Casale-Falcone, M. (Manuele)
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- Could the use of a new novel bipolar radiofrequency device (Aerin) improve nasal valve collapse? A systematic review and meta-analysis(2023) Lugo, R. (Rodolfo); Pierri, M. (Michelangelo); Jacobowitz, O. (Ofer); Mofa, A. (Antonio); NO USAR Baptista-Jardin, P. (Peter); Giorgi, L. (Lucrezia); Casale-Falcone, M. (Manuele)BackgroundSurgical treatment for nasal obstruction caused by nasal valve collapse requires a significant recovery period and risks of complications, while nasal dilators are uncomfortable. Recently, radiofrequency treatment of lateral walls has been used under local anesthesia as an office base surgery. This work aims to assess the efficacy of a new radiofrequency device, the Vivaer (TM) System (Aerin Medical, Sunnyvale, CA), to treat nasal obstruction through a systematic review and meta-analysis.MethodsTwo researchers independently reviewed the literature up to December 2021. Studies on patients seeking treatment for nasal obstruction due to nasal valve collapse were included in the analysis.ResultsFour studies (218 patients) met the inclusion criteria and treated the nasal valve regions bilaterally with the Aerin Medical Vivaer (TM) System. After the treatment, the NOSE score was reduced at three months postoperatively. Minor adverse events were reported in the included studies, and two showed no complications. None of the studies reported changes in the external appearance of the nose.ConclusionThe radiofrequency treatment using the Vivaer device can be useful for treating nasal valve collapse, improving significantly subjective breathing symptom scores. Further studies on a large scale are needed to confirm these results.
- Surgical anatomy of the lingual nerve for palate surgery: where is located and how to avoid it(Springer, 2022) Fernández-González, S. (Secundino); Garaycochea, O. (Octavio); Moffa, A. (Antonio); O’Connor-Reina, C. (Carlos); Calvo-Imirizaldu, M. (Marta); Alcalde, J. (Juan); Terrasa, D. (David); Baptista, P.M. (Peter M.); Casale-Falcone, M. (Manuele); Plaza-Mayor, G. (Guillermo)Purpose To describe the anatomic relationship of the lingual nerve with the lateral oropharyngeal structures. Methods An anatomic dissection of the lateral oropharyngeal wall was conducted in eight sides from four fresh-frozen cadaveric heads. Small titanium clips were placed along the lingual nerve and the most anterior and medial border of the medial pterygoid muscle. Radiological reconstructions were employed for optimal visualization; the coronal view was preferred to resemble the surgical position. The distance between the lingual nerve and the medial pterygoid muscle at its upper and lower portion was measured radiologically. The trajectory angle of the lingual nerve with respect to the pterygomandibular raphe was obtained from the intersection between the vector generated between the clips connecting the upper and lower portion of the medial pterygoid muscle with the vector generated from the lingual nerve clips. Results The mean distance from the upper portion of the medial pterygoid muscle and superior lingual nerve clips was 10.16±2.18 mm (mean±standard deviation), and the lower area of the medial pterygoid muscle to the lingual nerve was separated 5.05±1.49 mm. The trajectory angle of the lingual nerve concerning to the vector that describes the upper portion of the most anterior and medial border of the medial pterygoid muscle with its lower part was 43.73º±11.29. Conclusions The lingual nerve runs lateral to the lateral oropharyngeal wall, from superiorly–inferiorly and laterally–medially, and it is closer to it at its lower third.
- Obstructive sleep apnea syndrome: from phenotype to genetic basis(Bentham Science Publishers, 2009) Rinaldi, V. (V.); Baptista, P.M. (Peter M.); Casale-Falcone, M. (Manuele); Salvinelli, F. (F.); Bressi, F. (F.); Pappacena, M. (M.)Obstructive sleep apnea syndrome (OSAS) is a complex chronic clinical syndrome, characterized by snoring, periodic apnea, hypoxemia during sleep, and daytime hypersomnolence. It affects 4-5% of the general population. Racial studies and chromosomal mapping, familial studies and twin studies have provided evidence for the possible link between the OSAS and genetic factors and also most of the risk factors involved in the pathogenesis of OSAS are largely genetically determined. A percentage of 35-40% of its variance can be attributed to genetic factors. It is likely that genetic factors associated with craniofacial structure, body fat distribution and neural control of the upper airway muscles interact to produce the OSAS phenotype. Although the role of specific genes that influence the development of OSAS has not yet been identified, current researches, especially in animal model, suggest that several genetic systems may be important. In this chapter, we will first define the OSAS phenotype, the pathogenesis and the risk factors involved in the OSAS that may be inherited, then, we will review the current progress in the genetics of OSAS and suggest a few future perspectives in the development of therapeutic agents for this complex disease entity.
- Defining epiglottic collapses patterns in obstructive sleep apnea patients: Francia-Lugo classification(2023) Lugo, R. (Rodolfo); Di-Giovanni, S. (Simone); Iafrati, F. (Francesco); Moffa, A. (Antonio); Francia, C. (Carlos); NO USAR Baptista-Jardin, P. (Peter); Giorgi, L. (Lucrezia); Casale-Falcone, M. (Manuele)Obstructive Sleep Apnea (OSA) is characterized by repetitive collapse of the upper airway during sleep. Drug-Induced Sleep endoscopy (DISE) is used to identify the collapse site. Among the possible sites of collapse, the epiglottis occurs more frequently than previously described. In this study, we reviewed DISE findings and classified different epiglottic collapse patterns. We found 104 patients (16.4%) with epiglottis collapse (primary 12.5% and secondary 3.9%). We described the following patterns of epiglottis collapse: Anterior-Posterior (AP) collapse with rigid component trapdoor type (48%); AP collapse with lax component floppy type (13.5%); Lateral- Lateral (LL) collapse with omega shape component book type (14.5%); and secondary due to lateral pharyngeal wall or tongue base collapse (24%). The identification of the epiglottic collapse pattern is crucial in decision-making when attempting to ameliorate OSA. These findings in OSA phenotyping could influence the type of treatment chosen.
- Topical ectoine: a promising molecule in the upper airways inflammation—a systematic review(Hindawi Limited, 2019) Lopez, M.A. (Michele Antonio); Rinaldi, V. (V.); Moffa, A. (Antonio); Fraccaroli, F. (Francesca); Costantino, A. (Andrea); Cassano, M. (Michele); Sabatino, L. (Lorenzo); Baptista, P.M. (Peter M.); Casale-Falcone, M. (Manuele); Carbone, S. (Samanta)To date, topical therapies guarantee a better delivery of high concentrations of pharmacologic agents to the mucosa of the upper airways (UA). Recently, topical administration of ectoine has just been recognized as adjuvant treatment in the Allergic Rhinitis (AR) and Rhinosinusitis (ARS). The aim of this work is to review the published literature regarding all the potential therapeutic effects of ectoine in the acute and chronic inflammatory diseases of UA. Pertinent studies published without temporal limitation were selected searching on MEDLINE the following terms: “ectoine” and “nasal spray,” “oral spray,” “upper respiratory tract infections,” “rhinosinusitis,” “rhinitis,” “rhinoconjunctivitis,” “pharyngitis,” and “laryngitis.” At the end of our selection process, six relevant publications were included: two studies about the effect of ectoine on AR, one study about ARS, one study about rhinitis sicca anterior, and two studies about acute pharyngitis and/or laryngitis. Due to its moisturizing and anti-inflammatory properties, topical administration of ectoine could play a potential additional role in treatment of acute and chronic inflammatory diseases of UA, in particular in the management of sinonasal conditions improving symptoms and endoscopic findings. However, these results should be viewed cautiously as they are based on a limited number of studies; some of them were probably underpowered because of their small patient samples.
- Nasal delivery devices: A comparative study on cadaver model(Hindawi Limited, 2019) Campisi, P. (Paolo); Rinaldi, V. (V.); Moffa, A. (Antonio); Costantino, A. (Andrea); Cassano, M. (Michele); Sabatino, L. (Lorenzo); Baptista, P.M. (Peter M.); Casale-Falcone, M. (Manuele); Consiglia-Trecca, E.M. (Eleonora Maria)Nasal nebulization is a more effective method of delivering topical medication than nasal spray. The purpose of this study was to assess the deposition patterns of nebulization in delivering topical agents to the nasal cavities in the human cadaveric model using a color-based method. We have compared these following nasal devices: single-dose vial irrigation, syringe-irrigation, common nasal spray, Spray-sol, MAD nasal, and Rinowash nasal douche. Endoscopic images were recorded at six anatomical regions prior to and following each nasal device application and four reviewers evaluated the amount of surface area staining. At the nasal vestibule, the blue dye distribution achieved with Spray-sol was more extensive than nasal sprays. At inferior turbinate and nasal cavity floor, single dose vial, syringe, MAD nasal, Spray-sol, and Rinowash demonstrated a greater extent of dye distribution than nasal spray. At the middle turbinate, the average score of both Spray-sol and MAD nasal was significantly higher than other nasal investigated devices. At the nasopharynx, Spray-sol nebulization covers a surface significantly greater than other devices. Compared to traditional sprays, Spray-sol and MAD nasal provided a more effective method of delivering topical agents to the deeper and higher portions of the nasal cavities.
- Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea: patient selection and new perspectives(Dove press, 2020) Rinaldi, V. (V.); Moffa, A. (Antonio); Costantino, A. (Andrea); Baptista, P.M. (Peter M.); Casale-Falcone, M. (Manuele)Hypoglossal nerve stimulation (HNS) is an increasingly widespread OSA treatment. It is a non-anatomical modifying surgery able to achieve an adequate objective and subjective result with a reasonable complication rate. HNS exploits the neurostimulation to reduce upper airway collapsibility providing a multilevel upper airway improvement within a single procedure. Proper patient selection has a fundamental role in determining an adequate long-term clinical outcome. All patient candidates for HNS undergo a standard comprehensive sleep medicine assessment and upper airway surgical examination. Several features should be assessed preoperatively in order to predict patients' response to HNS treatment. In particular, the assessment of OSA severity, BMI > 32 Kg/m2 , collapse pattern during drug-induced sleep endoscopy (DISE), and many other parameters, is central for a good patient selection and customization of OSA treatment. HNS is indeed one of the most promising tools in the widespread context of personalized sleep medicine. HNS is an adjustable medical device that could be titrated in order to improve HNS effectiveness, maintaining patient comfort. Moreover, HNS provides the opportunity for patients to play an active role in their own care, with a potential improvement in therapy adherence and efficacy. This review summarizes the current evidence in patient selection for HNS, highlighting the reasons behind the optimistic future of this OSA treatment in the context of personalized medicine.
- Sialoendoscopia: una nueva alternativa en el tratamiento de la patología salival. Nuestra experiencia(Elsevier, 2008) Rey-Martinez, J.A. (Jorge Alberto); Gimeno-Vilar, C. (Carlos); Baptista, P.M. (Peter M.); Casale-Falcone, M. (Manuele)Objectives: Sialoendoscopy is a procedure used to visualize the salivary ducts and their pathology. It can be used either as a diagnostic method to rule out inflammatory processes in the parotid and submandibular glands (diagnostic sialoendoscopy) or to treat pathological areas (stenosis, extract foreign bodies or sialolithiasis) through the use of appropriate instruments (interventionist sialoendoscopy). We attempt to prove a declining rate of salivary gland excision. Patients and method: Sialoendoscopy was performed in 8 patients. Results: Of these, 50 % of patients were diagnosed as having sialolithiasis and the other 50 % had chronic sialoadenitis. In patients with sialolithiasis, sialoendoscopy allowed the extraction of the calculus in two patients (50 %). In the remainder, sialoendoscopy provided confirmation of the diagnosis in all cases. Conclusions: Sialoendoscopy is a new technique for use in the diagnosis, treatment and post-operative management of sialolithiasis, sialoadenitis and other salivary gland pathologies.
- Barbed pharyngoplasty for snoring: does it meet the expectations? a systematic review(2023) Lugo, R. (Rodolfo); Carnuccio, L. (Luca); Moffa, A. (Antonio); Cassano, M. (Michele); Giorgi, L. (Lucrezia); Baptista, P.M. (Peter M.); Casale-Falcone, M. (Manuele)To date, the use of barbed sutures for the surgical management of patients suffering from obstructive sleep apnea and snoring with retropalatal collapse and vibration has significantly increased. A systematic review was carried out, which included clinical studies that used barbed sutures for the treatment of snoring. A qualitative analysis, including six clinical studies, was conducted. Of these, five were studies on barbed pharyngoplasties, and one study involved a minimally invasive surgical procedure. The population consisted of 176 patients, aged 26 to 58 years old. Overall, the included studies showed a mean gain in the snoring Visual Analog Scale of 5.67 +/- 1.88, with a mean preoperative value of 8.35 +/- 1.17 and a postoperative value of 2.68 +/- 1.27. No major complications were described. Given the lack and heterogeneity of this evidence, the conclusion calls for being cautious. In carefully selected snorers and obstructive sleep apnea patients, the use of barbed sutures could represent a valid therapeutic strategy for snoring, ensuring a statistically significant improvement in the subjective parameters. Further studies on a larger scale that assess the role of barbed pharyngoplasties in snoring surgery and more extended follow-up studies are needed in order to confirm these promising results.
- High-definition 3D exoscope-assisted barbed pharyngoplasty for OSAS and snoring: better than live(2023) Pierri, M. (Michelangelo); Moffa, A. (Antonio); Giorgi, L. (Lucrezia); Baptista, P.M. (Peter M.); Casale-Falcone, M. (Manuele)Recently, a high-definition 3D exoscope (VITOM), a new magnification system that provides a 3D image of the surgical field, has been introduced. This study aims to describe the first use of VITOM 3D technology in Barbed Pharyngoplasty (BP) for Obstructive Sleep Apnea (OSA). VITOM 3D technology is used to support visualization during BP in a male patient affected by severe OSA with a circular palatal collapse pattern at drug-induced sleep endoscopy. During the surgical procedure, this approach markedly improves the visualization of the surgical field through anatomic details of the oral cavity, facilitating surgical dissection and enhancing the teaching environment. It allows for a better involvement and more interactions during the surgery, as scrubbed and assistant nurses can see the surgical field and anticipate the surgeon's choice of instrument. VITOM 3D technology, by combining a telescope with a standard endoscope, has been successfully used in various surgical disciplines and could be very useful, especially in teaching hospitals. VITOM 3D can guarantee a real immersive surgical experience for all participants in the operating room. Economic and efficacy studies would be conducted to support the use of a VITOM-3D exoscope in common clinical practice.