24 November 2022 : Case report
A Rare Presentation of Recalcitrant Oropharyngeal Stenosis in a 54-Year-Old Male Patient Following Transoral Robotic Surgery for Obstructive Sleep Apnea
Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Educational Purpose (only if useful for a systematic review or synthesis)Pietro Canzi 12ABCDEF*, Eugenia Maiorano1BCDEF, Fabio Sovardi 1CDEF, Matteo Nardo 12BF, Antonio Occhini1CDF, Marco Benazzo12ABCDEF
Am J Case Rep 2022; 23:e937123
BACKGROUND: Transoral robotic surgery (TORS) is an effective and safe option for obstructive sleep apnea syndrome (OSAS) patients with isolated retrolingual obstruction, as well as part of multilevel surgical approach in case of multilevel obstruction. Stenosis after TORS in OSAS patients is rarely described and no literature review has investigated this dramatic untoward event.
CASE REPORT: We report on a case of severe recalcitrant oropharyngeal stenosis after multilevel surgery with transoral robotic tongue base resection in an OSAS patient, leading to tracheotomy and gastrostomy dependence. Following the failure of numerous conservative therapeutic attempts, oropharyngeal patency was restored after extensive scar tissue removal through an open-neck approach, followed by a pharyngeal reconstruction with radial forearm free flap (RFFF).
CONCLUSIONS: Recalcitrant oropharyngeal stenosis is a dramatic complication that must be considered in OSAS patients submitted to TORS in a multilevel strategy and that is rarely described in the literature. A thorough review of the existing literature is presented to assess which factors are involved and the therapeutic strategies invoked in this scenario. The adoption of resection tools suited for robot-assisted surgery and the staging of TORS in case of multilevel surgery could decrease the risk of extensive scar formation. To date there is still no broad consensus on which therapeutic choice is the best for recalcitrant oropharyngeal stenosis. When minimally invasive treatments fail, a wide scar resection with a RFFF oropharyngeal reconstruction could be considered as a valuable option to restore the upper aerodigestive tract patency.
Keywords: Oropharynx, Robotic Surgical Procedures, Sleep apnea, obstructive, Surgical Flaps
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