title: Combined open rhinoplasty with spreader grafts and laser-assisted uvuloplasty for sleep-disordered breathing: long-term subjective outcomes.
abstract: OBJECTIVE
  To subjectively assess the long-term outcomes of combined functional open rhinoplasty with spreader grafts and laser-assisted uvuloplasty (LAUP) for polysomnogram (PSG)-confirmed sleep-disordered breathing (SDB).
  
  
  METHODS
  Postoperative Epworth Sleepiness Scale (ESS) questionnaires were given to 30 patients and compared with preoperative ESS. Patients were also asked questions concerning postoperative improvement in upper airway breathing, nasal appearance, and snoring. Statistical analysis used 2-tailed parametric and nonparametric tests.
  
  
  RESULTS
  Thirty patients (average age 55 years) with an average (+/- standard deviation) preoperative apnea-hypopnea index (AHI) of 37 +/- 27 and mean follow-up times of 21 months were evaluated. A statistically significant 50% (P < .001) postoperative decrease in average ESS was observed. Patients with severe (AHI > 30) and very severe obstructive sleep apnea (OSA) (AHI > 60) also had statistically significant (61% and 66%, respectively, P < .001) postoperative decreases in average ESS. In all patients, subjective upper airway breathing was statistically improved (P < .008), graded as significantly in 47% and moderately in 33% of patients. According to the patient's bed partner, snoring was improved and/or decreased in 76% of patients (P = .008). All patients were satisfied with the postoperative cosmetic appearance of their nose (P < .0001). Finally, 90% of patients stated that they would have the procedure again (P = .009) and 90% stated that they would recommend the procedure to a friend or relative with the same condition (P = .009).
  
  
  CONCLUSIONS
  Subjective assessment at long-term follow-up for combined open rhinoplasty with spreader grafts and LAUP for PSG-confirmed SDB produced a statistically significant decrease in excessive daytime sleepiness, even in patients with very high AHI, with high patient satisfaction.
authors.affiliation: Oral and Maxillofacial Surgery, Parkland Memorial Hospital, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Cillo
authors.forename: Richard
authors.initials: R
authors.lastname: Finn
authors.forename: Richard M
authors.initials: RM
authors.lastname: Dasheiff
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000601:surgery*; D009300:Nasal Septum / Q000637:transplantation; D019647:Oral Surgical Procedures / Q000523:psychology*; D010160:Palate, Soft / Q000601:surgery*; D017060:Patient Satisfaction; D012225:Rhinoplasty / Q000295:instrumentation / Q000379:methods* / Q000523:psychology; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D012913:Snoring / Q000601:surgery; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome