Swallowing evaluation after surgery for obstructive sleep apnea syndrome: uvulopalatopharyngoplasty vs. expansion pharyngoplasty

Corradi, Anne M. B.; Valarelli, Liciane Pinelli; Grechi, Thaís H.; Éckeli, Alan Luiz; Aragon, Davi Casale; Küpper, Daniel; Almeida, Lucas Ferreira de; Sander, Heidi H.; Trawitzki, Luciana Vitaliano Voi; Valera, Fabiana Cardoso Pereira

doi:10.1007/s00405-018-4898-3

Cited by 14 publications

(20 citation statements)

References 18 publications

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“…Other authors have shown that asymptomatic OSA patients might also have altered swallowing patterns before surgery. 16 They investigated 17 OSA patients with objective swallowing videofluoroscopy before and after surgery and found that both UPPP and expansion pharyngoplasty were related to transitory changes in swallowing biomechanics. However, complete or partial reversal to preoperative swallowing parameters occurred already 1 month after both techniques.…”

Section: Discussionmentioning

confidence: 99%

Long‐term evaluation of satisfaction and side effects after modified uvulopalatopharyngoplasty

2019

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Objectives/Hypothesis: We have previously shown that modified uvulopalatopharyngoplasty (UPPP) is effective to treat obstructive sleep apnea (OSA) and that the effect is stable after 24 months. This continuous report includes questionnaires and phone interviews.Study Design: Prospective intervention study. Methods: Sixty-five patients with apnea-hypopnea index (AHI) score ≥ 15, body mass index <36 kg/m 2 , and Epworth Sleepiness Scale (ESS) score ≥ 8 underwent modified UPPP after failing nonsurgical treatment. The results from a patient questionnaire at 6 and 24 months after surgery were correlated with age, body mass index, and ESS and AHI scores. Patients reporting side effects and/or regretting the surgery after 24 months were selected for phone interviews 9 years after surgery.Results: The response rate was 80% and 74% at the 6-and 24-month follow-ups, respectively. Of those who responded to the questionnaire, 96% and 83% were satisfied after 6 and 24 months, respectively; 98% and 92% recommended the surgery. Side effects (globus, mucus, and voice and swallowing disorders) occurred in 38% and 31%, respectively. Dissatisfaction correlated significantly with high postoperative AHI and ESS scores, but not with occurrence of side effects. Younger subjects had a higher rate of recommendation and lower rate of side effects than did older subjects. Phone interviews after 9 years were responded to by 14 of 16 selected patients, and the responders reported minor or no side effects.Conclusions: The vast majority of the OSA patients were satisfied 24 months after surgery, even though a third of them were experiencing side effects. Younger patients had fewer side effects than did older patients. Patients with better OSA outcomes were also more satisfied. After 9 years the side effects were no longer problematic.

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Section: Discussionmentioning

confidence: 99%

Long‐term evaluation of satisfaction and side effects after modified uvulopalatopharyngoplasty

2019

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“…UPPP and other previous palatal surgery techniques (e.g., LAUP, UPF) for OSA were based on ablative techniques to remove the uvula and a significant amount of soft palate tissue. Over the years, these procedures were associated with a high incidence of unfavorable postoperative complications and morbidities [13][14][15][16]. In the short and long term, the most typical problems reported in these patients were dysphagia, rhinolalia, velopharyngeal insufficiency and nasopharyngeal regurgitation, phlegm in throat, and abnormal scarring with velopharyngeal stenosis [13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

“…Another important aspect to keep in mind is postoperative pain, especially during swallowing [12][13][14]. These complications were often reported for UPPP and laser-assisted uvulopalatoplasty (LAUP) where major palate resections were performed [15,16]. On the other hand, lateral pharyngoplasty techniques would seem to have a lower incidence of these postoperative complications [12,13].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Subjective Outcomes of Barbed Reposition Pharyngoplasty for Obstructive Sleep Apnea Syndrome Treatment

Iannella

Vallicelli

Magliulo

et al. 2020

IJERPH

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Background: The purpose of this study was to evaluate long-term subjective outcomes of barbed reposition pharyngoplasty for obstructive sleep apnea syndrome (OSAS) treatment using a specific questionnaire, the Palate Postoperative Problem Score (PPOPS). Methods: 140 patients who underwent barbed reposition pharyngoplasty (BRP) surgery in the Morgagni Pierantoni Hospital of Forlì, Italy were enrolled in the study. Postoperative outcomes were evaluated in a short- and long-term follow-up using the PPOPS questionnaire. The average period of follow-up was 26 months. All patients received the PPOPS questionnaire by telephone in a period between April and August 2019. Results: 51% of patients complained of swallowing problems after surgery. In 91% of cases, the problem cleared up spontaneously. At the time of the interview, only 9% of patients had a residual swallowing difficult. At the time of PPOPS evaluation, rhinolalia was observed in 8% of patients, whereas nose regurgitation was present in 2% of patients. In 20% of patients, the foreign body sensation was present during follow-up. The value of apnea–hypopnea index (AHI) reduced from the preoperative value of 31.5 to the postoperative value of 11.4. Conclusions: BRP surgery proved to be an effective technique, appreciated by the majority of patients. Use of the PPOPS questionnaire has demonstrated that the BRP technique seems to ensure efficacy and lower morbidity, with few complications after surgery.

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“…Palate procedures such as UPPP and expansion sphincteroplasty have been demonstrated to increase hyoid movement time, increase duration of food stasis in the hypopharynx, and decrease pharyngeal constriction time. 5 Patients who underwent transoral robotic tongue base reduction surgery for OSA have exhibited findings of vallecular residue and early spillage, presumably from postoperative changes leading to decreased base of tongue sensitivity from neural damage as well as postoperative scarring. Postoperative dysphagia can present both in the immediate postoperative period and in late stage follow-up.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Upper Airway Stimulation on Swallowing Function

et al. 2019

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Objective: To evaluate the impact of upper airway stimulation therapy (UAS) on swallowing function in patients with obstructive sleep apnea. Study Design: Prospective cohort study. Setting: Academic medical center. Participants and Outcome Measures: We recorded demographic, preoperative polysomnogram (PSG), operative, and postoperative PSG data. We assessed the patients swallowing function using the Eating Assessment Tool (EAT-10) dysphagia questionnaire. This was administered both pre- and postoperatively. The postoperative EAT-10 survey was administered at least 3 months after UAS implantation. Results: During the study period, 27 patients underwent UAS implantation, completed the pre- and postoperative EAT-10 questionnaire, met inclusion/exclusion criteria, and were included in the study. The cohort consisted of 16 men and 11 women with a mean age of 63.63 years. The mean preoperative BMI, Epworth Sleepiness Scale (ESS), and Apnea Hypopnea Index (AHI) were 29.37, 10.33, and 34.90, respectively. The mean postoperative ESS and AHI were 5.25 and 7.59, respectively. These were both significantly lower than the preoperative values ( P = .026 and P < .001). The mean pre- and postoperative EAT-10 scores were 0.37 and 0.22, respectively ( P = .461). Conclusion: Our data suggest that UAS likely does not lead to postoperative dysphagia.

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Swallowing evaluation after surgery for obstructive sleep apnea syndrome: uvulopalatopharyngoplasty vs. expansion pharyngoplasty

Abstract: OSAS patients show sub-clinical changes in swallowing pattern before surgery. Both surgical techniques are related to transitory changes in swallowing biomechanics. Complete or partial reversal to pre-operative swallowing parameters occurs 1 month after both surgery techniques.

Cited by 14 publications

References 18 publications

Long‐term evaluation of satisfaction and side effects after modified uvulopalatopharyngoplasty

Long‐term evaluation of satisfaction and side effects after modified uvulopalatopharyngoplasty

Long-Term Subjective Outcomes of Barbed Reposition Pharyngoplasty for Obstructive Sleep Apnea Syndrome Treatment

The Impact of Upper Airway Stimulation on Swallowing Function

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