title: Palatal stiffening after failed uvulopalatopharyngoplasty with the Pillar Implant System.
abstract: OBJECTIVE
  The objective of this study was to measure subjective and objective improvement after palatal stiffening in patients after uvulopalatopharyngoplasty (UPPP) who were experiencing persistence or recurrence of snoring with or without daytime sleepiness symptoms.
  
  
  METHODS
  The authors conducted a prospective, nonrandomized study of 26 patients after UPPP who underwent the Pillar Implant Technique (PIT) as a revision procedure.
  
  
  METHODS
  Patients were selected to undergo revision PIT if they presented with recurrence or persistence of snoring after UPPP. Patients had mild or moderate obstructive sleep apnea-hypopnea syndrome (OSAHS) (apnea-hypopnea index [AHI] >5 and < or =40), persistent retropalatal obstruction, and a residual palate > or =2 cm. Some patients experienced daytime somnolence as well. Patients with severe OSAHS (AHI > or =40), Friedman anatomic stage IV, and/or nasopharyngeal stenosis were excluded. Pre-/postoperative snoring levels, Epworth Sleepiness Scale (ESS), SF-36v2 Quality of Life (QOL) questionnaires, and polysomnograms were obtained.
  
  
  RESULTS
  We completed data on 23 patients. Postoperative snoring levels (3.4 +/- 1.8) and ESS (8.7 +/- 1.8) significantly improved (P < .0001) compared with preoperative values (8.7 +/- 1.8 and 13.2 +/- 2.9). A total of 73.9% of patients improved subjectively. Seven of eight SF-36v2 QOL domains showed significant improvement (P < .05). Postoperative AHI and minimum oxygen saturation also improved significantly (P < .05). Objective cure was only achieved in 21.7% of patients.
  
  
  CONCLUSIONS
  Revision PIT is effective in achieving subjective improvement of recurrent symptoms after UPPP. Objective cure was only obtained in 21.7% of patients. As a result of the safety and low morbidity of the procedure, it is an alternative to improve symptoms, especially snoring, in patients not willing to accept continuous positive airway pressure permanently or patients who refuse revision surgery.
authors.affiliation: Department of Otolaryngology and Bronchoesophagology, Rush University Medical Center, Chicago, Illinois, USA. hednnek@aol.com
authors.forename: Michael
authors.initials: M
authors.lastname: Friedman
authors.forename: Paul
authors.initials: P
authors.lastname: Schalch
authors.forename: Ninos J
authors.initials: NJ
authors.lastname: Joseph
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010160:Palate, Soft / Q000473:pathology* / Q000601:surgery*; D010614:Pharynx / Q000601:surgery*; D017286:Polysomnography; D011446:Prospective Studies; D019736:Prostheses and Implants; D011788:Quality of Life; D012891:Sleep Apnea Syndromes / Q000628:therapy*; D020181:Sleep Apnea, Obstructive / Q000628:therapy; D012913:Snoring / Q000209:etiology; D014609:Uvula / Q000601:surgery*