title: The Role of Obstruction Length and Height in Predicting Outcome of Velopharyngeal Surgery.
abstract: OBJECTIVE
  To measure obstruction length and height using drug-induced sleep endoscopy (DISE) in obstructive sleep apnea (OSA) patients and to evaluate their association with outcomes of velopharyngeal surgery.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  University medical center.
  
  
  METHODS
  Forty-three consecutive patients with OSA were evaluated by DISE using dexmedetomidine. The 2 new parameters, obstruction length (defined as the distance from the most superior point of the collapse to the most inferior point of the collapse) and obstruction height (the distance from the posterior border of the nasal septum to the most proximal point of the collapse), were measured by both DISE and a pressure transducer catheter method before surgery. All of the patients received velopharyngeal surgery, including revised uvulopalatopharyngoplasty with uvula preservation and transpalatal advancement pharyngoplasty. We followed up with all of the patients using polysomnography at least 3 months after surgery.
  
  
  RESULTS
  Twenty-six (60.5%) patients were responders, and 17 (39.5%) were nonresponders. The mean obstruction length and obstruction height were 1.3 ± 0.5 cm (range, 0.4-2.2 cm) and 3.4 ± 0.9 cm (range, 1.1-5.0 cm), respectively. Nonresponders had a longer obstruction length and a shorter obstruction value. Multivariate logistic regression analysis revealed that obstruction length >1.4 cm (odds ratio [OR], 0.21; 95% confidence interval [CI], 0.04-0.98; P = .048) and obstruction height ≥3.2 cm (OR, 9.35; 95% CI, 1.79-48.80; P = .008) were the only independent predictors of velopharyngeal surgery success.
  
  
  CONCLUSIONS
  Accurate measurement of obstruction length and height can be performed with both DISE and a pressure transducer catheter method. The 2 parameters can predict the outcome of velopharyngeal surgery.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Beijing Tsinghua Changgunng Hospital, Beijing, China yejingying@yeah.net.
authors.forename: Jingying
authors.initials: J
authors.lastname: Ye
authors.affiliation: Department of Anesthesia, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
authors.forename: Chuxiong
authors.initials: C
authors.lastname: Pan
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
authors.forename: Nian
authors.initials: N
authors.lastname: Sun
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Kang
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000473:pathology* / Q000601:surgery; D020927:Dexmedetomidine; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017286:Polysomnography; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome; D055158:Velopharyngeal Sphincter / Q000473:pathology* / Q000601:surgery*
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine
keywords: drug-induced sleep endoscopy; obstruction height; obstruction length; obstructive sleep apnea; velopharyngeal surgery