In a blog post from September 2012, I described modifications developed by Italian surgeons of the expansion sphincter pharyngoplasty procedure.  This technique of soft palate surgery for the treatment of obstructive sleep apnea was designed to reduce the risks and enhance the stability of the procedure.  I have received many e-mails and calls from other surgeons about these modifications and my experience with the new technique.  In short, the modifications of the expansion sphincter pharyngoplasty procedure have entirely prevented the major issue I had with the original technique: in every case, the palatopharyngeus sutures would fail to hold the rotated muscle in the new position.

The November 2013 issue of the journal The Laryngoscope included an article written by Giovanni Sorrenti and Ottavio Piccin, two surgeons from the University of Bologna.  The University of Bologna happens to be the oldest university in the world, and I am indebted to the University of Bologna because my father graduated from medical school there.  Drs. Sorrenti and Piccin are responsible for one of the modifications and have shared their innovation with the team in Forli that developed the other modification: Aldo Campanini and Claudio Vicini.  They have named their revised technique functional expansion pharyngoplasty, and the article presents a description of the technique, along with illustrations. I had the good fortune of spending some time with all of them last year, in their operating room and giving lectures at the same international conferences.  I was impressed with the modifications and encouraged Giovanni and Ottavio to share their technique in print; I am flattered that they acknowledged my support in the paper.

The modified expansion sphincter pharyngoplasty sleep apnea procedure, a true international effort

My blog post from last year indicated that I felt this modified technique was an unique international effort and the product of the dialogues that have become more common over the past decade.  Furthermore, it reflects the willingness of surgeons to disclose honestly poor outcomes or inability to match the experience that we read in the medical literature.  From the earliest days in my own training, I have had the utmost respect for some of the world’s top surgeons who would give lectures and share such experiences, whether complications or poor outcomes, and then share the changes in their own practice to enable others to benefit.  The only way I learned of these modifications was by telling my Italian colleagues that I was unable to perform the procedure properly because my stitches rotating the palatopharyngeus muscles were not holding, and I am so glad that I did.  I hope this publication helps others to overcome problems if they are occurring.

The International Surgical Sleep Society is in the midst of planning their next meeting in fall 2014.  As the field of sleep surgery develops with advances in the evaluation and treatment of patients, these opportunities to exchange ideas and develop international collaborations are even more important.