Modified Expansion Sphincter Pharyngoplasty for Treatment of Children With Obstructive Sleep Apnea

Abstract

Modified ESP provided objective clinical improvement of OSA in children with severe OSA and lateral pharyngeal wall collapse and might serve as an effective alternative to TA for treatment of OSA.

Combined Expansion Pharyngoplasty and Anterior Palatoplasty for the Treatment of OSA

“…By combining the use of cautery The difference was noted in these two groups, but may be attributed to the drop in BMI in the No DISE group of 6.7, compared to the DISE group where there was a gain of 0.5 (p \ 0.001) with the principles of the laser palatoplasty technique and the creation of a horizontal denuded mucosal strip on the soft palate, with the suturing/closure of this horizontal strip, this technique is able to move the soft palate anteriorly and superiorly, while opening up the anterior-posterior velopharyngeal space. This technique is aimed at opening up the retropalatal area by transposing the soft palate anteriorly; this is similar to advancing the entire palate forwards, as with the Woodson's transpalatal advancement pharyngoplasty [14], however, without the bone surgery, and with less resulting morbidity and a much lower risk of oro-nasal fistula. In 2007, Pang et al [6] had showed an 82.6 % success rate (with 50 % reduction of pre-operative AHI and AHI \ 20) in their randomized controlled clinical trial.…”

“…The authors had also showed that the success rate (with 50 % reduction of pre-operative AHI and AHI \ 20) of the expansion pharyngoplasty was 90 % [17]. Ulualp et al [14] performed the modified expansion pharyngoplasty technique on 50 matched children with severe OSA. They demonstrated that the success rate of the modified expansion pharyngoplasty technique group for a post-operative AHI \ 5 was 80 %, while compared to traditional adeno-tonsillectomy group for a post-operative AHI \ 5 was only 60 % [14].…”

“…Ulualp et al [14] performed the modified expansion pharyngoplasty technique on 50 matched children with severe OSA. They demonstrated that the success rate of the modified expansion pharyngoplasty technique group for a post-operative AHI \ 5 was 80 %, while compared to traditional adeno-tonsillectomy group for a post-operative AHI \ 5 was only 60 % [14]. Sorrenti and Piccin [13] demonstrated in 85 patients with OSA, who had the functional expansion pharyngoplasty technique done, a reduction from pre-operative mean AHI 33.3 to post-operative mean AHI 11.7; and an encouraging success rate (with 50 % reduction of pre-operative AHI and AHI \ 20) of 89.2 %.…”

“…There have been some modifications of the expansion pharyngoplasty technique, namely the Functional Expansion Pharyngoplasty [13,14] and the Modified Expansion Pharyngoplasty [14], both being similar and fundamentally alike (with the crucial isolation of the palatopharyngeus muscle and its rotation antero-supero-laterally). Both techniques describe the use of a tunneling method of mobilizing the palatopharyngeus muscle antero-superolaterally through an incision made on the anterior surface of the soft palate, just medial to the last upper molar on their respective sides [13,14].…”

“…Both techniques describe the use of a tunneling method of mobilizing the palatopharyngeus muscle antero-superolaterally through an incision made on the anterior surface of the soft palate, just medial to the last upper molar on their respective sides [13,14].…”