Indications for and Outcomes of Expansion Sphincter Pharyngoplasty to Treat Lateral Pharyngeal Collapse in Patients With Obstructive Sleep Apnea

Hong, Seung No; Kim, Hyung Gu; Han, Sang-Hoon; Ji, Jeong Yeon; Kim, Min Kyung; Han, Doo Hee; Won, Tae‐Bin; Kim, Dong Young; Kim, Hyun Jik

doi:10.1001/jamaoto.2019.0006

Cited by 33 publications

(24 citation statements)

References 35 publications

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“…In a multicenter study on 75 patients who refused or did not tolerate CPAP and were treated with EPP, they reported 90% improvement according to Sher's criteria (AHI < 50% and < of 20) [7]. In another study, 63 patients treated with EPP reported an improvement of 67% (according to Sher´s criteria) [8].…”

Section: Discussionmentioning

confidence: 99%

Pharyngoplasty in the Treatment of Sleep Apnea: Efficacy of Surgical Techniques

S¹,

L²

2020

J Sleep Disord Manag

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In sleep apnea/hypopnea syndrome (SAHS) a superior airway collapse can occur in the anteroposterioror lateral direction. The primary or secondary decrease in the tone of the dilating muscles of the pharynx, due to the negative pressure produced by the contraction of the diaphragm cause the collapse. Pharyngoplasty surgical techniques try to improve lateral collapse by repositioning the muscles that constitute the pharyngeal lateral wall, mainly the palatopharyngeal (PP), palatoglossal (PG) and upper constrictor (UC).

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Section: Discussionmentioning

confidence: 99%

Pharyngoplasty in the Treatment of Sleep Apnea: Efficacy of Surgical Techniques

S¹,

L²

2020

J Sleep Disord Manag

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“…Although lateral pharyngoplasty produced better clinical and PSG outcomes in OSA patients than did UPPP, cross-sectional measurements of the pharyngeal airway did not differ between treatments 16 . In addition, many patients experienced significant dysphagia following lateral pharyngoplasty because it is an invasive process that undermines the superior pharyngeal constrictor muscle, and lateral pharyngoplasty exhibited more complications, such as oronasal reflux of liquid and wound dehiscence, than did relocation pharyngoplasty and ESP 14,21 .…”

Section: Discussionmentioning

confidence: 99%

“…ESP thus creates more powerful tension in the lateral pharyngeal wall and reduces the www.nature.com/scientificreports www.nature.com/scientificreports/ bulk of lateral pharyngeal soft tissue by isolating and rotating the PP muscle super-anterolaterally. In a previous study, we found ESP combined with uvuloplasty to be an effective surgical option for lateral pharyngeal collapse in patients with severe OSA with minimal complications 14 . Based on our clinical data, relocation pharyngoplasty also provided a high cure rate for OSA patients with lateral pharyngeal collapse and effectively reduced lateral pharyngeal bulk, resulting in enhanced soft-palate tension or widening of the pharynx without severe complications after surgery.…”

Section: Pre-op [Mean (Sd)] Post-op [Mean (Sd)] Difference [Mean (Sd)mentioning

confidence: 91%

“…Palatal surgeries for OSA aim to correct the pharyngeal tissues narrowing the upper airway, enhance the tension of the pharyngeal muscle, and widen the pharyngeal lumen. Multiple studies have demonstrated the clinical benefits of palatal surgeries, including relief from both subjective symptoms and life-threatening conditions in OSA patients, and the addition of new surgical options can potentially improve the success rate of management of OSA patients with palatal narrowing or collapse in their upper airway [11][12][13][14][15] .The lateral pharyngeal wall is a complex structure composed of numerous pharyngeal muscle groups, such as the palatopharyngeus, superior pharyngeal constrictor, and palatoglossus muscles in addition to lymphoid tissue,…”

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The clinical efficacy of relocation pharyngoplasty to improve retropalatal circumferential narrowing in obstructive sleep apnea patients

Kim

Pyo

et al. 2020

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Lateral pharyngeal wall appears to be a critical culprit of obstructive sleep apnea (OSA) subjects and relocation pharyngoplasty has been expected to be a promising surgical option to correct retropalatal circumferential narrowing in OSA patients. The purpose of our study is to evaluate the therapeutic outcomes of relocation pharyngoplasty and its clinical effectiveness in OSA patients with retropalatal circumferential narrowing. We performed relocation pharyngoplasty combined with nasal surgery in 133 OSA patients with the following characteristics: apnea-hypopnea index (AHI) over 10, retropalatal circumferential narrowing greater than grade I when awake, and redundant soft tissue around the lateral pharyngeal wall. The analysis of surgical success rate was performed with the data of 68 subjects who underwent pre and postoperative polysomnography. The objective success rate of relocation pharyngoplasty was 52.9%, and significant reduction of mean AHI with improvement of lowest SpO2 was seen in 69% of patients 3 months after the surgery. The median AHI was decreased from preoperative 37.3 to postoperative 21.4. Median lowest SpO2 changed from 78.4 to 84.1%. Total sleep time, daytime sleepiness, and visual analogue scale for snoring showed improvement as well. Postoperative complications including pain or bleeding were minimal in 133 subjects and a few patients complained of subtle taste loss. Our data demonstrate that relocation pharyngoplasty can be a favorable surgical option fighting against retropalatal circumferential narrowing.Obstructive sleep apnea (OSA) is a common sleep disorder characterized by upper-airway collapse that causes reduction or cessation of airflow during sleep. Clinically, abnormal anatomy in the upper airway is obvious in OSA patients and reduced airflow from the nasal cavity and narrowing of the upper airway increase negative pressure in the pharyngeal airway and predispose the pharynx to collapse 1,2 . Both upper airway narrowing and increased airway resistance reportedly contribute to the underlying pathogenesis of OSA, leading to sleep-related symptoms such as loud snoring, apnea, fatigue, daytime sleepiness and systemic complications if not properly treated [3][4][5][6][7][8] . OSA occurs due to fixed or dynamic upper-airway obstruction caused by anatomical factors or abnormal upper-airway motor tone, and upper-airway obstruction can be caused by collapse at multiple levels, such as the soft palate, uvula, palatine tonsils, lateral pharyngeal walls, and base of the tongue 5,9 . A palatal pattern of collapse is most frequent and numerous surgical techniques have been designed to modify the palate anatomy in OSA patients 10 . Palatal surgeries for OSA aim to correct the pharyngeal tissues narrowing the upper airway, enhance the tension of the pharyngeal muscle, and widen the pharyngeal lumen. Multiple studies have demonstrated the clinical benefits of palatal surgeries, including relief from both subjective symptoms and life-threatening conditions in OSA patients, and the addition of ...

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“…DISE could modify surgical treatment options and procedures in 50% of OSA patients, but the available published studies lack evidence on the association between this impact and surgical outcomes [75]. However, patient selection based on site-specific upper airway behavior has been shown to be of value in improving treatment outcomes [76][77][78][79][80][81][82]. More specifically, a complete circular collapse at the level of the palate (Fig.…”

Section: Evaluation and Inter-and Intrarater Variabilitymentioning

confidence: 99%

Drug-Induced Sleep Endoscopy: Evaluation of a Selection Tool for Treatment Modalities for Obstructive Sleep Apnea

2020

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Obstructive sleep apnea (OSA) is a very common disorder with important day and nighttime symptoms and long-term effects on health. Different treatment modalities such as positive airway pressure (PAP), oral appliance therapy using custom-made, titratable mandibular advancement devices (MAD), different types of surgery and positional therapy have been introduced over the years, with patient preference and adherence to therapy being key elements in improving treatment outcomes. Several patient selection tools to improve treatment outcomes have been introduced and evaluated over the years. Drug-induced sleep endoscopy (DISE) is a procedure that provides real-time upper airway evaluation of the sites of flutter and upper airway collapse. This review focuses on the indications and contraindications for DISE, methods of sedation and evaluation, add-on maneuvers, and the results on patient selection and treatment outcomes. A PICO approach was used to clarify the aims of this review. DISE has the advantage of being easily accessible in most ENT practices and being 3-dimensional, dynamic, site specific, safe and it is valuable in selecting patients for upper airway surgery and oral appliance therapy. There is a strong interest for further standardization and exploration of the predictive value of this evolving technique.

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Indications for and Outcomes of Expansion Sphincter Pharyngoplasty to Treat Lateral Pharyngeal Collapse in Patients With Obstructive Sleep Apnea

Cited by 33 publications

References 35 publications

Pharyngoplasty in the Treatment of Sleep Apnea: Efficacy of Surgical Techniques

Pharyngoplasty in the Treatment of Sleep Apnea: Efficacy of Surgical Techniques

The clinical efficacy of relocation pharyngoplasty to improve retropalatal circumferential narrowing in obstructive sleep apnea patients

Drug-Induced Sleep Endoscopy: Evaluation of a Selection Tool for Treatment Modalities for Obstructive Sleep Apnea

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