Lateral-Expansion Pharyngoplasty: Combined Technique for the Treatment of Obstructive Sleep Apnea Syndrome

Abstract

Introduction Obstructive sleep apnea syndrome (OSAS) is a multifactorial disease characterized by episodes of partial or complete collapse during sleep of different regions of the upper airway. Surgery for OSAS evolved with the introduction of different techniques, considering new surgical concept of reconstruction of the upper airway. Objective To retrospectively evaluate the effectiveness of a new approach aimed at reducing pharyngeal collapse by combining two surgical techniques: lateral and expansion pharyngoplasty. Methods We reviewed the medical records of 38 patients with OSAS undergoing lateral/expansion pharyngoplasty from January 2012 to December 2016. The following data were collected: patient age, gender, and pre- and postoperative body mass index (BMI), Epworth sleepiness scale (ESS) scores, snoring visual analogue scale (VAS) scores, and polysomnography (PSG) results. Results The PSG results showed a significant reduction in the apnea/hypopnea index (AHI) from 22.4 ± 27.3 events/h preoperatively to 13.6 ± 17.9 events/h postoperatively ( p = 0.009), with postoperative AHI reduction greater than 50% in 63.2% of the patients. There was also a significant reduction in the microarousal index (19.5 ± 22.6 vs 11.0 ± 13.4 events/h; p = 0.001) and in the minimum oxygen saturation (82.6 ± 10.3 vs 86.9 ± 11.1; p = 0.007). Conclusions Lateral-expansion pharyngoplasty represents a new surgical strategy for the treatment of OSAS in patients with palatal collapse by combining two different techniques: lateral and expansion pharyngoplasty. The two techniques, performed as a one-stage procedure, led to improvements in excessive daytime sleepiness, snoring, and PSG respiratory parameters by acting on lateral and retropalatal collapse, producing favorable results with good applicability in otolaryngology clinical practice.

Manipulation of Lateral Pharyngeal Wall Muscles in Sleep Surgery: A Review of the Literature

“…The majority of samples included in the study consisted of patients affected by severe OSAS (mean pre-op apnea–hypopnea index (AHI) > 30). A mean reduction of more than 50% of AHI and a mean post-op AHI < 20 were observed in all series except one [ 10 ]. Some authors did not specify complications and their rates.…”

“…Despite the possible swallowing complication presented by LP, other authors consider SPC a successful target. José Antonio Pinto et al [ 10 ], in so-called lateral-expansion pharyngoplasty, suggested the association of LP with expansion sphincter pharyngoplasty, presented for the first time by Pang and Woodson. In this way, the SPC section is combined with the section of PP muscle and the further suture of its cranial flap to the hamulus of the pterygoid process in order to improve the retropalatal obstruction.…”

Effectiveness of drug-induced sleep endoscopy in improving outcomes of barbed pharyngoplasty for obstructive sleep apnea surgery: a prospective randomized trial

“…Patient selection and choice of surgical procedure for OSA have traditionally relied on static examination of the awake patient, and thus may not accurately predict sites of obstruction during the sleeping state [15,16,18,19]. Awake upper airway endoscopy can be done safely in the office setting and it is useful for evaluating any anatomic variants of the upper airway structures such as deviated nasal septum, turbinate hypertrophy, and adenotonsillar hypertrophy as well as for ruling out pathological obstruction such as nasal polyps and tumors [15,16,[20][21][22][23][24][25][26][27][28][29][30]. Tonsil grade, Friedman palate position, and Friedman lingual tonsil grade have been considered useful scores for identifying patients in whom single-level velopharyngeal surgery should be avoided [28,29].…”

“…Therefore, as indicated in the European position paper on drug-induced sleep endoscopy [19], DISE could be useful for guiding clinicians in the choice of the best surgical treatment. If during DISE only a velar and oropharyngeal obstruction is identified, a single-level pharyngoplasty surgery is usually indicated [20][21][22][23][24][25][26][27][28][29][30].…”

The Evaluation and Treatment of Obstructive Sleep Apnea Syndrome

“…Abdullah Alhelali Otolaryngology Department, Aseer Central Hospital, Abha, Saudi Arabia *Address all correspondence to: alhelaliii@hotmail.com proposed [51][52][53]. Many noncomparative studies reported its success in treating OSAS [54,55]. One systematic review with a meta-analysis showed a significantly better EPP result than other traditional surgeries [56].…”