Respiratory arousal is the change from a state of sleep to a state of wakefulness following an apnea or hypopnea. In patients with obstructive sleep apnea (OSA), it could have a helpful role to activate upper airway muscles and the resumption of airflow and an opposing role to contribute to greater ventilatory instability, continue cycling, and likely exacerbate OSA. Patients with very severe OSA (apnea-hypopnea index (AHI) ≥ 60 events/h) may have specific chemical (e.g., possible awake hypercapnic hypoxemia) and mechanical (e.g., restricted dilator muscles) stimuli to initiate a respiratory arousal. Little was reported about how respiratory arousal presents in this distinct subgroup, how it relates to AHI, Epworth Sleepiness Scale (ESS), body mass index (BMI), and oxygen saturation, and how a non-framework surgery may change it. Here, in 27 patients with very severe OSA, we show respiratory arousal index was correlated with each of AHI, mean oxyhemoglobin saturation of pulse oximetry (SpO2), mean desaturation, and desaturation index, but not in BMI or ESS. The mean (53.5 events/h) was higher than other reports with less severe OSAs in the literature. The respiratory arousal index can be reduced by about half (45.3%) after a non-framework multilevel surgery in these patients.

Presence of metastatic tumour in the retropharyngeal node has a negative impact on the prognosis. We present here our 5-year experience and the outcomes of transoral robotic retropharyngeal node dissection (RPND) in salvage settings. Hospital database was accessed to extract details of patients with head and neck cancer who developed retropharyngeal (RP) node metastasis. Patients who underwent transoral robotic surgery (TORS) for RPND in salvage settings were included for the study. Patients were first followed-up after 10 days of discharge and then on a monthly basis after completion of treatment. At each follow-up, swallow functions and disease status were recorded. A total of 10 patients met the inclusion criteria and underwent salvage transoral robotic RPND. The total number of lymph nodes removed from these patients were 11, with all having malignant tumour deposits. The median follow-up was 20 months. Four patients developed distant metastasis. There were no major procedure-related complications. Our experience suggests that TORS as treatment modality is oncologically sound and feasible for salvage RP node dissection.Level of evidence Retrospective Study (3).

Tenosynovial giant cell tumor (TSGCT) represents a family of benign tumors that arise from the synovial tissue of a joint, tendon sheath, or bursa. It usually involves the joints of the extremities and rarely occurs in the head and neck region. Here, we describe a case of a 32-year-old man with a submucosal mass bulging in the posterior pharyngeal wall since one month. The lesion was removed and diagnosed with localized type of TSGCT based on histopathological investigations and clinical presentation. It is very rare that TSGCT occurs in the retropharynx, which reminds clinicians to consider this entity as a possible diagnosis.

A step-by-step demonstration of the transoral robotic surgical approach (TORS) used in retropharyngeal node dissection (RND) in a recurrent head and neck carcinoma.
Clinical human study of TORS RND via en bloc resection using a daVinci Si system (Intuitive Surgical, Inc., Sunnyvale, California).
A daVinci Si system provided sufficient access, reach, and visualization to perform TORS-RND. Access and exposure were achieved with a Feyh-Kastenbauer (FK) retractor (Gyrus Medical Inc., Tuttlingen, Germany). Two surgical instruments and one 3D camera arm can be deployed with minimal collision or restriction of arm movement.
Routine transcervical, transparotid, and transmandibular RNDs can provoke potentially serious surgical morbidities and complications. This study demonstrates the technical feasibility of TORS RND in a 68-year-old man.

OBJECTIVE: To describe the feasibility, effectiveness, and improved morbidity profile of transoral robotic surgery (TORS) for the excision of a retropharyngeal intramuscular lipoma.
METHODS: Case report of a robot-assisted transoral resection of a retropharyngeal intramuscular lipoma.
RESULTS: A 62-year-old woman presented with tongue pain and globus with dysphagia for six months. Transoral exam revealed a pharyngeal submucosal mass, and MRI demonstrated a prevertebral lipomatous lesion with protrusion into the airway. The patient elected for robot-assisted transoral surgical treatment. The patient tolerated the procedure well, experienced no complications, and was discharged on post-operative day one. At six months post-operatively, the patient was without dysphagia and was disease free on imaging.
CONCLUSIONS: TORS is an effective, safe, feasible, and likely more efficient way to excise a retropharyngeal intramuscular lipoma or other retropharyngeal masses.

This study was conducted to describe a retropharyngeal myxoma and discuss clinical concerns regarding this pathology and a retropharyngeal site of occurrence. We present a case report and review of literature. A 71-year-old woman presented with mild right neck pressure for 3 weeks. Imaging studies and head neck examination confirmed a 5.3 × 3.1 × 1.0 cm retropharyngeal mass with no communication to the vertebral column but was intimately involved with the pharyngeal mucosa. A transoral fine needle aspiration biopsy suggested a possible spindle cell neoplasm. A presurgical swallowing consultation was obtained. A transoral excision of the tumor was possible with no intraoperative complications. Histopathology was a cellular myxoma. Postoperative dysphagia required swallowing therapy and nasogastric tube feeding for 2 weeks before oral intake was possible. The patient has no evidence of clinical or radiological recurrence more than 1 year after surgical intervention. We present the second case of a myxoma in the retropharynx reported in English literature. Transoral excision was safe, feasible, and cosmetically appealing option in our patient. Additional clinical data are required to valid its safety and utility as an approach to tumors in the retropharynx. Postoperative dysphagia can be significant and consequently we recommend preoperative swallowing evaluation and counseling.

Acute calcific prevertebral tendinitis, which is also known as retropharyngeal calcific tendinitis and longus colli tendinitis, is an under-recognized cause of acute cervical pain produced by an inflammation of the longus colli muscle. The typical characteristics of this entity are calcifications at the superior insertion of the longus colli tendons at the C1-C2 level and fluid collection in the retropharyngeal space. The differential diagnosis includes a retropharyngeal abscess, infectious spondylitis or traumatic injury. Knowledge of the clinical and imaging findings can prevent a misdiagnosis and inappropriate attempts at surgical drainage.