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

Abstract

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.

Minimally invasive, single‐stage, multilevel surgery for obstructive sleep apnoea: A systematic review and meta‐analysis

“…Subgroup analysis revealed that OSA patients with mild/moderate disease severity (AHI < 30) had greater improvement in AHI, snoring score, ESS, REM% and LSAT than those with severe OSA, but the generally high heterogeneity with wide and overlapped CI of the both groups potentially indicated less statistical significance. On the other hand, the success rate was substantially higher in the mild/moderate OSA group than in the severe OSA group (mild/moderate vs. severe = 46% vs. 18%), which may imply that mild disease is easier to be corrected than severe disease, and is consistent with the concept promoted by the previous literature 27,28 . However, the results of subgroup analysis according to BMI were instead not consistent.…”

“…On the other hand, the success rate was substantially higher in the mild/moderate OSA group than in the severe OSA group (mild/moderate vs. severe = 46% vs. 18%), which may imply that mild disease is easier to be corrected than severe disease, and is consistent with the concept promoted by the previous literature. 27,28 However, the results of subgroup analysis according to BMI were instead not consistent. The patients with BMI less than 27.5 had higher improvements in subjective outcomes including snoring VAS score and ESS, but the AHI improvement was higher in patients with BMI ≥ 27.5.…”

Evaluation of oropharyngeal structure and DISE findings for successful soft palatal webbing flap pharyngoplasty in obstructive sleep apnea

“…In particular, the surgical outcome of SPWFPP was not successful and AHI score was aggravated in OSA patients with lateral pharyngeal wall collapse combined with epiglottis narrowing. SPWFPP provides a favorable improvement of sleep parameters in mild OSA patients or patients with primary snoring who had lateral bulk around the posterior pillar and circumferential narrowing at the retropalatal level in our previous study 10 . However, the present study showed that SPWFPP can be applied to OSA patients in whom lateral pharyngeal wall collapse is characteristic, especially in severe OSA patients.…”

“…In our previous data, we recommended SPWFPP to mild, moderate, and severe OSA patients with more than 50% narrowing in their lateral pharyngeal wall and tonsil enlargement, and we expected greater tension required to improve lateral pharyngeal wall collapse 10 . We found that SPWFPP yielded a 42.4% success rate and a 71.2% response rate in OSA patients with lateral pharyngeal wall collapse 10 .…”

“…Moreover, the addition of surgical options that widen the palatal lumen in anterior, superior, and lateral directions potentially can improve the success rate of management of OSA patients with palatal narrowing or collapse in the upper airway. Soft palate webbing ap palatopharyngoplasty (SPWFPP) has been proposed as a surgical technique to enhance the tension of the lateral pharyngeal wall 8,9 , and its e cacy has been demonstrated for patients with mild OSA and primary snoring 10 . The main feature that differentiates SPWFPP from other surgeries to correct lateral pharyngeal wall collapse is that it increases lateral pharyngeal wall tension without tonsillectomy.…”