This study seeks to determine the success rates of the expansion sphincter pharyngoplasty and its variants on the treatment of obstructive sleep apnea (OSA). Systematic review and meta-analysis. Two independent searches of MEDLINE, Google Scholar, Cochrane Library and Evidence Based Medicine Reviews to identify publications relevant to OSA and expansion pharyngoplasty. All relevant studies published before 31 March 2015 were included. Five studies were included in the systematic review and meta-analysis. The numbers of patients in each paper ranged from 10 to 85 (total = 155), and mean age ranged from 8 to 56 years. Substantial and consistent improvement in PSG outcomes were observed post-expansion pharyngoplasty patients, with or without multilevel surgery groups. The results showed that the expansion pharyngoplasty technique has significantly lower AHI than control group [Standardised mean difference -7.32, 95 %CI (-11.11, -3.52), p = 0.0002]; however, substantial heterogeneity between these studies were observed. The mean pre-operative AHI (in the five papers) improved from 40.0 ± 12.6 to 8.3 ± 5.2 post-operatively. The overall pro-rated pooled success rate for all the patients was 86.3 %. The expansion pharyngoplasty is effective in the management of patients with OSA.
Objectives/Hypothesis Our objective was to determine whether drug‐induced sleep apnea (DISE) affects the successfulness of the surgical outcome. Study Design Prospective, seven‐country, nonrandomized trial. Methods There were 326 consecutive obstructive sleep apnea (OSA) patients who had nose, palate, and/or tongue surgery included in the study. DISE was performed in only one group. Results There were 170 patients in the DISE group and 156 patients in no‐DISE group. The mean preoperative body mass index (BMI) for the DISE group was 27.6 ± 4.6, whereas in the no‐DISE group it was 28.1 ± 3.9 (P = .23). The mean preoperative systolic blood pressure (SBP) for the DISE group was 130.4 ± 16.7, whereas in the no‐DISE group it was 142.9 ± 15.5 (P < .001). The mean preoperative diastolic blood pressure (DBP) for the DISE group was 81.4 ± 9.7, whereas in the no‐DISE group it was 89.1 ± 9.7 (P < .001). The mean preoperative apnea‐hypopnea index (AHI) for the DISE group was 32.6 ± 18.8, whereas in the no‐DISE group it was 33.7 ± 19.6 (P = .61). The mean postoperative AHI for the DISE group was 15.9 ± 12.6, whereas in the no‐DISE group it was 13.2 ± 8.8 (P = .023). The age‐, gender‐, BMI‐adjusted percentage change in AHI for the DISE group was −48.4 ± 31.9, whereas in the no‐DISE group it was −59.8 ± 18.6 (P < .001). The age‐, gender‐, and BMI‐adjusted success rate for the DISE group was 66.5%, whereas in the no‐DISE group it was 80.8% (P = .004). The age‐, gender‐, and BMI‐adjusted change in SBP for the DISE group was −6.1 ± 8.6, whereas in the no‐DISE group it was −13.3 ± 11.1 (P < .001). The age‐, gender‐, and BMI‐adjusted change in DBP in the DISE group was −5.2 ± 12.1, whereas in the no‐DISE group it was −12.4 ± 11.7 (P < .001). The mean age‐ and gender‐adjusted change in BMI for the DISE group was −4.6 ± 12.9, whereas in the no‐DISE group it was −6.3 ± 18.5 (P = .34). The Cohen effect of BMI on the overall AHI, lowest oxygen saturation, and blood pressure changes was 0.08. Conclusions DISE may not significantly affect surgical success in OSA. Level of Evidence 2c Laryngoscope, 130:551–555, 2020
To evaluate the success rates of combined Expansion Sphincter Pharyngoplasty and the Anterior Palatoplasty in the treatment of OSA. A two center prospective series of 73 patients with OSA. All patients were [18 years old, retro-palatal obstruction, concentric velo-pharyngeal collapse, BMI \ 33, Friedman clinical stage II, with all grades of AHI. The procedure involved the anterior palatoplasty, tonsillectomy and expansion sphincter pharyngoplasty with or without nasal surgery. There were 68 men and 5 women, the mean age was 46.8 years old (range of 25-67 years), mean BMI was 25.5 (range of 20.3-31.2). All patients had pre-operative and post-operative PSG. The AHI improved in all patients, mean AHI improved from 26.3 ± 17.7 to 12.6 ± 5.8 (p \ 0.001). There were 20 mild OSA, 33 moderate OSA and 20 severe OSA patients. Twenty-three patients had preoperative DISE, and 61 patients had nose/palate surgery, while only 12 had palate surgery alone. The overall success rate (50 % reduction and AHI \ 20) was 86.3 %. The mean snore scores (VAS) improved from 8.8 ± 1.2 to 2.0 ± 1.3 (p \ 0.001). The mean Epworth score improved from 11.5 ± 2.2 to 2.9 ± 2.1 (p \ 0.001). Lowest oxygen saturation also improved in all patients. Subjectively, all the patients felt less tiredness. Pre-operative DISE assessment did not seem to confer any advantage over the patients who had no pre-operative DISE (p = 0.027), and patients who had nose/palate surgery seemed to have better success rates compared to those who only had palate surgery (p = 0.081). This combined technique has been shown to be effective in selected group of OSA patients. Level of evidence IV.
Better understanding of the upper airway and objective airway evaluation diagnostic techniques and innovative palate surgeries have improved success rates of OSA surgery.
Objectives/Hypothesis: To investigate long-term complications of newer reconstructive palate surgery techniques. Study Design: Retrospective case-series analysis. Methods: Retrospective six-country clinical study of OSA patients who had nose and palate surgery. Results: There were 217 patients, mean age = 43.9 AE 12.5 years, mean body mass index = 25.9 AE 4.7, mean preoperative apnea-hypopnea index [AHI] = 30.5 AE 19.1, follow-up 41.3 months. A total of 217 palatal procedures were performed, including 50 expansion sphincter pharyngoplasties (ESP), 34 functional expansion pharyngoplasties (FEP), 40 barbed reposition pharyngoplasties (BRP), 64 modified uvulopalatopharyngoplasties (mUPPP), 11 uvulopalatal flap procedures (UPF), nine suspension pharyngoplasties (SP), eight relocation pharyngoplasties (RP), and one z-pharyngoplasty (ZPP). Complications included were constant and/or felt twice per week; dry throat (7.8%), throat lump feeling (11.5%), throat phlegm (10.1%), throat scar feeling (3.7%), and difficulty swallowing (0.5%). Of the 17 patients who had a dry throat complaint, two were constant (one SP, one RP), 15 were occasional (10 mUPPP, three SP, two BRP). Of the 25 patients with the throat lump feeling, four were constant (three RP, one ZPP), 21 were occasional (10 mUPPP, five SP, five UPF, one BRP). Of the 22 patients with the throat phlegm feeling, four were constant (two SP, two RP), 18 were occasional (10 mUPPP, four BRP, two FEP, two SP). Of the eight patients with throat scar feeling, eight were occasional (four SP, two mUPPP, one FEP, one RP), none were constant. One patient had difficulty swallowing (RP procedure). There was no velopharyngeal incompetence, taste disturbance, nor voice change. Highest symptom complaints were mUPPP, SP, and RP, whereas the lowest symptom complaint was ESP.Conclusions: Newer palatal techniques have shown to have less long-term complications compared to the older ablative techniques.
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