Palate surgery for obstructive sleep apnea: a 17-year meta-analysis

Pang, Kenny P.; Plaza, Guillermo; J, Peter M. Baptista; O’Connor-Reina, Carlos; Chan, Yiong Huak; Pang, Kathleen A.; Pang, Edward B.; Wang, Cybil Mei Zhi; Rotenberg, Brian

doi:10.1007/s00405-018-5015-3

Cited by 39 publications

(27 citation statements)

References 76 publications

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“…As the use of these new techniques became widespread, promising success rates were published, and these results were shown to be superior to conventional methods such as UPPP. Pang et al, in their meta‐analysis evaluating the success of palatal surgeries, had reported the mean apnea hypopnea index (AHI) reductions as 24.7, 19.8, and 17.2 for AP, ESP, and UPPP, respectively . Furthermore, a recent meta‐analysis showed that OSA patients had greater benefit from the ESP technique compared to UPPP .…”

Section: Introductionmentioning

confidence: 99%

“…Pang et al, in their meta-analysis evaluating the success of palatal surgeries, had reported the mean apnea hypopnea index (AHI) reductions as 24.7, 19.8, and 17.2 for AP, ESP, and UPPP, respectively. 4 Furthermore, a recent meta-analysis showed that OSA patients had greater benefit from the ESP technique compared to UPPP. 5 Vicini et al showed a significant decrease in mean AHI from 43.65 to 13.57 with BP.…”

Section: Introductionmentioning

confidence: 99%

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Barbed palatoplasty vs. expansion sphincter pharyngoplasty with anterior palatoplasty

2019

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Objective/Hypothesis To compare the functional outcomes and complication rates in patients who underwent expansion sphincter pharyngoplasty with anterior palatoplasty (ESPwAP) versus barbed pharyngoplasty (BP). Study Design Retrospective cohort study. Methods A medical database was used to retrieve the records of 129 patients who had an isolated palatoplasty surgery between January 2014 and July 2018. Patients who had mild or moderate obstructive sleep apnea without a history of revision surgery and underwent ESPwAP or BP in addition to traditional tonsillectomy were included in the study. Pre‐ and postoperative polysomnography and Epworth Sleepiness Scale (ESS) was evaluated in the patients who completed at least a 6‐month follow‐up period. Results Forty‐five and 53 patients met the inclusion, and were comprised of BP and ESPwAP groups, respectively. ESPwAP and BP significantly improved mean apnea hypopnea index (AHI) from 28.5 to 9.1 (P = .000) and 25.9 to 7.4 (P = .000), respectively. No significant statistical difference was found between the mean AHI scores of two groups. Selecting a threshold of a 50% reduction in AHI and AHI less than 20 events/h, success rates were 86.6% in BP group and 84.9% in ESPwAP group. Conclusions Our study showed that both types of surgeries are effective with comparable results. The BP technique may be preferred when possible to avoid soft tissue excision and seems to be a less invasive procedure with a similar success rate when compared to ESPwAP. Level of Evidence 4 Laryngoscope, 130:E275–E279, 2020

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Barbed palatoplasty vs. expansion sphincter pharyngoplasty with anterior palatoplasty

2019

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“…Various techniques of palatopharyngoplasty such as lateral pharyngoplasty, expansion sphincter pharyngoplasty, and transpalatal advancement pharyngoplasty have been introduced to resolve the limitations of classic UPPP. Collectively, they have shown more successful outcomes than the classic UPPP [28,[71][72][73][74][75]. Sleep surgeons can individualize the options according to the pattern of collapse.…”

Section: Oropharynx: Uvulopalatopharyngoplastymentioning

confidence: 99%

Surgical Algorithm for Obstructive Sleep Apnea: An Update

Liu

Riley

2020

Clin Exp Otorhinolaryngol

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Sleep surgery is part of a continuum of care for OSA that involves medical, pharmacologic, and behavioral therapy. Upper airway surgery for OSA can significantly improve stability by way of modulating the critical negative closing pressure. This is the same mechanism of action as PAP or oral appliance therapy (OAT). The updated surgical algorithm in this review adds precision in 3 areas: 1) patient selection, 2) identification of previously unaddressed anatomic phenotypes with associated treatment modality, and 3) improved techniques of previously established procedures. While the original Riley and Powell Phase 1 and 2 approach to sleep surgery has focused on individual surgical success rate, this algorithm strives for an overall treatment success with multi-modal and patient-centric treatments.

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“…For OSA refractory to CPAP and lifestyle modifications, palatopharyngoplasty (PPP) is one of the most commonly performed procedures. 18 Multilevel procedures have additional interventions to supplement those of the PPP and may include tonsillectomy, treatment of the epiglottis, nasal passages, tongue, or addition of hyoid suspension. One meta-analysis of 59 papers reported success rates—reduction of AHI of about 67.5% for a combination of PPP and multilevel surgeries.…”

Section: Introductionmentioning

confidence: 99%

Adult Palatopharyngoplasty: Trends in Morbidity and Mortality from the NSQIP Database

Gates

Ramadan

Coutras

et al. 2020

Ann Otol Rhinol Laryngol

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Objectives: Describe the postop morbidity of adults undergoing palatopharyngoplasty (PPP). Method: Adults who underwent PPP were studied using ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database (2016-2017) via CPT code 42145. Analyzed outcomes included length of stay (LOS), readmission, reoperation, and postop complications. Predictive variables were age, gender, BMI, comorbidities. Results: A total of 1081 patients (73.7% male, mean age 42.0 years, range 18-79 years) were included. 95 (8.8%) were diabetic, 183 (16.9%) were smokers, 30 (2.8%) had preoperative dyspnea. 328 (30.3%) took medicine for hypertension. Concurrent procedures occurred in 646 (59.76%), 357 (33.02%) had nasal procedures, 320 (29.60%) had tonsil procedures, 66 (6.11%) had tongue procedures. Within 30 days postop, there were two (0.19%) mortalities. Complications included six wound infections, two dehiscences, four with pneumonia, two pulmonary embolisms, three myocardial infarctions, one DVT, three sepsis, one UTI, one who required CPR, and two who were ventilated for >48 hours. Five required reintubation. A total of 41 (3.79%) returned to OR for a related reason, at least 27 (65.90%) for bleeding. LOS ranged from 0 to 15 days, median 1 day. Overall 38 (3.52%) were readmitted for a related reason, 12 (31.58%) for bleeding and three (7.89%) for pain. Using a significance level of 0.002 (Bonferroni correction), LOS varied with presence of any concurrent procedure, BMI, and estimated probability of mortality and morbidity indices; readmission and reoperation had no significantly associated variables. Conclusion: PPP is associated with low frequency but significant morbidity and mortality.

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Palate surgery for obstructive sleep apnea: a 17-year meta-analysis

Abstract: Better understanding of the upper airway and objective airway evaluation diagnostic techniques and innovative palate surgeries have improved success rates of OSA surgery.

Cited by 39 publications

References 76 publications

Barbed palatoplasty vs. expansion sphincter pharyngoplasty with anterior palatoplasty

Barbed palatoplasty vs. expansion sphincter pharyngoplasty with anterior palatoplasty

Surgical Algorithm for Obstructive Sleep Apnea: An Update

Adult Palatopharyngoplasty: Trends in Morbidity and Mortality from the NSQIP Database

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