title: Upper airway anatomical changes after velopharyngeal surgery in obstructive sleep apnea patients with small tonsils.
abstract: OBJECTIVE
  To evaluate the relationships between anatomical changes and treatment outcomes after velopharyngeal surgery in obstructive sleep apnea (OSA) patients with small tonsils (grade 0-2 on the Brodsky scale).
  
  
  METHODS
  Case series with planned data collection.
  
  
  METHODS
  University medical center.
  
  
  METHODS
  Thirty-six OSA patients with small tonsils underwent velopharyngeal surgery including revised uvulopalatopharyngoplasty with uvula preservation and transpalatal advancement pharyngoplasty. Pre- and postoperative upper airway 3-dimensional computed tomography and polysomnography findings were obtained for comparison and analysis.
  
  
  RESULTS
  The overall apnea hypopnea index (AHI) decreased from 56.8 (interquartile range, 37.5-70.1) preoperatively to 16.1 (10.8-33.5) postoperatively (P < .001). The change in minimal cross-sectional area of the velopharynx (VmCSA) was independently associated with the change in AHI (P = .001, R (2) = 0.271). Preoperative VmCSA was the only preoperative anatomical variable that was an independent predictor of change in VmCSA (P = .009, R (2) = 0.184). Postoperative VmCSA was independently associated with postoperative AHI (P < .001, R (2) = 0.341).
  
  
  CONCLUSIONS
  In patients with small tonsils, an adequate increase in VmCSA is associated with a successful outcome after surgery. Patients with a relatively small preoperative VmCSA are more likely to have favorable anatomical changes after surgery.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
authors.forename: Junbo
authors.initials: J
authors.lastname: Zhang
authors.forename: Jingying
authors.initials: J
authors.lastname: Ye
authors.forename: Junfang
authors.initials: J
authors.lastname: Xian
authors.forename: Jiangyong
authors.initials: J
authors.lastname: Wang
authors.forename: Jiajia
authors.initials: J
authors.lastname: Dong
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D014066:Palatine Tonsil / Q000000981:diagnostic imaging* / Q000601:surgery; D010614:Pharynx / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D017286:Polysomnography; D011184:Postoperative Period; D020181:Sleep Apnea, Obstructive / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014609:Uvula / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
keywords: 3-dimensional computed tomography; obstructive sleep apnea; polysomnography; small tonsils; velopharyngeal surgery