Impact of Minimally Invasive Multilevel Surgery on Mild/Moderate OSA

Salapatas, Anna M.; Bonzelaar, Lauren B.; Hwang, Michelle S.; Goyal, Vinay; Bakhsheshian, Joshua; Ellenberg, Elie C.; Friedman, Michael

doi:10.1177/0194599816651240

Cited by 12 publications

(22 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results are consistent with previous studies of surgical outcomes from soft-palate webbing flap pharyngoplasty [10,20] that also concluded that it is an effective approach to improve sleep parameters, snoring intensity, and subjective symptoms such as breathing improvement, better sleep quality, and lower snoring volume in OSA. However, we provide a different surgical concept whether tonsillectomy need to be included for correction of lateral pharyngeal wall collapse.…”

Section: Discussionsupporting

confidence: 92%

“…Actually, complete lateral pharyngeal wall narrowing may be closely related to higher apnea-hypopnea index (AHI) scores, and excessive lateral pharyngeal collapsibility is seen in subjects with OSA who show a relapse of snoring or apneic events after surgery [13,14]. Previous clinical research has demonstrated the clinical benefits of palatal surgeries for OSA with lateral pharyngeal wall collapse, including relief of subjective symptoms and improvement of sleep parameters [8][9][10], and diverse surgical techniques such as lateral pharyngoplasty, relocation pharyngoplasty, and expansion sphincter pharyngoplasty (ESP) to improve lateral pharyngeal wall narrowing and intensify the stability of the lateral pharyngeal wall have been introduced [13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Optimal application of soft-palate webbing flap pharyngoplasty combined with nasal surgery for surgical treatment of primary snoring and obstructive sleep apnea

et al. 2022

View full text Add to dashboard Cite

Background Excessive collapse of the soft palate and lateral pharyngeal wall narrowing are established causes of loud snoring and sleep apnea in subjects with obstructive sleep apnea (OSA). Therefore, delicate surgical techniques are needed to reshape the soft palate and create sufficient tension in the lateral pharyngeal wall. This study aimed to determine the therapeutic outcome and favorable indications of soft-palate webbing flap pharyngoplasty in subjects with OSA and primary snoring. Methods A total of 174 subjects who underwent soft-palate webbing flap pharyngoplasty combined with uvulopalatal flap and septoturbinoplasty from August 2015 to February 2020 were included in this study. Medical records, including pre- and postoperative sleep parameters, were retrospectively reviewed. The primary outcome measure was the degree of improvement in AHI after surgery. Other outcomes were differences in surgical response rates, subjective visual analog score (VAS) for snoring, sleep quality, and complications. Results Polysomnographic results showed that apnea–hypopnea index (AHI) scores were significantly reduced from 39.6 ± 6.1 to 22.9 ± 3.6 following soft-palate webbing flap pharyngoplasty in 59 subjects, and overall success and response rates of this technique were analyzed with 71%. We found that the successful outcomes were observed in 50% of mild (n = 12) and 56% of moderate (n = 16) subjects with OSA subjects due to lateral pharyngeal wall collapse. The success rate of soft-palate webbing flap pharyngoplasty was relatively higher in subjects with mild and moderate OSA than those with severe OSA. Additionally, the mean VAS snoring scale was 4.7 and subjects’ primary snoring intensity significantly improved to 2.9 after soft-palate webbing flap pharyngoplasty. Subjective symptoms such as daytime sleepiness and sleep quality also showed improvement. Most complications were found to be minimal and improved by 1 month after the operation. Conclusion Our data demonstrate that soft-palate webbing flap pharyngoplasty is an effective treatment for OSA and primary snoring and may be a promising technique to reduce lateral pharyngeal wall collapse.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Optimal application of soft-palate webbing flap pharyngoplasty combined with nasal surgery for surgical treatment of primary snoring and obstructive sleep apnea

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Other minimally invasive techniques are not useful in severe OSA patients 28 . In particular, transoral endoscopic techniques have <30% success with a relatively high risk of complications (5–25%) 12 .…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have demonstrated clinical benefits of sleep surgeries, including relief from both subjective symptoms and life-threatening conditions 9–11 . Diverse surgical techniques have been introduced to correct abnormal upper airway narrowing and the addition of new surgical options can potentially improve the therapeutic outcomes 11,12 .…”

Section: Introductionmentioning

confidence: 99%

Robot-assisted Tongue Base Resection ensures favorable therapeutic outcome to Obstructive Sleep Apnea patients with Lingual tonsil hypertrophy

Cho

Hong

Han

et al. 2019

Sci Rep

View full text Add to dashboard Cite

Tongue base (TB) narrowing is recognized as a significant site of upper airway collapse during sleep in obstructive sleep apnea (OSA) patients and robot technology is expected to have promising clinical utility in OSA patients with TB narrowing. The purpose of our study is to demonstrate the better therapeutic conditions and favorable indications of robot-assisted TB resection (TBR) in OSA. We performed robot-assisted TBR combined with nasal and palatal surgery in 16 OSA patients with any of the following characteristics: severe TB narrowing (over grade II) and moderate or severe OSA. The preoperative median AHI was 48.8/hr and the median lowest SaO2 was 82.0%. The median AHI decreased to 18.7/hr and ten patients (62.5%) were included in the responder group following robot-assisted TBR combined with nasal and palatal surgery. The lowest SaO2 improved to 90.5% and the posterior airway space (PAS) was significantly increased following robot-assisted TBR. Cephalometric results showed that wider PAS were observed in responders compared to non-responders prior to robot-assisted TBR. Interestingly, there was greater improvement in the objective parameters including PAS in the OSA patients with lingual tonsilar hypertrophy than they were in those without and all patients with lingual tonsillar hypertrophy (n = 6) responded to robot-assisted TBR. Robot-assisted TBR exhibited minimal morbidity and postoperative complications in OSA patients. Robot-assisted TBR can be considered a promising and innovative surgical option to reduce TB volume and improve sleep parameters in OSA patients with TB narrowing. OSA patient with TB narrowing due to lingual tonsil hypertrophy shows greater therapeutic outcome and lingual tonsil hypertrophy appears to be most favorable surgical indications of robot-assisted TBR.

show abstract

“…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,…”

mentioning

confidence: 99%

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

Kim

Pyo

et al. 2020

Sci Rep

View full text Add to dashboard Cite

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 ...

show abstract

Impact of Minimally Invasive Multilevel Surgery on Mild/Moderate OSA

Cited by 12 publications

References 32 publications

Optimal application of soft-palate webbing flap pharyngoplasty combined with nasal surgery for surgical treatment of primary snoring and obstructive sleep apnea

Optimal application of soft-palate webbing flap pharyngoplasty combined with nasal surgery for surgical treatment of primary snoring and obstructive sleep apnea

Robot-assisted Tongue Base Resection ensures favorable therapeutic outcome to Obstructive Sleep Apnea patients with Lingual tonsil hypertrophy

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

Contact Info

Product

Resources

About