Management of pharyngeal collapse in patients affected by moderate obstructive sleep apnoea syndrome

Abstract

SUMMARY Objective This study reports our experience in a selected cohort of patients affected by mild-moderate OSAS, without tonsillar obstruction, and treated with pharyngoplasty. Methods In a case-control retrospective study, we compared modified expansion sphincter pharyngoplasty (MESP) to modified barbed reposition pharyngoplasty (MBRP) in adult patients with oropharyngeal transversal collapse with a BMI ≤ 30 kg/m 2 , and mild-moderate obstructive sleep apnoea syndrome (OSAS). A clinical evaluation, including collection of anthropometric data and sleep endoscopy, was performed. Six months after surgery, symptoms recording, clinical evaluation and polysomnography (PSG) were repeated. Results We enrolled 20 patients: 10 treated with MESP and 10 treated with MBRP. Mean apnoea-hypoapnoea index (AHI) was 22.8 (± 5.63). We observed in both groups a significant reduction of AHI and oropharyngeal obstruction (p = 0.01), with a success rate, according with Sher’s criteria, of 90% for MESP and 80% for MBRP, respectively. Post-surgical pain and snoring reduction were significantly lower with MBRP. Conclusions We recorded similar success rates for both techniques. MBRP may be considered better than MESP due to less surgical time, no potential mucosal damage, absence of knots, and faster recovery with less pain.

Comparative Efficacy of Velopharyngeal Surgery Techniques for Obstructive Sleep Apnea: A Systematic Review

“…For the BRP technique, the surgical success rate ranged between 66% and 86.6%, with the best outcomes in the majority of studies. However, it achieved similar outcomes compared with the modified ESP described by Lorusso et al (80% vs. 90%) [ 14 ] and with ESPwAP analyzed by Babademez et al (86.6% vs. 84.9%) [ 19 ]. The success rate of the ESP technique ranged from 64.81% to 90%.…”

“…Table 1 provides a synthesis of the main features of the studies included ( Table 1 ). The majority of included studies were retrospective [ 14 , 15 , 16 , 17 , 18 , 19 ], while two of them were prospective [ 20 , 21 ]. The sample size of each study exhibited variability, with the number of subjects ranging from 20 [ 14 ] to 122 [ 18 ].…”

“…The majority of included studies were retrospective [ 14 , 15 , 16 , 17 , 18 , 19 ], while two of them were prospective [ 20 , 21 ]. The sample size of each study exhibited variability, with the number of subjects ranging from 20 [ 14 ] to 122 [ 18 ]. The total count of patients who underwent velopharyngeal surgery across all studies was 614, for which uvulopalatopharyngoplasty (UPP) and variations in the technique (m-UPP, RF-UPP) were described and performed in four studies (209 patients), anterior palatoplasty (AP) in two studies (52 patients), uvulopalatoflap placement in one study (23 patients), and lateral pharyngoplasty (LP/CLP) in two studies (41 patients).…”

“…Table 3 provides a summary of the number of patients who experienced complications in each study, along with their corresponding citations. Lorusso et al [ 14 ] described a persistent feeling of a foreign body in the throat, both in MESP and MBRP, that disappeared after a few months, and suggested the pain was more prolonged in the MESP group. Additionally, two cases of early bleeding were described.…”

“…A recent review concluded that the VOTE classification was the preferred scoring system among different studies [ 25 ]. Two studies in our review used VOTE classification during DISE in assessing surgical plans and operative indications [ 16 , 19 ], and one study used NOHL grading [ 14 ], while the others did not mention any DISE criteria for patient selection. Nevertheless, only Lorusso et al [ 14 ] conducted a post-surgical DISE to assess the impact of palatopharyngeal surgery on the upper airway space and confirm the appropriate selection of patients [ 14 ].…”