Lateral Pharyngeal Wall Tension After Maxillomandibular Advancement for Obstructive Sleep Apnea Is a Marker for Surgical Success: Observations From Drug-Induced Sleep Endoscopy

Liu, Stanley Yung‐Chuan; Huon, Leh-Kiong; Powell, Nelson B.; Riley, Robert; Cho, Hyunje Grace; Torre, C. de la; Capasso, Robson

doi:10.1016/j.joms.2015.01.028

Cited by 85 publications

(68 citation statements)

References 33 publications

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“…Palate surgery techniques (other than traditional uvulopalatopharyngoplasty) such as lateral pharyngoplasty, expansion sphincter pharyngoplasty, relocation pharyngoplasty, or palatal advancement pharyngoplasty may treat oropharyngeal lateral wall‐related obstruction; the present study could not examine specific palate surgery techniques. Hypoglossal nerve stimulation and maxillomandibular advancement also may address oropharyngeal lateral wall‐related obstruction. Finally, when considering treatment, there may be differences in whether the oropharyngeal lateral wall‐related obstruction may be due to tonsil tissue (easily resectable), increased muscle mass (potentially addressed with procedures that reposition muscle or muscle attachments), or fat deposition (likely less amenable to existing procedures).…”

Section: Discussionmentioning

confidence: 99%

Drug‐Induced Sleep Endoscopy and Surgical Outcomes: A Multicenter Cohort Study

et al. 2018

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Objective To evaluate the association between findings of blinded reviews of preoperative drug‐induced sleep endoscopy (DISE) examinations using the VOTE Classification and obstructive sleep apnea (OSA) surgical outcomes in a large multicenter, international cohort. Methods Retrospective, multi‐center cohort study of adults without tonsillar hypertrophy who underwent pharyngeal surgery for OSA. The study included only participants without enlarged tonsils. Four independent reviewers performed blinded review of preoperative DISE videos using the VOTE Classification system and scoring of a primary structure contributing to airway obstruction. DISE findings were examined for an association with surgical outcomes with univariate analyses and multiple regression. Results Two hundred seventy‐five study participants were included from 14 centers. Mean age was 51.4 ± 11.8 years, and body mass index was 30.1 ± 5.2 kg/m2. There was moderate interrater reliability (kappa = 0.40–0.60) for DISE findings. Oropharyngeal lateral wall‐related obstruction was associated with poorer surgical outcomes (adjusted odds ratio (AOR) 0.51; 95% CI 0.27, 0.93). Complete tongue‐related obstruction was associated with a lower odds of surgical response in moderate to severe OSA (AOR 0.52; 95% CI 0.28, 0.98), with findings that were similar but not statistically significant in other analyses. Surgical outcomes were not clearly associated with the degree and configuration of velum‐related obstruction or the degree of epiglottis‐related obstruction. Surgical response was associated with tonsil size and body mass index (inversely). Conclusion DISE findings concerning the oropharyngeal lateral walls and tongue may be the most important findings of this evaluation technique. Level of Evidence 2B Laryngoscope, 129:761–770, 2019

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Section: Discussionmentioning

confidence: 99%

Drug‐Induced Sleep Endoscopy and Surgical Outcomes: A Multicenter Cohort Study

et al. 2018

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“…Our institution's protocol has been previously discussed in detail . The subject's nasal cavity was decongested with phenylephrine 30 minutes before the procedure, and the subjects were placed in the supine position.…”

Section: Methodsmentioning

confidence: 99%

Impact of continuous positive airway pressure in patients with obstructive sleep apnea during drug‐induced sleep endoscopy

Torre

Liu

Kushida

et al. 2017

Clinical Otolaryngology

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The differential nCPAP effects observed in this study may help to understand some of the mechanisms responsible for inadequate patient response and poor nCPAP compliance. The use of DISE in combination with CPAP may serve as a first step in optimizing patients that failed to adapt to treatment with CPAP. This approach can help the physician identify patterns of airway collapse that may require varying pressures different from the one the patient is using, as well as anatomical factors that may be corrected to help with compliance.

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“…Therefore, the summary of these beneficial and adverse DISE phenotypes may be helpful in predicting treatment outcome, as the different phenotypes clearly describe the difference in collapsibility at the level of the upper airway in individual patients. Lateral pharyngeal wall collapsibility as observed during DISE has been shown to improve upon MMA surgery, and this improvement was correlated with surgical success . Serious consideration should be given to MMA surgery as a first‐line therapy in such patients according to the present findings.…”

Section: Discussionmentioning

confidence: 52%

“…Previous research states that partial collapse is more favorable to be treated successfully than complete collapse, that anteroposterior collapse is more favorable than concentric collapse, and that unilevel collapse is more favorable than multilevel collapse . Severe laterolateral collapse has been linked to treatment failure in patients receiving MAD therapy or targeted interventions with multilevel surgery such as palatopharyngoplasty and tongue base surgery . A recent study observed 15 patients with CPAP failure and CCCp as a DISE baseline collapse pattern, and all patients underwent a uvulopalatopharyngoplasty with tonsillectomy (TE‐UPPP) .…”

Section: Discussionmentioning

confidence: 99%

Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

et al. 2019

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Objectives/Hypothesis To evaluate upper airway (UA) collapse patterns during drug‐induced sleep endoscopy (DISE) and maxillomandibular advancement (MMA) surgery outcome, paying particular attention to the DISE phenotype complete concentric collapse at the level of the palate (CCCp). Study Design Prospective case series. Methods Nineteen patients diagnosed with obstructive sleep apnea (OSA) prospectively underwent mandibular advancement device (MAD) treatment followed by MMA surgery. UA collapse patterns were evaluated before and after MMA surgery. Baseline apnea‐hypopnea index (AHI) was compared with AHI during MAD treatment and after MMA surgery. UA collapse patterns and the presence of baseline CCCp were assessed. AHI differences between patients with and without CCCp after MMA surgery were compared. Results In 14 patients, a full dataset was obtained: 8/6 (male/female), mean age = 51 ± 7 years, body mass index (BMI) = 25.6 ± 3.7 kg/m2, and baseline AHI = 40.2 ± 25.6 per hour of sleep. MMA surgery reduced AHI to 9.9 ± 7.2 per hour of sleep (P = .0001). Eight patients benefited from additional AHI reduction compared to MAD treatment (P = .0113). Six out of 14 (43%) patients showed baseline CCCp. Baseline patient characteristics (age, BMI, and AHI) did not significantly differ between patients with and without CCCp. AHI was equally reduced after MMA, whether (P = .0145) or not (P = .0075) CCCp was present at baseline. All patients showed resolution of CCCp (P = .0159) during postoperative DISE. Conclusions CCCp seems not to be a negative predictor for MMA surgery outcome measured by AHI reduction. Furthermore, MMA is likely to eliminate CCCp. Therefore, MMA might be a solution for OSA patients showing CCCp and broadens the perspective for personalized medicine and combination therapy. However, a large sample is required for definitive results. Level of Evidence 4 Laryngoscope, 130:E268–E274, 2020

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Lateral Pharyngeal Wall Tension After Maxillomandibular Advancement for Obstructive Sleep Apnea Is a Marker for Surgical Success: Observations From Drug-Induced Sleep Endoscopy

Cited by 85 publications

References 33 publications

Drug‐Induced Sleep Endoscopy and Surgical Outcomes: A Multicenter Cohort Study

Drug‐Induced Sleep Endoscopy and Surgical Outcomes: A Multicenter Cohort Study

Impact of continuous positive airway pressure in patients with obstructive sleep apnea during drug‐induced sleep endoscopy

Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

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