Cautery‐assisted palatal stiffening operation

Abstract

Outpatient surgical therapy of habitual snoring and mild obstructive sleep apnea has evolved significantly in recent years. We introduce the cautery-assisted palatal stiffening operation (CAPSO) and detail its important advantages over uvulopalatopharyngoplasty, laser-assisted uvulopalatoplasty, and palatal radiofrequency ablation. CAPSO is critically analyzed with regard to extent of surgery, need for repetition of procedure, results, complications, predictors of success, and cost analysis. CAPSO is a mucosal surgery that induces a midline palatal scar that stiffens the floppy palate. Two hundred six consecutive patients underwent CAPSO over an 18-month period, followed by office examination and telephone evaluation. The success rate was initially 92% and dipped to 77% after 1 year. CAPSO eliminates excessive snoring caused by palatal flutter and has success rates that were comparable with those of traditional palatal surgery. CAPSO is a simple and safe office procedure that avoids the need for multiple-stage operations and does not rely on expensive laser systems or radiofrequency generators and hand pieces.

Results of Anterior Palatoplasty to Treat Snoring and Obstructive Sleep Apnea

“…The surgical technique of anterior palatoplasty was described by Kenny Pang in 2013 [6], modifying previous techniques such as CAPSO, which had good results in improving snoring (77% reduction in snoring at one year in 206 patients) [4]. However, CAPSO caused unpredictable scarring of the soft palate with adhesions that pulled the lateral pharyngeal walls, leading to narrowing of the lateral distance between the tonsil and the pillars.…”

“…For ASA III or moderate/severe OSA patients, the surgeries were performed with the patients staying hospitalized for 24 hours in the intermediate care unit. Surgical outcomes were assessed at 6 months, considering the surgery successful if the improvement in snoring was ≥ 50% and the apnea/hypopnea index decreased by 50% or more or to less than 10. such as interstitial radiofrequency [2], palate implants [3], CAPSO (palate stiffening by cauterization) [4], and barbed suture placement [5] are most commonly used to address anteroposterior collapse of the soft palate. The anterior palatoplasty described by Kenny Pang [6] combines the CAPSO technique with suturing of resected mucosa margins, producing stiffness and anterior displacement of the soft palate.…”

Feasibility of Myxomatous Mitral Valve Repair Using Direct Leaflet and Chordal Radiofrequency Ablation

“…Interestingly, this technique has been used in oral surgery to stiffen the palate to prevent snoring. 23 It has been speculated that RFA may cause direct valve tissue injury in patients undergoing ablation of accessory pathways. 24 In fact, Wolfsohn et al 20 found that when they accidentally applied energy to one of the valves of the heart they caused a fibrous scar.…”

Comprehensive review of surgeries for obstructive sleep apnea syndrome

“…When performed for snoring treatment, Blythe et al 29 describe that 83% of spouses reported either resolution or significant improvement in the patients' snoring. Mair & Day 31 reported treating 200 consecutive patients over an 18-month period with success rates of 92% initially, and a slight decrease in success down to 77% after 1 year. Wassmuth et al 30 demonstrated a decrease in AHI from 25 ± 12.9/h to 16.6 ± 15.0/h ( p = 0.01).…”