Combined Expansion Pharyngoplasty and Anterior Palatoplasty for the Treatment of OSA

Abstract

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 preoperative 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 evidence IV.

Barbed palatoplasty vs. expansion sphincter pharyngoplasty with anterior palatoplasty

“…Similar result for BP was reported by Montevecchi et al, as a decreasing in mean AHI from 33.4 to 13.5 . Recently, Pang et al reported the results of combined ESP and AP for OSA treatment and they showed a decrease in mean AHI from 26.3 to 12.6 …”

“…Karakoc et al evaluated the outcomes of patients who were treated with the new surgical procedures in their prospective study and the success rates had been reported as 45% and 74% for AP and ESP, respectively . However, a combination of ESP and AP, had reported by Pang et al, gives better results for patients with OSA as the success rate of 83.2% . Our study showed 84.9% success rates for ESPwAP.…”

“…Although many palatal surgeries have been reported along the last two decades, the success of surgical treatment of OSA depends on determination of appropriate surgical procedures which focused on the anatomical and physiological site of obstruction. Both ESP and AP techniques are performed in different OSA patients, based on their pattern of velo‐pharyngeal collapse and obstruction; ESP for lateral pharyngeal wall obstruction and AP for antero‐posterior obstruction of the velopharynx . However, the use of these two techniques alone is insufficient in patients with both antero‐posterior and lateral wall collapse at the velo‐pharynx.…”

“…Both ESP and AP techniques are performed in different OSA patients, based on their pattern of velo-pharyngeal collapse and obstruction; ESP for lateral pharyngeal wall obstruction and AP for antero-posterior obstruction of the velopharynx. 7 However, the use of these two techniques alone is insufficient in patients with both antero-posterior and lateral wall collapse at the velo-pharynx. Therefore, we carried out AP and ESP in combination for the treatment of OSA patients with both antero-posterior and lateral wall collapse at the velo-pharynx.…”

“…6 Recently, Pang et al reported the results of combined ESP and AP for OSA treatment and they showed a decrease in mean AHI from 26.3 to 12.6. 7 Determining the sites and patterns of collapse of the upper airway (UA) in OSA patients is pivotal for selection of the appropriate surgical intervention. In our study, attention is mainly focused on retropalatal collapse, the most common site causing OSA, and its surgical treatment with recent procedures.…”