IMPORTANCE:This study provides insight into the response and cure rates of oral appliances (OAs) in patients with primary retropalatal, retroglossal, or retroepiglottic obstruction, as well as the effect of minimal cross-sectional area on the overall decrease in the apnea-hypopnea index (AHI) across all anatomical locations of collapse.OBJECTIVE:To examine the role of regional upper airway obstruction measured with acoustic pharyngometry as a determinant of OA success.DESIGN, SETTING, AND PARTICIPANTS:This retrospective case-series included patients with obstructive sleep apnea-hypopnea syndrome at a tertiary care center.INTERVENTIONS:Patients were fitted with a custom OA between July 1, 2011, and January 1, 2012.MAIN OUTCOMES AND MEASURES:Regions of maximal upper airway collapse were determined on acoustic pharyngometry: retropalatal, retroglossal, or retroepiglottic. Apnea-hypopnea index improvement at titration polysomnography was assessed against regional collapse.RESULTS:Seventy-five patients (56 [75%] men; mean [SD] age, 49.0 [13.6] years; mean body mass index [calculated as weight in kilograms divided by height in meters squared], 29.4 [5.2]; and mean AHI, 30.6 [20.0]) were assessed, and data were grouped on the basis of region of maximal collapse at pharyngometry (retropalatal in 29 patients, retroglossal in 28, and retroepiglottic in 18). The overall reduction in AHI at OA titration showed no significant difference between groups. There was no significant difference in the response rate to treatment, defined as more than 50% AHI reduction plus an AHI of less than 20 (response rate, 69% for retropalatal, 75% for retroglossal, and 83% for retroepiglottic collapse; P = .55) or the cure rate, defined as an AHI of less than 5 (cure rate, 52% for retropalatal, 43% for retroglossal, and 72% for retroepiglottic collapse; P = .15). The correlation between minimal cross-sectional area and response trended toward significance (r = 0.20; range -0.03 to 0.41; P < .10).CONCLUSIONS AND RELEVANCE:Oral appliance therapy achieves reasonable response and cure rates in patients with primary retropalatal, retroglossal, or retroepiglottic obstruction at the time of initial titration polysomnography. However, success is not predicted by identification of the region of maximal upper airway collapse measured with acoustic pharyngometry.

BACKGROUND:Hyperglycemia is associated with poor postoperative outcomes after carotid endarterectomy. This retrospective study examined the effect of lactated Ringer's and normal saline solutions on intraoperative blood glucose control in diabetic patients undergoing carotid endarterectomy.METHODS:The anesthetic and surgical records of type 2 diabetic patients who underwent carotid endarterectomy and received either lactated Ringer's solution or normal saline exclusively during the case were reviewed, and 20 patients were randomly selected from each group for further analysis. The outcome of interest was preoperative to postoperative change in blood glucose.RESULTS:The preoperative to postoperative mean changes in glucose for the normal saline and lactated Ringer's groups were 34.4 ± 70.32 mg/dL and 64.5 ± 61.38 mg/dL, respectively. This slight difference in the mean change in glucose between the 2 groups was not statistically significant (P=0.157).CONCLUSION:Lactated Ringer's solution does not appear to cause a significant change in the mean blood glucose levels in diabetic patients undergoing carotid endarterectomy compared to patients receiving normal saline. Randomized controlled trials are needed to further determine whether lactated Ringer's solution adversely affects glucose control in diabetic surgical patients.

The performance of bilateral supraclavicular brachial plexus nerve blocks is controversial. We present the challenging case of a 29-year-old male who suffered bilateral high-voltage electrocution injuries to the upper extremities, resulting in severe tissue damage, sensory and motor deficits, and wounds in both axillae. This injury necessitated bilateral below-elbow amputations. His postoperative course was complicated by pain refractory to intravenous narcotics. The decision was made to attempt bilateral supraclavicular brachial plexus blocks. Our concerns with this approach included the risks of pneumothorax and respiratory failure due to phrenic nerve block. Initial attempts at brachial plexus blockade using nerve stimulation were unsuccessful; therefore, ultrasound guidance was employed. With vigilant monitoring in an intensive care unit setting, we were able to safely perform bilateral continuous supraclavicular brachial plexus nerve blocks with an excellent analgesic response and no noted complications.

IMPORTANCEEfficient diagnosis and early treatment of obstructive sleep apnea may help prevent the development of related morbidity and mortality. Compared with polysomnography (PSG), ambulatory sleep study devices offer the possibility of an accurate diagnosis with convenience and low cost.OBJECTIVETo assess the correlation between sleep indexes measured by a portable sleep-testing device (peripheral arterial tonometry [PAT]) and those measured by PSG.DATA SOURCESWe searched PubMed, MEDLINE, the Cochrane Trial Registry (through May 2013), and relevant article bibliographies.STUDY SELECTIONSystematic review and meta-analysis of studies assessing correlation of sleep indexes between PAT devices and PSG in adults (aged >18 years). Included studies provided a bivariate correlation coefficient for sleep indexes, specifically the respiratory disturbance index (RDI), apnea-hypopnea index (AHI), and oxygen desaturation index (ODI).DATA EXTRACTION AND SYNTHESISIncluded studies were reviewed by 2 independent reviewers. Reported correlation values for the RDI, AHI, and ODI between a commercially available PAT device (WatchPAT) and PSG were systematically reviewed. A comprehensive meta-analysis software package was used for statistical analysis.MAIN OUTCOMES AND MEASURESAssessment of the correlation between PAT and PSG as measured by AHI, RDI, and ODI.RESULTSFourteen studies met inclusion criteria and had data suitable for pooling (909 patients). Of these, 13 studies had blinded study designs, with PAT and PSG conducted simultaneously in the home or the laboratory setting. One study contained 2 trial phases for the same patient group (n = 29), one laboratory based and the other home based, which were analyzed separately. One study contained 2 different study groups based on age. Overall, correlation of the RDI and AHI was high (r = 0.889 [95% CI, 0.862-0.911]; P < .001). Studies comparing the RDI between PAT and PSG had a combined correlation of 0.879 (95% CI, 0.849-0.904; P < .001); those comparing the AHI, 0.893 (0.857-0.920; P < .001); and those comparing the ODI, 0.942 (0.894-0.969; P < .001). Analysis of publication bias revealed a nonsignificant Egger regression intercept.CONCLUSIONS AND RELEVANCERespiratory indexes calculated using PAT-based portable devices positively correlated with those calculated from the scoring of PSG. Strengthened by the blinded design of most of the included studies, this technology represents a viable alternative to PSG for confirmation of clinically suspected sleep apnea.

Pillar implants provide a reasonable outcome with minimal post-operative morbidity and complications in treating patients with sleep-disordered breathing (SDB) who had obvious palatal obstruction. The palatal structure is responsible for a normal functioning Eustachian tube; however, little is known if there is any potential otologic implication of minimally invasive palatal stiffening surgery for SDB. The aim of this study is to evaluate the effects of Pillar implantation on middle ear function. We performed a prospective study in a tertiary referral center. Thirty SDB patients (25 men, 5 women; mean age, 44.3 years) who underwent Pillar implants for treating palatal obstruction were enrolled. The subjects had normal otologic exam and no previous history of chronic ear disease. Pure-tone audiometry and tympanometry were performed pre-operatively, and post-operative days 1 and 7, and months 1 and 3. Baseline and post-operative middle ear pressures (MEPs) in decipascals were compared. Statistical analysis was performed by repeated measures of ANOVA. Eight patients (8/30, 26.7%) reported otologic complaints such as ear pressure and/or otalgia within 1 week post-operatively. No permanent otologic discomfort occurred. A trend toward reduced MEP was noted in this study. The decrease in MEP became apparent on post-operative day 1 after surgery. However, mean pressure changes were no longer significantly different from pre-operative values by 1 week after surgery. Pillar implantation for SDB induces changes in middle ear function. However, the changes were temporary and not significant 1 week after surgery.

Objective. To assess the association between the Mallampati classification and Friedman tongue position for obstructive sleep apnea severity as determined by apnea-hypopnea index and to determine which method is most closely correlated with prediction of obstructive sleep apnea severity.Data Sources. English-language searches of PubMed, MedLine, and the Cochrane database. Reference sections of identified studies were examined for additional articles.Review Methods. Databases through December 2011 were searched, combined with review of relevant article bibliographies, and assessed by 4 reviewers. Systematic review and random-effects meta-analysis of studies evaluating tongue position and obstructive sleep apnea severity were performed. Outcomes were reported as correlations.Results. Ten studies met inclusion criteria and had data for pooling (2513 patients). Friedman tongue position and Mallampati classification were significantly associated with obstructive sleep apnea severity, with a correlation of 0.351 (0.094-0.564, P = .008). Analysis of the correlation of tongue position with obstructive sleep apnea severity reveals correlations of 0.184 (0.052, 0.310, P = .006) and 0.388 (0.049, 0.646, P = .026) for the Mallampati classification and Friedman tongue position, respectively. Publication bias does not yield a significant Egger regression intercept; however, 4 imputed values to the right of the mean were found using Duval and Tweedie's trim-and-fill method, yielding an overall correlation of 0.498 (confidence interval = 0.474-0.521).Conclusion. The Mallampati classification and Friedman tongue position assessment techniques are significantly correlated with predicting obstructive sleep apnea severity. Publication bias does not significantly affect our results. The strength of this correlation is higher for Friedman tongue position, although 95% confidence intervals for the respective correlation coefficients overlap.

Radical base of skull surgery and aggressive and expanded endoscopic sinonasal procedures have contributed to the need for repair of skull base defects. Current techniques for the repair involve the use of skeletal grafts, soft tissue on a vascular pedicle, and postoperative buttressing with Gelfoam and nasal packing. We describe a modified technique for treating skull base defects using a composite mucochondral flap from the nasal septum.

Objective To assess the correlation between respiratory sleep indices as measured by portable sleep testing using peripheral arterial tonometry (PAT) and respiratory sleep indices as measured by formal polysomnography (PSG). Thereby assess the validity of PAT devices as diagnostic tools for obstructive sleep apnea in the adult population. Method PubMed, MEDLINE, Cochrane Trial Registry (through 12/2011), and relevant article bibliographies were searched. Articles were assessed by 3 reviewers. Systematic review and meta‐analysis of studies assessing correlation of respiratory sleep indices between PAT devices and PSG in adults (>18 years) was conducted. Included studies provided an r value for correlation. Results Eleven studies met inclusion criteria and had data suitable for pooling (775 patients). Of these, 10 studies were “blinded” in that PAT and PSG were conducted simultaneously in either the home or laboratory setting. One study contained 2 trial phases for the same patient group (n = 21), 1 laboratory and 1 home‐based, which were analyzed separately. Overall correlation of respiratory sleep indices was high (r =. 867,. 836‐.892, P <. 001). Studies comparing respiratory disturbance index (RDI) had a combined r =. 854 (.823‐.880, P <. 001), and those comparing apnea‐hypopnea index (AHI) had a combined r =. 890 (.833‐.929, P <. 001). Analysis of publication bias revealed a nonsignificant Egger’s regression intercept. Conclusion Respiratory indices calculated using PAT‐based portable devices correlate well with those calculated from the scoring of formal PSG. The strength of this correlation is supported by the “blinded” nature of the majority of the included studies. This technology represents a viable alternative to PSG for confirmation of clinically suspected sleep apnea.

Objective1) Assess the association between tongue position and risk of obstructive sleep apnea (OSA) as measured by both Mallampati (MP ‐including classic 3‐level and modified 4‐level scoring with tongue protrusion) and Friedman Tongue Position (FTP‐no tongue protrusion). 2) Determine which of these assessment scales best predicts OSA risk.MethodPubMed, MEDLINE, Cochrane Trial Registry (through 12/2011), and relevant article bibliographies were searched. All studies were assessed by 3 reviewers. Systematic review and random‐effects meta‐analysis of studies assessing the association of tongue position and risk of OSA were performed. Outcomes are reported as odds ratios (OR).ResultsCombined data from 5 studies (46,264 patients) revealed an overall OR of 2.436 (1.828, 3.248; P P P P P =. 012) and 2.219 (1.109, 4.437; P =. 024) per 1‐point increase in MP and FTP, respectively.ConclusionTongue position 3 or 4, whether classified by MP or FTP, is significantly associated with increased OSA risk. In the clinical assessment of patients with suspected OSA, FTP 3/4 appears to have a higher predictive value for OSA than classic MP 3 or modified MP 3/4.

OBJECTIVE:To compare the efficacy of adenotonsillectomy (T&A) with and without pharyngoplasty (tonsillar pillar closure) in the treatment of pediatric obstructive sleep apnea-hypopnea syndrome (OSAHS).STUDY DESIGN:Randomized single-blind controlled study.SETTING:Tertiary care center.SUBJECTS AND METHODS:Sixty pediatric patients with a clinical diagnosis of OSAHS presenting between January 2009 and December 2010 were enrolled and randomized to undergo either standard T&A (n = 30) or T&A with pharyngoplasty (n = 30). Surgical cure was defined as apnea-hypopnea index (AHI) <5 plus OSA-18 health-related quality-of-life (HRQL) score <60. Other outcomes included postsurgical AHI and minimum oxygen saturation (SpO(2)) improvement, changes in OSA-18 scores at 1 month, and postsurgical days to resume normal diet and activity.RESULTS:Three patients from each group did not undergo surgery. Of the 54 patients treated, 8 from the pharyngoplasty group and 2 from the standard group were lost to follow-up. Intention-to-treat analysis revealed no difference in cure rate between groups (standard 60%, pharyngoplasty 56.6%, P = .793). Limiting analysis to those patients with complete data, a higher, but not significantly increased, cure rate with pharyngoplasty was noted (72% vs 89.5%, P = .155). Greater OSA-18 improvement (P = .036) and greater (although nonsignificant) AHI improvement and earlier return to normal function were noted with pharyngoplasty.CONCLUSION:The addition of pharyngoplasty to traditional adenotonsillectomy did not significantly improve OSAHS cure rates as measured by sleep testing and HRQL, although a nonsignificant increase in cure rate was observed in those who completed the study protocol. An unexpectedly high rate of patient dropout rendered the study statistically underpowered and therefore inconclusive.

Objective. Evaluate the effects of continuous positive airway pressure (CPAP) on C-reactive protein (CRP) levels, reported either as a primary or secondary end point among patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) based on a meta-analysis of published studies.Data Sources. English-language searches of PubMed, Ovid, and the Cochrane databases were completed. Reference sections of identified studies were also examined for additional relevant articles to review.Review Methods. Studies of adult patients with OSAHS who reported pre- and post-CPAP treatment CRP were reviewed and analyzed. Two independent reviewers extracted data from 10 peer-reviewed studies, which were combined using a random effects meta-analysis model.Results. The CPAP treatment was found to lead to a significant reduction in CRP levels (17.8%, P = .002). This corresponds to an effect size of -0.485 (-0.731, -0.240). Sensitivity analysis was done to determine the impact of study design. Both case-control studies and case-series studies yielded a significant effect. Sensitivity analysis also yielded a significant effect for studies with average body mass index <30, studies where CPAP was employed over automatic positive airway pressure, and studies treating patients <= 3 months. Analysis of publication bias, however, revealed a likelihood of "missing" studies.Conclusion. Although there is a significant lack of high-quality studies addressing this question, this analysis suggests that treatment with CPAP leads to a statistically significant reduction in CRP levels. However, the mean pre- and post-treatment CRP levels observed are considered "high risk" for cardiovascular morbidity. The clinical significance of this finding as it relates to cardiovascular risk reduction and the relationship between CRP and OSAHS requires further study.

OBJECTIVE:To assess the need for pH testing in diagnosing laryngopharyngeal reflux (LPR).STUDY DESIGN:Case series with planned data collection.SETTING:Tertiary care center.SUBJECTS AND METHODS:On the basis of symptoms and/or abnormal endoscopic findings, more than 500 patients underwent 24-hour pharyngeal pH testing at a single center (using the Dx-pH probe) between January 2009 and June 2011. A total of 163 patients not on proton-pump inhibitors at the time of study and with complete data available for analysis (pH results, body mass index, smoking status, pretest reflux symptom index) were divided into 2 groups by positive (n = 70) and negative (n = 93) Ryan Score. The Reflux Symptom Index (RSI) was compared between groups and assessed overall against Ryan Score parameters at different pH thresholds. The diagnostic utility of an RSI ≥ 13 for prediction of Ryan Score was assessed.RESULTS:No significant difference in RSI was seen between Ryan-positive (17.50 ± 11.47) and Ryan-negative (14.95 ± 11.43) patients (P = .161). Overall, RSI correlated poorly with percentage time spent below pH thresholds 6.5, 6.0, 5.5, and 5.0 and upright and supine Ryan parameters at these thresholds (as determined by linear regression analysis). The sensitivity, specificity, positive predictive value, and negative predictive value of RSI ≥ 13 for Ryan positivity were 55.7%, 47.3%, 44.3%, and 58.7%, respectively.CONCLUSION:Our findings show that in our population of otolaryngology patients, the diagnosis of LPR cannot be reliably made on the basis of symptoms alone. Diagnosis, and in particular treatment decisions, should ideally be made on the basis of a combination of symptoms, signs, and confirmatory testing.

Objective1) Review the available literature reporting on the success of single and multi‐level sleep surgery in relation to Friedman Anatomical Staging (FAS). 2) Combine statistical outcomes of multiple studies (where appropriate) to determine surgical success rates (defined by postoperative apnea‐hypopnea index [AHI] <20 and 50% reduction) for each clinical stage.MethodPubMed, MEDLINE, and Cochrane Trial Registry (through 12/2011) were searched, combined with manual review of relevant article bibliographies. All studies were assessed by 3 reviewers. Systematic review and random‐effects meta‐analysis of studies assessing the success of sleep surgery in relation to FAS were performed. Outcomes are reported as proportional success rates.ResultsSix studies met inclusion criteria and had data suitable for pooling (521 patients). Success rate (SR) for single‐level palatal surgery with FAS‐1 was. 806 (.630,. 910; P =. 002). Multi‐level surgical data for FAS‐1 yielded SR. 706 (.458,. 872; P =. 1). Single‐level surgery for FAS‐2 yielded SR. 379 (.224,. 564; P =. 197). Multi‐level surgical data for FAS‐2 yields SR. 647 (.527,. 751; P =. 017). Single‐level surgery for FAS‐3 yields SR. 081 (.037,. 169; P P =. 334). Analysis of publication bias yielded non‐significant Egger’s regression intercepts for studies reporting FAS‐2/3 success. Too few studies reported FAS‐1 success to allow statistical analysis of publication bias.ConclusionThese findings demonstrate the utility of FAS in predicting the success of OSA surgery. Findings further reinforce the value of OSA surgery in patients with FAS‐1 regardless of disease severity. In addition, they add to the evidence that multi‐level surgery is often necessary to treat patients with more advanced staging.

ObjectiveTo assess the utility of facial nerve monitoring in preventing transient and permanent facial paralysis in patients undergoing parotid surgery.MethodPubMed, MEDLINE, and Cochrane Trial Registry through December 2011 were searched and combined with manual review of relevant article bibliographies. All studies were assessed by 3 reviewers. Systematic review and random‐effects meta‐analysis were performed of studies comparing the incidence of facial nerve injury in monitored and unmonitored parotid surgery.ResultsFive studies met inclusion criteria and had data suitable for pooling (374 patients). Overall, monitoring provided no benefit in reduction of facial paralysis with an odds ratio (OR) of 0.754 (0.488, 1.165; P =. 203). In addition, sensitivity analysis revealed that neither transient nor permanent facial paralysis is significantly reduced with the use of monitoring. Analysis of publication bias revealed a nonsignificant Egger’s regression intercept; however, a single imputed value representing a “missing” study was found to the left of the calculated OR. Addition of this imputed value in no way altered the significance of our findings.ConclusionFacial nerve monitoring does not significantly reduce the incidence of transient or permanent facial paralysis in parotid surgery. While few “high‐level evidence” studies were available for review, our results were not affected by publication bias. Nerve integrity monitoring should not be considered the standard of care for parotid surgery.

Recently, 32% of Helicobacter pylori (H pylori) infected patients who were treated for differentiated thyroid carcinoma (DTC) were found to have a negative urease breath test at 2 months posttreatment. Our objectives were to eradication of clarify equivocal findings, and determine whether radioiodine eradicates this chronic bacterial infection. Twenty-eight patients (25 DTC patients and 3 with hyperthyroidism) positive for H pylori stool antigen were treated with oral radioiodine (131I) at a dose of 100 to 200 mCi in 18 patients with thyroid carcinoma; 30 mCi in 1 patient with a significant residual mass in the thyroid bed after surgery; and 4 mCi in 6 patients who had been treated with 100 to 150 mCi over the last 5 years. The hyperthyroid patients received 10 to 20 mCi. To standardize the results, and better compare with a previous study, only those patients who received a dose of 100 to 200 mCi were included for analysis. All 18 DTC patients who tested positive for H pylori stool antigen before radioiodine treatment remained positive 3 months posttreatment, indicating an eradication rate of 0% with an upper 95% confidence limit of 18.53%. Radioiodine administered to H pylori infected patients did not eradicate infection in Israeli patients. Recently, 32% of Helicobacter pylori (H pylori) infected patients who were treated for differentiated thyroid carcinoma (DTC) were found to have a negative urease breath test at 2 months posttreatment. Our objectives were to eradication of clarify equivocal findings, and determine whether radioiodine eradicates this chronic bacterial infection. Twenty-eight patients (25 DTC patients and 3 with hyperthyroidism) positive for H pylori stool antigen were treated with oral radioiodine (131I) at a dose of 100 to 200 mCi in 18 patients with thyroid carcinoma; 30 mCi in 1 patient with a significant residual mass in the thyroid bed after surgery; and 4 mCi in 6 patients who had been treated with 100 to 150 mCi over the last 5 years. The hyperthyroid patients received 10 to 20 mCi. To standardize the results, and better compare with a previous study, only those patients who received a dose of 100 to 200 mCi were included for analysis. All 18 DTC patients who tested positive for H pylori stool antigen before radioiodine treatment remained positive 3 months posttreatment, indicating an eradication rate of 0% with an upper 95% confidence limit of 18.53%. Radioiodine administered to H pylori infected patients did not eradicate infection in Israeli patients.

Objective Upper airway collapse measured using supine acoustic pharyngometry at respiratory residual volume (RV) has previously been correlated with obstructive sleep apnea‐hypopnea syndrome (OSAHS) severity. We aim to assess the agreement between sites of maximal upper airway obstruction measured by supine acoustic pharyngometry and drug‐induced sleep‐endoscopy (DISE) in snoring/OSAHS patients. Method In this case series, 50 consecutive patients with known snoring/OSAHS underwent in‐office supine acoustic pharyngometry and DISE. Pharyngometric measurements at respiratory tidal volume were compared against the standard normal curve to establish airway landmarks. Sites of minimal cross‐sectional‐area at respiratory RV were compared with sites of maximal obstruction identified through DISE. Results Fifty patients (68% male, 32% female, age 47.3 ± 13.7, mean AHI 37.0 ± 26.8) were evaluated. All endoscopic assessments were performed by a single investigator (M.F.). Regions of maximal upper airway collapse per DISE were classified as retropalatal, mixed retropalatal and retroglossal, retroglossal, mixed retroglossal and retroepiglottic, or retroepiglottic. Graphical and numerical pharyngometric data were assessed by 3 investigators with complete agreement regarding regional collapse. Agreement between sites of maximal upper airway obstruction per DISE and regions of minimal cross‐sectional‐area per supine pharyngometry was 89.2% (95% CI 74.5, 95.9; P <. 001). Conclusion Acoustic pharyngometry is a completely non‐invasive mode of assessment through which numerical and graphical data regarding regional upper airway collapse can be rapidly obtained. Findings demonstrate a high level of agreement with those of DISE in the pretreatment/preoperative evaluation of patients with known snoring and/or OSAHS.

Objective1) Present the safety, morbidity, and efficacy of robotic midline glossectomy (RG) for the treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS) in the first series of patients undergoing this procedure without tracheotomy. 2) Compare the efficacy of robotic midline glossectomy (RG) vs coblation and radiofrequency base‐of‐tongue (RFBOT) MG.MethodRetrospective review of patients treated between January 2009 and December 2010 at a tertiary care center. Efficacy and morbidity of 40 RG patients was compared with a matched cohort of 40 patients who underwent traditional MG. Outcome variables included: postoperative pain, narcotic use, postoperative reduction of AHI, disposable costs, and complications.ResultsTwenty patients with severe disease treated with ZPP+RG were compared with 20 patients with ZPP + Coblation. The mean AHI of patients undergoing RG decreased from 55.1 (SD 28.7) preoperative to 25.9 (SD 9.9) postoperative which was significantly greater than the AHI reduction for (P <. 05). Twenty patients with moderate disease treated with palatal stiffening + RG were compared with 20 patients with RFBOT + palatal stiffening. Pain outcomes measured on postoperative days 0‐5 using the Faces Visual Analogue Scale (VAS) resulted in no statistical difference between RG and coblation whereas RG vs RFBOT showed higher pain levels for RG.ConclusionThis is the first recorded series of robotic MG performed without the need for tracheotomy. Results demonstrated an excellent safety profile with no significant complications. Although morbidity vs standard hypopharyngeal treatments is significant, robotic glossectomy allows for more aggressive tissue removal vs coblation and RFBOT thereby significantly improving efficacy.