[Surgical treatment of obstructive sleep apnea syndrome: from palatopharyngeal surgery to multilevel surgical reconstruction of the pharynx. Basis, results and future perspectives].
In this paper is evaluated the effectiveness, as a function of the morphologic structure of the Upper Airways (UA)--evaluated by vigil ENT exploration plus cephalometrics--in the treatment of Obstructive Sleep Apnea Syndrome (OSAS) of the UPPP with or without Nasal Surgery (NS), performed on 33 OSAS patients, and the Multilevel UA Reconstruction (MUAR), performed on 13 patients with multilevel UA obstruction. 10 patients of this group were also evaluated by UA pressure Measurements during Sleep (PMS). UPPP shows an effectiveness of 60% in cases of favourable UA topography: Predominant palatal obstruction (Type I: euthopic palate with no hypopharyngeal obstruction and Type IIa: palate of low implantation with no hypopharyngeal obstruction, neither N+ (nasal obstruction present) or N- (nasal obstruction absent) and 0% in cases of unfavourable UA structure: Extrapalatal obstruction (Type IIb: palatal and hypopharyngeal obstruction and Type III: hypopharyngeal obstruction, either N+ or N-). The maximum UPPP effectiveness is achieved in UA topography IN+ (80%), followed by IIaN- (60%), IIaN+ (57%) and IN- (47%). MUAR, applied on failures of UPPP and patients with UA topography unfavourable to UPPP (Types IIb and III) that rejected CPAP therapy, shows a success rate of 50% in IIaN+ UA type (allowing the recuperation of the 50% of the UPPP failures having this UA topography), 80% in type IIbN+ (where UPPP is contraindicated) and 0% in types IIaN- and IIbN-. PMS shows UA multilevel obstruction during sleep. The role of UPPP, NS and MUAR in the treatment of SAOS is are discussed.
Biurrun Unzué
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Servicio de ORL, Unidad de Estudio de la Roncopatía Crónica y Trastornos del Sueño, Clínica Tres Torres, Barcelona.
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010159:Palate / Q000601:surgery*; D018579:Patient Selection; D010614:Pharynx / Q000473:pathology / Q000601:surgery*; D020181:Sleep Apnea, Obstructive / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors