 1984, but was later abandoned by most surgeons for the easier to perform advancement to the laryngeal cartilage. New modifications of the hyo-mandibular advancement technique has made this approach easier to perform and are described in this paper. The hyo-mandibular advancement technique has a higher success rate for the treatment of sleep apnea, especially in women. Hyoid advancement to the mandible (hyo-mandibular advancement)Samuel A. Mickelson10.1016/j.otot.2011.07.002Operative Techniques in Otolaryngology - Head and Neck Surgery 23, 1 (2012)2012-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2012-03-01231S1043-1810(11)X0006-45659http://www.optecoto.com/article/PIIS1043181011001497/abstract?rss=yes Maxillomandibular advancement enlarges the entire pharynx by pulling anteriorly the bony squelettal structures. It is performed in sleep apnea patients who refuse or fail to use continuous positive airway pressure. It is constantly associated to esthetic modifications but not necessarily disgraceful. Perioperative breathing complications can occur which implies a good cooperation between the surgeon and the anesthesiologists in the operating room and in the following hours in the ICU. Hypoesthesia of the lower lip and chin is the most frequent long term complication. Nevertheless, bimaxillary advancement is one of the most effective treatments for OSAS even on a long term basis. Maxillomandibular advancement for obstructive sleep apnea syndromeMarc B. Blumen, Jean Philippe Vezina, Jean Luc Pigot, Frédéric Chabolle10.1016/j.otot.2011.11.011Operative Techniques in Otolaryngology - Head and Neck Surgery 23, 1 (2012)2012-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2012-03-01231S1043-1810(11)X0006-46066http://www.optecoto.com/article/PIIS1043181011000959/abstract?rss=yes Nasal valve collapse is a challenging, but common, source of nasal obstruction. Many surgical techniques have been described to stabilize the nasal valve, but each has important limitations. Nasal valve stabilization is a new technique that draws on advantages of the nasal valve suspension techniques but minimizes the drawbacks associated with the suspension techniques. The indications, technique, advantages, and disadvantages are described herein. Nasal valve stabilizationEdward M. Weaver10.1016/j.otot.2011.09.008Operative Techniques in Otolaryngology - Head and Neck Surgery 23, 1 (2012)2012-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2012-03-01231S1043-1810(11)X0006-46771http://www.optecoto.com/article/PIIS1043181011000418/abstract?rss=yes Oral appliances that advance the mandible in relationship to the maxilla offer a relatively simple and viable option in the treatment of sleep-related breathing disorders. Oral appliances are indicated for the treatment of snoring and mild to moderate sleep apnea or for those who prefer this type of therapy to positive airway pressure therapies. This article will describe the different appliance types, the proposed mechanisms of action, fabrication, and management of adverse events that may occasionally occur with oral appliance therapy. Oral appliance therapy for sleep-related breathing disordersSteven D. Bender10.1016/j.otot.2011.06.007Operative Techniques in Otolaryngology - Head and Neck Surgery 23, 1 (2012)2012-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2012-03-01231S1043-1810(11)X0006-47278http://www.optecoto.com/article/PIIS1043181011000923/abstract?rss=yes Sleep-disordered breathing encompasses a spectrum of disorders that increase in severity from snoring to obstructive sleep apnea (OSA). OSA is a clinical disorder that requires a polysomnogram (PSG) to make the diagnosis. The PSG is the gold standard to confirm OSA. Alternative diagnostic tests are presented to supplement the clinical evaluation with objective information when evaluating the snoring child. Diagnostic tests to identify the anatomical site of obstruction are also discussed. Novel methods to diagnose obstructive sleep apnea in childrenNorman R. Friedman10.1016/j.otot.2011.09.005Operative Techniques in Otolaryngology - Head and Neck Surgery 23, 1 (2012)2012-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2012-03-01231S1043-1810(11)X0006-47983