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Background Nasopharyngeal stenosis (NPS) is a rare condition defined as the obstruction of the communication between the oropharynx and nasopharynx owing to scar contracture of the soft palate, tonsillar pillars, and posterior pharyngeal wall. NPS could be primary (attributed to a disease process such as rhinoscleroma) or secondary caused by prior surgery. In this study, we discuss the clinical manifestation of the acquired nasopharyngeal stenosis (NPS) and to investigate if there is a relation between the grade of the acquired NPS and the severity of obstructive sleep apnea (OSA) and patients’ symptoms. So, this cross-sectional study was conducted on patients who had post-surgical NPS of different grades. Then, the severity of snoring ± OSA and VAS of symptoms in those patients was assessed in different grades of the NPS, and the results were also statistically compared. Results Within the included 22 patients, there were no statistical differences between grade 1 and in grade 2 as regards age ( p = 0.0619) or sex ( p = 0.21137). The mean AHI was significantly more ( p = 0.004) in grade 2 NPS than grade 1 NPS. The VAS of difficult nasal breathing and dysphagia were significantly worse ( p < 0.0001) in grade 2 NPS than in grade 1, while the VAS of snoring did not differ significantly ( p = 0.3466) between grade 1 and grade 2 NPS. Conclusion Grade 2 NPS leads to significantly more severe AHI, dysphagia, and difficult nasal breathing than grade 1 NPS. But the difference in the grade of NPS did not cause differences in the snoring intensity.

Head and neck surgery for benign and malignant disease is undergoing a groundbreaking transformation. Robot-assisted surgery is quickly being recognized as a significant innovation, demonstrating the potential to change treatment paradigms for head and neck disease. State-of-the-art robotics enables surgeons to access complex anatomy using a more minimally invasive approach, with the potential to improve patient outcome and reduce surgical morbidity. Learn from international clinicians who have pioneered new paths in the application of robotic-assisted surgery. Throughout the 16 chapters of this book, the authors provide comprehensive discussion of robotic surgical procedures for diseases affecting the oropharynx, larynx, hypopharynx, parapharyngeal space, thyroid, neck, and skull base. Key Features: * Fundamental training and education-from ethical considerations and room set-up-to avoiding complications and clinical pearls * Ten videos on the treatment of squamous and spindle cell carcinomas * 150 superb illustrations enhance the didactic text Although further innovations and refinement of this technology will be forthcoming, the current state of robotic surgery encompassed in these pages lays a foundation for today and inspiration for tomorrow's advancements. The book is an invaluable resource for surgeons and residents interested in learning about and incorporating surgical robotics into otolaryngology practice, and will also benefit medical and radiation oncologists.

Tongue base hypertrophy is an obstructive condition in many if not most cases of obstructive sleep apnea–hypopnea syndrome (OSAHS). Base of tongue is difficult to manage surgically, and its surgery remains a great challenge for both surgeon and patient. The 3-D array of the tongue base associated with its complex relationships to surrounding structures and its critical physiological functions make tongue base surgery technically demanding and encumbered with complications that are not insignificant. In this chapter, we try to present different surgical techniques other than TORS for management of tongue base hypertrophy together with comparing the results with that of TORS. These techniques range from minimally invasive approaches through more technically demanding open approaches and finally recent advances in the area of tongue stimulation using implantable devices.

Current surgical management of obstructive sleep apnea (OSA) is most successfully achieved by multilevel surgery. This was confirmed after thorough understanding of the complexity of airway obstruction by drug-induced sleep endoscopy (DISE) that showed that the hypopharynx and base of tongue, not only the palate, are important anatomic components of obstruction in OSA. Vicini et al. have performed 160 cases of TORS for OSA between May 2008 and April 2014. In the beginning, all the palate surgeries were treated performing a classic UPPP. Since June 2010, the UPPP palate technique has in most cases been replaced by a modified expansion sphincter pharyngoplasty (ESP) and barbed reposition pharyngoplasty (BRP) later on. The authors were able to show the functional and objective superiority of ESP and BRP when compared to the traditional UPPP as a multilevel procedure. So, the associated palate procedure should not be under-evaluated as it may impact the final outcomes of TORS.