How to: Barbed Stayed Bridge Pharyngoplasty (BSBP)

by Giuseppe Magliulo, Giannicola Iannella, PhD, Manuele Casale, Claudio Vicini, MD, and Annalisa Pace, PhD •

any transection.

5. The needle passes longitudinally across the entire PPM as far as its inferior margin. The PGM is not involved.

6. The barbed suture is rolled up the PPM in the inferior part and turned back to the raphe.

7. The same operation is repeated in the middle and superior portions of the PPM and PMR.

8. It reaches the inferior point of the PMR and is rolled up the PPM. The operation is repeated in the middle and superior parts.

9. The needle passes backward lateral to the raphe, applying the right amount of tension to the suture to reposition the PPM more laterally and anteriorly and to splint and tighten the lateral wall.

A senior surgeon performed all procedures (G.M.).

Statistical Analysis

Descriptive statistics were used to summarize the characteristics of the study sample; numerical data were reported as mean with standard deviation.

A comparison between them was performed using Student’s t-test. Statistical significance was set at 0.05. All the analyses were conducted using statistical software R (version 4.0.4).

RESULTS

Ten male patients were enrolled (age = 43.8, ±9.8 years; BMI = 27.2 ± 3.05). Using the Friedman staging system, the authors recorded two pts at stage I, seven pts at stage II, and one pt at stage III. Using the lingual tonsil hypertrophy grading system, the authors recorded four pts at grade 0 and six pts at grade I.

The preoperative mean of ESS was 5.1 ± 3.5; at three months postoperative, it was 3.5 ± 2.6; at six months postoperative, it was 3.1 ± 2.6; and at 12 months postoperative, it was 2.4 ± 1.9. No statistical difference was found.

All preoperative and postoperative polysomnographic data and DISE are in Table I (Laryngoscope. https://doi.org/10.1002/lary.31425).

The comparison between AHI values preoperatively (preop) and postoperatively (three, six, and 12 months) always showed a statistical difference (p < 0.05) using the Student’s t-test. The same was true for the oxygen desaturation index (ODI) comparison, with a p < 0.05, while time under 90% oxygen saturation (t90%) was not statistically significant (p > 0.05)

Sher’s cutoff was successful in all patients (Table I), with an AHI reduction of more than 50% at 12 months; 60% of pts had an AHI < 10 and 40% had an AHI < 5.

The swelling of the palate and uvula was moderate in the postoperative period. The therapy included antibiotics and corticosteroids (prednisolone 40 mg/day/three days; at-home deflazacort 30 mg/day/seven days). Painful symptoms were mild and manageable, with paracetamol 1 g as needed.

No hemorrhagic complications were reported. In three cases, the suture was partially extruded at the palatal level without affecting the procedure’s success. The extrusion was located on the superior pole of the anterior tonsillar pillar, in the first two months. Patients complained of a foreign body sensation and slight swallowing difficulty. The thread was always cut without any long-term effects on the stability of the palate.