Long-term functional results of barbed reposition pharyngoplasty vs. hyoid suspension for obstructive sleep apnea hypopnea syndrome

The first specifically devised palate procedure for snoring and obstructive sleep apnea was described in the 1980s by Fujita. The key to the technique named uvulopalatopharyngoplasty (UPPP) was the planned trimming of a long drooping palate under general anesthesia. Though UPPP is really painful and somehow dangerous, it was for many years the workhorse for sleep surgeons all over the world, and until recent years it was identified as the “prototypal” sleep surgery procedure. In the 1990s, laser technology changed the palate sleep surgery. Laser-assisted uvulopalatoplasty (LAUP) by Kamamy and Krespy made palate surgery easier and possible under local anesthesia and in outpatient settings. In the late 1990s, a different technology based on radiofrequency volume reduction paired up with LAUP and was widely popularized as a painless and multistep outpatient option for snoring and OSA by Powell and Coll. More or less in the same period, the same Stanford Group described an original conservative technique for the same purposes. The uvulopalatal flap (UPF) did not require any special equipment, and it was theoretically reversible. Last but not least, among the innovative technologies proposed for snoring palate management, the so-called Pillar Procedure was devised, based on the inser- tion of a polyester implant into the soft palate. The magic decade between 2000 and 2010 produced a large group of innovative techniques based on different and original solutions. Lateral palatoplasty technique by the pioneer Cahali moved the atten- tion to the stabilization of the lateral pharyngeal wall. The Tucker Woodson and Pang technique optimized the same concept reverting the action of Orticochea sphincter pharyngoplasty for velopharyngeal insufficiency. The Friedmann Z-palatoplasty technique applied the general concept of any Z-plasty to the special problem of a narrow palatopharyngeal area. Finally, Dr. Li from Taiwan devised an elegant technique for relocation of the palatopharyngeal muscle in order to increase pharyngeal stability. The decade between 2010 and 2020 is featured by the introduction into the palate surgery of a special knotless technology of suture: the barbed suture. Dr. Mantovani, a brilliant ENT and plastic surgeon, developed the idea to transfer the experience of barbed wire face-lift with the reabsorbable barbed sutures into the “palate lift” for snoring and OSA. This basic idea spread inside the Milan area and branched into many different techniques which were devised, applied, and described at the Policlinico under the guidance of Prof. Lorenzo Pignataro and at the Humanitas San Pio X Hospital—Milan by Fabrizio Salamanca, an enthusiastic leader of a group of young sleep surgeons. The seed of the new idea was accepted almost at the same time by a second group of sleep surgeons in Forlì, where a new palate technique of Barbed Reposition Pharyngoplasty was developed by Prof. Vicini, introduced into practice, and carefully studied, as well as exported into many countries around the world. The first aim of the present monograph may be considered our grateful tribute to Mario Mantovani for his clever ideas and for his never-ending effort to share this basic concept. The second aim of our job is an attempt to organize in a comprehensive way the many published papers and moreover the great number of unpublished data about barbed palate surgery for sleep disordered breathing, as we routinely perform it in our institutions.