The clinical efficacy of relocation pharyngoplasty to improve retropalatal circumferential narrowing in obstructive sleep apnea patients

Abstract

Lateral pharyngeal wall appears to be a critical culprit of obstructive sleep apnea (OSA) subjects and relocation pharyngoplasty has been expected to be a promising surgical option to correct retropalatal circumferential narrowing in OSA patients. The purpose of our study is to evaluate the therapeutic outcomes of relocation pharyngoplasty and its clinical effectiveness in OSA patients with retropalatal circumferential narrowing. We performed relocation pharyngoplasty combined with nasal surgery in 133 OSA patients with the following characteristics: apnea-hypopnea index (AHI) over 10, retropalatal circumferential narrowing greater than grade I when awake, and redundant soft tissue around the lateral pharyngeal wall. The analysis of surgical success rate was performed with the data of 68 subjects who underwent pre and postoperative polysomnography. The objective success rate of relocation pharyngoplasty was 52.9%, and significant reduction of mean AHI with improvement of lowest SpO2 was seen in 69% of patients 3 months after the surgery. The median AHI was decreased from preoperative 37.3 to postoperative 21.4. Median lowest SpO2 changed from 78.4 to 84.1%. Total sleep time, daytime sleepiness, and visual analogue scale for snoring showed improvement as well. Postoperative complications including pain or bleeding were minimal in 133 subjects and a few patients complained of subtle taste loss. Our data demonstrate that relocation pharyngoplasty can be a favorable surgical option fighting against retropalatal circumferential narrowing.Obstructive sleep apnea (OSA) is a common sleep disorder characterized by upper-airway collapse that causes reduction or cessation of airflow during sleep. Clinically, abnormal anatomy in the upper airway is obvious in OSA patients and reduced airflow from the nasal cavity and narrowing of the upper airway increase negative pressure in the pharyngeal airway and predispose the pharynx to collapse 1,2 . Both upper airway narrowing and increased airway resistance reportedly contribute to the underlying pathogenesis of OSA, leading to sleep-related symptoms such as loud snoring, apnea, fatigue, daytime sleepiness and systemic complications if not properly treated [3][4][5][6][7][8] . OSA occurs due to fixed or dynamic upper-airway obstruction caused by anatomical factors or abnormal upper-airway motor tone, and upper-airway obstruction can be caused by collapse at multiple levels, such as the soft palate, uvula, palatine tonsils, lateral pharyngeal walls, and base of the tongue 5,9 . A palatal pattern of collapse is most frequent and numerous surgical techniques have been designed to modify the palate anatomy in OSA patients 10 . Palatal surgeries for OSA aim to correct the pharyngeal tissues narrowing the upper airway, enhance the tension of the pharyngeal muscle, and widen the pharyngeal lumen. Multiple studies have demonstrated the clinical benefits of palatal surgeries, including relief from both subjective symptoms and life-threatening conditions in OSA patients, and the addition of ...

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

“…These surgical techniques are associated with greater AHI score improvement and more effectively widen the pharyngeal lumen by reducing collapse of the lateral pharyngeal wall during sleep [13][14][15][16]. Although relocation pharyngoplasty and ESP produced better therapeutic outcomes in OSA with lateral pharyngeal wall narrowing, most subjects experienced significant pain and dysphagia immediately following surgeries because they are invasive processes that undermine the palatopharyngeus muscle and can cause uncomfortable complications, such as oronasal reflux of liquid, or taste loss [13][14][15][16][17][18].…”

“…This suggests a need for a surgical option to reduce lateral pharyngeal wall narrowing and adequate reduction of redundant tissue around the posterior pillar to provide a satisfactory therapeutic outcome. Additionally, the maintenance of lateral pharyngeal wall stability may be critical in sleep surgeries for subjects with OSA who show circumferential narrowing at the retropalatal level [ 17 , 18 ].…”

“…However, we provide a different surgical concept whether tonsillectomy need to be included for correction of lateral pharyngeal wall collapse. Bilateral tonsil hypertrophy might be one of the causes of lateral pharyngeal wall narrowing in subjects with OSA, and tonsillectomy may still be the most appropriate procedure among surgical options to improve lateral pharyngeal wall narrowing in a select group of subjects whose tonsil size is beyond grade 3 [ 17 , 18 , 30 ]. In these cases, lateral pharyngeal wall narrowing would not be effectively corrected if subjects with OSA did not undergo tonsillectomy.…”

“…Actually, complete lateral pharyngeal wall narrowing may be closely related to higher apnea-hypopnea index (AHI) scores, and excessive lateral pharyngeal collapsibility is seen in subjects with OSA who show a relapse of snoring or apneic events after surgery [13,14]. Previous clinical research has demonstrated the clinical benefits of palatal surgeries for OSA with lateral pharyngeal wall collapse, including relief of subjective symptoms and improvement of sleep parameters [8][9][10], and diverse surgical techniques such as lateral pharyngoplasty, relocation pharyngoplasty, and expansion sphincter pharyngoplasty (ESP) to improve lateral pharyngeal wall narrowing and intensify the stability of the lateral pharyngeal wall have been introduced [13][14][15][16][17][18].…”