Cautery‐Assisted Palatal Stiffening Operation for the Treatment of Obstructive Sleep Apnea Syndrome

Abstract

Cautery-assisted palatal stiffening operation (CAPSO) is a recently developed single office-based procedure performed with local anesthesia for the treatment of palatal snoring. A midline strip of soft palate mucosa is removed, and the wound is allowed to heal by secondary intention. The flaccid palate is stiffened, and palatal snoring ceases. This prospective study evaluated the ability of CAPSO to treat obstructive sleep apnea syndrome (OSAS). Twenty-five consecutive patients with OSAS underwent CAPSO. Responders were defined as patients who had a reduction in apnea-hypopnea index (AHI) of 50% or more and an AHI of 10 or less after surgery. By these strict criteria, 40% of patients were considered to have responded to CAPSO. Mean AHI improved from 25.1+/-12.9 to 16.6+/-15.0 (P = 0.010). The Epworth Sleepiness Scale, a subjective measure of daytime sleepiness, improved from 12.7+/-5.6 to 8.8+/-4.6 (P<0.001). These results indicate that CAPSO is as effective as other palatal surgeries in the management of OSAS.

Modalities of treatment for sleep disordered breathing

“… Caustery assisted palatal stiffening operation (CAPSO), where cautery causes fibrosis and palatal stiffening (Punnoose et al, 2012). Mean AHI improve from 25.1-16.6 (Wassmuth et al, 2000).  Palatal Implants-The Pillar procedure.…”

Medical and surgical treatment of obstructive sleep apnea syndrome, including dental appliances

“…These include laser palatoplasty (Ellis et al, 1993), laser cautery-assisted palatal stiffening (Wassmuth et al, 2000), and temperature-controlled radiofrequency tissue ablation (TCRFTA) of the tongue and soft palate (Stuck et al, 2004). A randomized controlled trial comparing TCRFTA with sham placebo surgery and nasal CPAP therapy has been performed in patients with mild to moderate OSAS (Woodson et al, 2003).…”

Maxillomandibular Advancement (MMA) in a Site-Specific Treatment Approach for Obstructive Sleep Apnea: A Surgical Algorithm

“…2 Adjunctive nonpharyngeal procedures (e.g., septoplasty, turbinate reduction, removal of sinus polyps and mandibular lingual tori, cervicofacial lipectomy) may also be performed concomitantly with MMA as a safe single-staged surgical treatment of OSAS. 2 In general, pharyngeal soft tissue surgery (e.g., T/A, UPPP, laserassisted uvuloplasty, 10 palatopharyngoglossoplasty, 15 uvulopalatopharyngoglossoplasty, 16 somnoplasty or radiofrequency volumetric tissue reduction of the tongue 17 and palate, 18 cautery-assisted palatal stiffening operation, 19 uvulopalatal flap, 20 laser midline glossectomy 21 with epiglottidectomy, 22 lingualplasty 23 ) may not be necessary and should probably not be performed concomitantly with MMA unless immediate tracheostomy, prolonged ETT intubation, or auto-titrating CPAP were to be employed for several days during the resolution of the postoperative pharyngeal edema, which-particularly if compounded with pre-existant hypopharyngeal narrowing-may be life-threatening. 2…”