title: Dynamic pharyngoscopy in predicting outcome of uvulopalatopharyngoplasty for moderate and severe obstructive sleep apnea.
abstract: OBJECTIVE
  We sought to determine whether preoperative fiberoptic pharyngoscopy (FOP) with Müller's maneuver (dynamic FOP) could be used to establish a subgroup of obstructive sleep apnea (OSA) patients with better outcome after uvulopalatopharyngoplasty (UPPP).
  
  
  METHODS
  Retrospective review of an observational cohort.
  
  
  METHODS
  Tertiary care referral center.
  
  
  METHODS
  Twenty-nine patients who underwent UPPP and nasopharyngeal surgery by one surgeon.
  
  
  METHODS
  The patients were divided into two groups based on the findings of preoperative dynamic FOP: group 1 (11 patients) had collapse of the velopharynx and the base of the tongue-epiglottis-hypopharynx (TEH) complex and group 2 (18 patients) had velopharyngeal collapse only.
  
  
  RESULTS
  Surgical success was defined using a conventional definition (> 50% reduction in the apnea-plus-hypopnea index [OAHI]), and a criterion for cure (> 90% reduction in OAHI and postoperative OAHI < 15). Both groups had a significant improvement in their OAHI. The success rate was significantly higher in patients with velopharyngeal collapse only compared with patients with additional collapse of the TEH complex (78 vs 36% with the conventional definition, and 50 vs 9% using the definition for cure, respectively). Predictive value of dynamic FOP in predicting cure failure when collapse of the TEH complex was present was 91%.
  
  
  CONCLUSIONS
  Dynamic FOP may help establish a subgroup of OSA patients with greater likelihood of successful UPPP. The high negative predictive value of dynamic FOP when a criterion for cure is used suggests that this maneuver could best be used to exclude patients with TEH complex collapse from UPPP.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, OH 44195, USA.
authors.forename: L S
authors.initials: LS
authors.lastname: Aboussouan
authors.forename: J A
authors.initials: JA
authors.lastname: Golish
authors.forename: B G
authors.initials: BG
authors.lastname: Wood
authors.forename: A C
authors.initials: AC
authors.lastname: Mehta
authors.forename: D E
authors.initials: DE
authors.lastname: Wood
authors.forename: D S
authors.initials: DS
authors.lastname: Dinner
mesh_terms: D000328:Adult; D000368:Aged; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012891:Sleep Apnea Syndromes / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome