Combined Expansion Pharyngoplasty and Anterior Palatoplasty for the Treatment of OSA.
To evaluate the success rates of combined Expansion Sphincter Pharyngoplasty and the Anterior Palatoplasty in the treatment of OSA. A two center prospective series of 73 patients with OSA. All patients were >18 years old, retro-palatal obstruction, concentric velo-pharyngeal collapse, BMI < 33, Friedman clinical stage II, with all grades of AHI. The procedure involved the anterior palatoplasty, tonsillectomy and expansion sphincter pharyngoplasty with or without nasal surgery. There were 68 men and 5 women, the mean age was 46.8 years old (range of 25-67 years), mean BMI was 25.5 (range of 20.3-31.2). All patients had pre-operative and post-operative PSG. The AHI improved in all patients, mean AHI improved from 26.3 ± 17.7 to 12.6 ± 5.8 (p< 0.001). There were 20 mild OSA, 33 moderate OSA and 20 severe OSA patients. Twenty-three patients had pre-operative DISE, and 61 patients had nose/palate surgery, while only 12 had palate surgery alone. The overall success rate (50 % reduction and AHI < 20) was 86.3 %. The mean snore scores (VAS) improved from 8.8 ± 1.2 to 2.0 ± 1.3 (p< 0.001). The mean Epworth score improved from 11.5 ± 2.2 to 2.9 ± 2.1 (p< 0.001). Lowest oxygen saturation also improved in all patients. Subjectively, all the patients felt less tiredness. Pre-operative DISE assessment did not seem to confer any advantage over the patients who had no pre-operative DISE (p= 0.027), and patients who had nose/palate surgery seemed to have better success rates compared to those who only had palate surgery (p= 0.081). This combined technique has been shown to be effective in selected group of OSA patients.Level of evidenceIV.
Otorhinolaryngology Head and Neck Surgery, Asia Sleep Centre, Paragon Medical Centre, Singapore, 238859 Singapore.
Kenny P
KP
Pang
Department Otolaryngology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
Ottavio
O
Piccin
Asia Sleep Centre, Singapore, Singapore.
Edward B
EB
Pang
Asia Sleep Centre, Singapore, Singapore.
Kathleen A
KA
Pang
Biostatistics Unit, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.
Yiong Huak
YH
Chan
Otolaryngology Head and Neck Surgery, Western University, London, ON Canada.
Brian W
BW
Rotenberg
Anterior palatoplasty; Expansion sphincter pharyngoplasty; Obstructive sleep apnea