Expansion SphincterPlasty & Multilevel OSA Surgery

Abstract

Objective To review multilevel surgery involving the Expansion SphincterPlasty (ESP) with tongue base surgery in the treatment of severe OSA. Methods Prospective non-randomized collection of 39 consecutive patients with severe OSA. Patients were >18 years old, type II Fujita with lateral pharyngeal wall collapse, small tonsils, BMI <30. Mean follow-up was 9.3 months. Results All 39 patients were male, with mean age of 44.1 years (range of 26 to 49 years), mean BMI was 25.7 (range of 21.1 to 29.1). 22 patients had ESP/Hyoid/RF Tongue Base procedure, while 17 patients had the ESP/Hyoid/Tongue Suspension procedure. The mean pre-operative AHI for the entire group improved from 56.3 ± 18.1 to 19.2 ± 14.0 postoperatively. There was a greater AHI improvement in the ESP/Hyoid/TS group than the ESP/Hyoid/RFBOT group. The 17 patients in the ESP/Hyoid/TS group had a mean pre-operative AHI that improved from 52.2 ± 18.7 to 18.0 ± 12.8 (p<0.05), compared to the ESP/Hyoid/RFBOT group, where AHI improved from 48.1 ± 17.9 to 25.6 ± 17.1 (p<0.05). Oxygen saturations also improved in both groups. When using the success criteria of a reduction in 50% of the pre-operative AHI and an AHI <20, the overall success rate for both groups was 71.2%. The success rate for the ESP/Hyoid/TS group was 74.8%, while the success rate for the ESP/Hyoid/RFBOT group was 67.5%. Conclusions The use of the ESP with tongue surgery is effective in the management of patients with severe OSA.