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Is work, the board evaluates identified tricky airway individuals and sufferers for whom difficulty in tracheostomy buy ACT-333679 decannulation is anticipated or who have failed prior attempts at decannulation. This group method has led for the application of TORS and also other procedures in delivering patients with powerful airway management top to successful decannulation. Not too long ago, this strategy has gained popularity as an efficient therapeutic solution both for OSA and head and neck cancer 3-5. The aims of our paper are: 1. To demonstrate how the otolaryngology team will help recognize sufferers at high threat for decannulation failure and 2. To demonstrate how TORS could help within the decannulation course of action of individuals at higher risk for failure resulting from extreme tongue base hypertrophy. We present the following case series.Fig. 1. Endoscopic examination ahead of TORS highlighted hypertrophy of the BOT associated to an oedema on the epiglottis occluding pretty much entirely the upper airway.Case seriesWe report on 4 cases where TORS helped inside the management of long-term cannulated patients. All individuals gave their consent to the procedure. TORS was carried out by the exact same group (C.V. and F.M.) with an Intuitive da Vinci robot. The operative setting was exactly the same as that described by Weinstein 5 for the tongue base neoplasms. The robot is setup on the proper side on the patient. The eyes and teeth are protected by implies of specific devices. Following the insertion of a mouth gag, the da Vinci robotic arms are placed in the oral cavity. Visualisation is achieved with a 30x magnification, 3-dimensional endoscope. Surgery starts together with the visualisation of your epiglottis to orientate the surgeon. Then a piecemeal resection on the BOT is performed working with a step-by-step strategy. First the medial and paramedial portions from the tongue base are addressed and then the lateral parts. Within this way, it is actually doable to determine and preserve the noble structures. Case 1: D.S.F., male, 69 years, came to our attention in October 2014 for evaluation of tracheostomy removal. The tracheostomy was performed in January 2014 for a serious respiratory impairment that occurred after a stroke. Several unsuccessful trials of decannulation had been attempted prior to our evaluation. The patient’s past medical history was difficult variety 2 diabetes, arterial hypertension, ischaemic cardiopathy (he underwent 7 coronary stents in 1995) and both alcohol and tobacco addiction. The endoscopic examination highlighted hypertrophy with the BOT and oedema from the epiglottis causing close to complete occlusion with the upper airway (Fig. 1). As part of his evaluation for failed decannulation, the patient also underwent each a CT scan and an MRI scan of the neck with contrast (Fig. 2).The case was discussed at the multidisciplinary airway conference where it was recommended that the patient undergo TORS BOT reduction and supraglottoplasty (SGP). The patient underwent TORS BOT resection and SGP in October 2014; a total of 12 mls of lingual tissue was resected. The patient was effectively decannulated in January 2015. At 6 months follow-up, the patient did not PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/2002540 complain any additional symptoms and didn’t demand replacement of the tracheostomy (Fig. 3).Fig. 2. MRI examination highlighted a muscular verticalised BOT having a considerable narrowing of the upper airway.F. Montevecchi et al.Fig. 3. Endoscopic view soon after six months of follow-up.Case 2: M.MA. is actually a 61-year-old lady who created a extreme post-operative oedema in the BOT in January 2.