title: Limited palatal muscle resection with tonsillectomy: a novel palatopharyngoplasty technique for obstructive sleep apnea.
abstract: OBJECTIVE
  The ideal palatal surgery for obstructive sleep apnea (OSA) and snoring must maintain the airway patency and correct anatomic abnormalities without complications. The purpose of this study was to investigate the efficacy of limited palatal muscle resection (LPMR) to improve OSA severity.
  
  
  METHODS
  Twenty-three patients with OSA underwent LPMR. The LPMR was initiated with a bilateral tonsillectomy in patients with tonsil size 2 and 3. The LPMR consisted of partial resection of palatal muscles (levator veli palatini, palatoglossus, and musculus uvulae) with preservation of the uvula and a simple double layer suturing. The retropalatal space and the length of soft palate were evaluated by magnetic resonance imaging. Subjective outcomes using visual analog scales, Epworth Sleepiness Scale, and overnight polysomnography (PSG) data were assessed.
  
  
  RESULTS
  Six months after the operation, there was significant symptomatic improvement in snoring, morning headaches, tiredness, and daytime sleepiness. Postoperative magnetic resonance images showed upward and forward movement of uvula and soft palate after LPMR. The length of the soft palate was significantly shortened and the retropalatal space was significantly increased. Postoperative PSG revealed significant improvement in apnea-hypopnea index (AHI) and the total sleep time spent with oxygen saturation below 90%, and reduction in AHI following PMR was found in all patients. Furthermore, no patient experienced velopharyngeal insufficiency, voice changes, and pharyngeal dryness at 6 months follow-up.
  
  
  CONCLUSIONS
  The LPMR obtained significant improvement in subjective and objective outcomes in OSA, with preserved pharyngeal function. PMR is an effective and safe technique to treat oropharyngeal obstruction in OSA surgery.
authors.affiliation: Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Busan, South Korea.
authors.forename: Kyu-Sup
authors.initials: KS
authors.lastname: Cho
authors.affiliation: Department of Otorhinolaryngology, Busan St. Mary's Medical Center, Busan, South Korea.
authors.forename: Soo-Kweon
authors.initials: SK
authors.lastname: Koo
authors.affiliation: Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Busan, South Korea.
authors.forename: Jong-Kil
authors.initials: JK
authors.lastname: Lee
authors.affiliation: Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Busan, South Korea.
authors.forename: Sung-Lyong
authors.initials: SL
authors.lastname: Hong
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Robson
authors.initials: R
authors.lastname: Capasso
authors.affiliation: Department of Otorhinolaryngology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea. Electronic address: rohhj@pusan.ac.kr.
authors.forename: Hwan-Jung
authors.initials: HJ
authors.lastname: Roh
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010156:Palatal Muscles / Q000473:pathology / Q000601:surgery*; D010160:Palate, Soft / Q000473:pathology / Q000601:surgery*; D010614:Pharynx / Q000601:surgery*; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014068:Tonsillectomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Muscles; Obstructive sleep apnea; Operative surgical procedures; Snoring; Soft palate