Suspension Palatoplasty for Obstructive Sleep Apnea- A Preliminary Study

Li, Hsueh‐Yu; Lee, Li‐Ang; Kezirian, Eric J.; Nakayama, Meiho

doi:10.1038/s41598-018-22710-1

Cited by 27 publications

(38 citation statements)

References 23 publications

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“…Expansion sphincter-pharyngoplasty, lateral pharyngoplasty, relocation pharyngoplasty, Han UPPP, suspension palatoplasty, and others are surgical techniques that have the goals to alter the lateral pharyngeal wall and soft palate at the level of the velopharynx and oropharynx. [1][2][3][4][5] A key element of many techniques is altering characteristics of the palatopharyngeus muscle and superior pharyngeal constrictor muscles (SC). The ESP which repositions the palatopharyngeus muscle laterally, anteriorly, and superiorly is an example of this class of technique, has demonstrated benefits in selected OSA patients ( Fig.…”

Section: Reconstructive Pharyngoplastymentioning

confidence: 99%

“…8 Suspension palatoplasty proposes to enlarge the retropalatal space by pulling the palatopharyngeus to the pterygomandibular raphe. 5…”

Section: Reconstructive Pharyngoplastymentioning

confidence: 99%

“…Expansion sphincter‐pharyngoplasty, lateral pharyngoplasty, relocation pharyngoplasty, Han UPPP, suspension palatoplasty, and others are surgical techniques that have the goals to alter the lateral pharyngeal wall and soft palate at the level of the velopharynx and oropharynx . A key element of many techniques is altering characteristics of the palatopharyngeus muscle and superior pharyngeal constrictor muscles (SC).…”

Section: Introductionmentioning

confidence: 99%

“…In 2015, a “barbed reposition pharyngoplasty” was introduced to combine tonsillectomy, a conservative ventral palatal mucosal excision, removal of associated submucosal tissues, and posterior pillar mucosal repositioning using a barbed bidirectional suture to the pterygomandibular raphe . Suspension palatoplasty proposes to enlarge the retropalatal space by pulling the palatopharyngeus to the pterygomandibular raphe …”

Section: Introductionmentioning

confidence: 99%

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Palatal anatomy for sleep apnea surgery

Olszewska

Woodson

2019

Laryngoscope Investig Oto

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The goal of this review is to advance the understanding of the muscular and soft tissue palatal anatomy as it relates to palatal surgery for sleep apnea and the phenotypic variations that generate the shape and collapsibility of the retropalatal airway. Anatomically, the soft palate has both a proximal and distal segments separated by the palatal genu. The proximal palatal segment has a variable angle from the hard palate (ie, alpha angle) determined by the position and length of the levator veli palatini muscle. The palatopharyngeus muscle (PP) is a major defining element of the palate and lateral pharyngeal wall and forms the medial wall of the lateral palatal space. It is composed of two divisions: the longitudinal palatopharyngeus fasciculi which acts to elevate the pharynx and depress the soft palate and the transverse palatopharyngeus fascicle (Passavant's ridge) which function is a nasopharyngeal sphincter. The lateral palatal space incorporates the supra‐tonsilar fat, and is bounded by muscles that determine the structure of the palate and associated lateral pharyngeal walls. Understanding of palatal muscles and pharyngeal airway phenotypes provides insight into the steps and mechanisms of pharyngoplasty procedures. Level of Evidence N/A

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Section: Reconstructive Pharyngoplastymentioning

confidence: 99%

“…8 Suspension palatoplasty proposes to enlarge the retropalatal space by pulling the palatopharyngeus to the pterygomandibular raphe. 5…”

Section: Reconstructive Pharyngoplastymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Palatal anatomy for sleep apnea surgery

Olszewska

Woodson

2019

Laryngoscope Investig Oto

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“…Two exceptions in the treatment of airway collapse by CPAP are nasal valve and epiglottis collapses, in which CPAP does not have optimal response and surgery commonly lead to improvement in clinical symptoms and OSA severity [15] , [16] , [17] . Based on the widely used nose-VOTE system, surgery takes advantage in treating obstruction/collapse of the nose, velopharynx, and epiglottis [18] , [19] , [20] , by contrast, CPAP has superiority in treating collapse from the oropharyngeal lateral wall and tongue [21] . Fig.…”

Section: Principle In Decision-making Between Cpap and Surgerymentioning

confidence: 99%

Intrapharyngeal surgery with integrated treatment for obstructive sleep apnea

Lee

Hsin

et al. 2019

Biomedical Journal

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Obstructive sleep apnea (OSA) is a common disease in adults, which influences human relations, quality of life and associates with major complications. Continuous positive airway pressure (CPAP) is the gold standard treatment modality in OSA patients. For patients incompliant or unwilling to CPAP therapy, surgery is an alternative treatment. Sleep surgery for OSA include intrapharyngeal surgery, extrapharyngeal surgery and bariatric surgery addressing upper airway soft tissue, maxillofacial bone, and obesity, respectively. Among sleep surgeries, intrapharyngeal surgery (soft tissue surgery) is widespread used and serves overwhelming majority in OSA surgical patients. Despite the popularity of intrapharyngeal surgery, its outcomes can be influenced by multiple factors and consequently need conjunctive remedy to enhance at the short-term and sustain in the long-term. In this article, we introduce updated indications for treating OSA, practical principle in decision-making between CPAP and surgery, hybrid procedures in treating obstruction at the nose, palate, tongue and epiglottis, and postoperative integrated treatment including oropharyngeal myofunctional therapy (local), positional therapy (regional), and body weight reduction (systemic), and circadian rhythm (central). In summary, intrapharyngeal surgery is a target-oriented procedure that needs to be performed precisely and combines with integrated treatment as a holistic care for OSA patients.

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Incidence of Multilevel Surgical Procedures and Readmissions in Uvulopalatopharyngoplasty in Taiwan

Hsu¹,

Hsu

et al. 2019

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Multilevel surgical procedures with uvulopalatopharyngoplasty (UPPP) appear to be associated with more complications than UPPP alone, but general and bleeding-related hospital readmissions have not been specifically investigated to date. OBJECTIVE To compare the risk of 30-day general and bleeding-related readmissions in adult patients who underwent UPPP alone and those who received a multilevel surgical procedure. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study retrospectively analyzed all cases of UPPP among adults (aged >20 years) in Taiwan from January 1, 2000, to December 31, 2012. Claims data in the Taiwan National Health Insurance Research Database were used. Participants were patients who underwent inpatient UPPP (n = 35 029), and their basic information was acquired from the database. Data analyses were conducted from June 22, 2018, to August 22, 2018. MAIN OUTCOMES AND MEASURES The risks of major complications in patients who underwent UPPP alone, UPPP with nasal operation, and UPPP with tongue or hypopharyngeal operation were compared using a generalized linear mixed model. RESULTS In total, 35 029 adults were identified (mean [SD] age of 39.2 [12.2] years, and 25 923 men [74.0%]). The proportion of UPPP concurrent with nasal operation increased from 2000 to 2012 (19.9% to 42.9%), as did that of UPPP with concurrent tongue or hypopharyngeal operation (2.7% to 5.2%). The rate of readmission for any reason after UPPP with nasal operation was higher than that for UPPP alone (4.7% vs 3.7%; adjusted odds ratio [aOR], 1.22; 95% CI, 1.09-1.37). The rate of readmission for any reason and readmission for bleeding for UPPP with tongue or hypopharyngeal operation (aOR, 1.68; 95% CI, 1.34-2.11) was also higher than that for UPPP alone (aOR, 2.34; 95% CI, 1.72-3.17). However, a multilevel surgical procedure was not associated with an increased risk of bleeding-related reoperation, regardless of the concurrent procedure. CONCLUSIONS AND RELEVANCE The incidence of multilevel UPPP in Taiwan increased from 2000 to 2012, and these surgeries appeared to be associated with a higher risk of complications; results of this study suggest that these findings should be considered during surgical decision-making.

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Suspension Palatoplasty for Obstructive Sleep Apnea- A Preliminary Study

Cited by 27 publications

References 23 publications

Palatal anatomy for sleep apnea surgery

Palatal anatomy for sleep apnea surgery

Intrapharyngeal surgery with integrated treatment for obstructive sleep apnea

Incidence of Multilevel Surgical Procedures and Readmissions in Uvulopalatopharyngoplasty in Taiwan

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