The role of lateral pharyngoplasty in obstructive sleep apnea syndrome

Abstract

Recent studies have shown that lateral pharyngoplasty is an effective procedure to correct obstructive sleep apnea. The objective of the paper was to evaluate factors contributing to obstructive sleep apnea syndrome and identify the different severity categories of obstructive sleep apnea that could benefit from lateral pharyngoplasty. We included 60 patients undergoing uvulopalatopharyngoplasty with or without lateral pharyngoplasty from December 1, 2008 to May 31, 2012. Six who did not complete the post-operative survey were excluded. 54 participants were assigned alternatively to either uvulopalatopharyngoplasty alone (control group, n = 29) or to uvulopalatopharyngoplasty with lateral pharyngoplasty (intervention group, n = 25). The reduction of apnea-hypoxia index in the intervention group (49.3%) was higher than it was in the control group (30.4%), but the average value was not statistically significant (p = 0.088). Only patients with moderate obstructive sleep apnea in the intervention group achieved a significant reduction of apnea-hypoxia index (30.7 vs. 10.8%; p = 0.020). Factors such as body mass index, nadir/mean SpO2, snoring index, Epworth sleepiness scale and periodic limb movement index did not change significantly following lateral pharyngoplasty. To evaluate patients' upper airway anatomy, we employed cephalometry, and found that the retroglossal space played a critical role in severe obstructive sleep apnea. Our study showed that only patients in the moderate category can be benefited from adding lateral pharyngoplasty to uvulopalatopharyngoplasty; however, patients in the mild or severe category did not benefit from adding this procedure. This information is vital when considering surgery for patients with obstructive sleep apnea syndrome. Level of evidence Prospective cohort study, Level II.

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

“…In recent years, lateral pharyngeal wall collapse has been reconsidered in the OSA pathogenesis, and palatal surgical techniques have evolved from ablative techniques towards the remodeling of the pharyngeal lateral walls and enlargement of the velopharyngeal lumen [7,8].…”

“…Different authors agree that the more recent palatal surgery techniques (e.g., ESP, BRP), based on more reconstructive principles that respect the lateral pharyngeal walls and preserve some or part of the uvula, appear to have less long-term postoperative complications and morbidities [7][8][9]. Pang et al [12], analyzing the long-term complications of palatal surgery in different surgical techniques, reported that the procedures with the highest incidence of long-term complaints were the UPPP, uvulopalatal flap, and relocation pharyngoplasties, whereas the lowest symptom rate was described by patients who underwent ESP or BRP.…”

“…Although multilevel collapse of the upper airway is not rare during sleep in patients with OSA, the velopharyngeal region is believed to be the most common site of obstruction, and lateral pharyngeal wall collapse was considered a determining factor in velopharyngeal obstruction [5][6][7].…”

“…Consequently, palatal surgical techniques have changed throughout recent years from the classic uvulopalatopharyngoplasty (UPPP) to lateral pharyngoplasty techniques [6][7][8].…”

Comparison of Traditional Upper Airway Surgery and Upper Airway Stimulation for Obstructive Sleep Apnea

“…5 Since the introduction of the UPPP, further refinements of the procedure have been developed to remove redundant tissue and reconstruct and support normal anatomy, thus limiting upper airway obstruction at the level of the velum and oropharynx. [6][7][8][9][10][11][12] These interventions are commonly combined with procedures designed to eliminate obstruction at the tongue base, allowing for alleviation of multilevel upper airway obstruction. 13 Upper airway stimulation (UAS) is an alternative option for the treatment of OSA in select patients who have been unable to tolerate CPAP.…”