title: New clinical staging for pharyngeal surgery in obstructive sleep apnea patients.
abstract: BACKGROUND
  The success of pharyngeal surgery in the treatment of obstructive sleep apnea syndrome depends on the appropriate selection of patients.
  
  
  OBJECTIVE
  To propose a new staging for indication of pharyngeal surgery in obstructive sleep apnea syndrome.
  
  
  METHODS
  A total of 54 patients undergoing extended tonsillectomy were retrospectively included, divided into six stages. Stage I: patients with palatine tonsils grade 3/4 and modified Mallampati index 1/2; stage II: palatine tonsils 3/4 and modified Mallampati index 3/4; stage III: palatine tonsils 1/2 and modified Mallampati index 1/2; stage IV: palatine tonsils 1/2 and modified Mallampati index 3/4; stage V: body mass index ≥40 kg/m(2) with palatine tonsils 3/4 and modified Mallampati index 1, 2, 3, or 4. Stage VI: body mass index ≥40 with palatine tonsils 1/2 and modified Mallampati index 1, 2, 3, or 4.
  
  
  RESULTS
  The surgical success rates were 88.9%, 75.0%, 35.7%, 38.5%, and 100.0% in stages I-V.
  
  
  CONCLUSIONS
  The presence of hypertrophic palatine tonsils was the anatomical factor in common in the most successful stages (I, II, and V), regardless of body mass index. Although the modified Mallampati index classes 3 and 4 reduced the success rate of surgery in patients with hypertrophic tonsils (stage II), the presence of modified Mallampati index classes 1 and 2 did not favor surgical success in patients with normal tonsils (stage III).
authors.affiliation: Department of Otorhinolaryngology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Tatiana Aguiar
authors.initials: TA
authors.lastname: Vidigal
authors.affiliation: Department of Otorhinolaryngology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil. Electronic address: femartinho@uol.com.br.
authors.forename: Fernanda Louise Martinho
authors.initials: FL
authors.lastname: Haddad
authors.affiliation: Instituto do Ronco e Apneia de Maringá, Maringá, PR, Brazil.
authors.forename: Rafael Ferreira Pacheco
authors.initials: RF
authors.lastname: Cabral
authors.affiliation: Department of Otorhinolaryngology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Maria Claudia Soares
authors.initials: MC
authors.lastname: Oliveira
authors.affiliation: Clínica Opus, São José dos Campos, SP, Brazil.
authors.forename: Ricardo Rodrigues
authors.initials: RR
authors.lastname: Cavalcante
authors.affiliation: Department of Otorhinolaryngology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Lia Rita Azeredo
authors.initials: LR
authors.lastname: Bittencourt
authors.affiliation: Department of Otorhinolaryngology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Sergio
authors.initials: S
authors.lastname: Tufik
authors.affiliation: Department of Otorhinolaryngology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Luis Carlos
authors.initials: LC
authors.lastname: Gregório
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014066:Palatine Tonsil / Q000473:pathology / Q000601:surgery*; D017286:Polysomnography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000145:classification / Q000601:surgery*; D014068:Tonsillectomy; D016896:Treatment Outcome; D055815:Young Adult
keywords: Apneia obstrutiva do sono; Classification; Classificação; Sleep apnea, obstructive; Tonsilectomia; Tonsillectomy