Long-term swallowing performance following transoral robotic surgery for obstructive sleep apnea

OBJECTIVES/HYPOTHESIS This study aimed to evaluate the long-term swallowing performance following transoral robotic surgery (TORS) to the base of tongue (BOT) in the treatment of obstructive sleep apnea (OSA). STUDY DESIGN Retrospective and prospective cohort study. METHODS Data analysis of 39 patients who underwent BOT reduction via TORS to treat OSA at our center from September 2013 to April 2016. Long-term swallowing functions were assessed using subjective self-evaluated swallowing disturbances questionnaire (SDQ) and objective fiberoptic endoscopic evaluation of swallowing (FEES). RESULTS Seven patients underwent TORS BOT reduction alone, whereas 32 had also uvulopalatoplasty ± tonsillectomy, with a surgical success rate of 71.4%. Mean time for swallowing evaluation was 27.4 ± 9.43 months. Twenty-five patients completed the SDQ with an average score of 9.26 ± 10.05. In 32%, the SDQ was positive for dysphagia. In 10 out of 14 patients who underwent FEES, swallowing problems were noticed. The most common pathological findings were food residue in the vallecula followed by early spillage of food into the hypopharynx, penetration of solid food and liquid on the vocal folds surface, and aspiration. CONCLUSIONS BOT reduction via TORS has a negative effect on long-term swallowing function. A self-assessment questionnaire can help detect patients who suffer from swallowing impairment. Postoperative objective swallowing tests are essential not only in the immediate postoperative period but also during late routine follow-up. Proper patient selection and detailed information about surgery and possible late-swallowing effect are important factors before scheduling BOT reduction via TORS for OSA treatment. LEVEL OF EVIDENCE 4 Laryngoscope, 129:422-428, 2019.