Tonsil size and outcome of uvulopalatopharyngoplasty with tonsillectomy in obstructive sleep apnea

Tschopp, Samuel; Tschopp, Kurt

doi:10.1002/lary.27899

Cited by 14 publications

(15 citation statements)

References 23 publications

(59 reference statements)

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“…37 In patients who received UPPP, AHI reduction was significantly greater when the resected tonsil volume was greater. 38 Langin et al also confirmed the correlation between greater oropharynx space in images and improvement in the AHI following UPPP. 39 In this study, greater resected BOT volume and better improvement in AHI were strongly correlated.…”

Section: Discussionmentioning

confidence: 83%

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Quantification of the Impact of Intraoperative Ultrasound in Transoral Robotic Tongue Base Reduction

Hsu

Hsiao

et al. 2021

The Laryngoscope

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Objectives/Hypothesis Transoral robotic surgery (TORS) in the base of the tongue (BOT) reduction has been shown to decrease the apnea‐hypopnea index (AHI) and improve daytime sleepiness in obstructive sleep apnea (OSA) patients. Intraoperative ultrasound (IOU) can be employed to guide the surgery and prevent massive bleeding. Study Design Cohort study with historical control. Methods A cohort study to compare the outcomes between OSA patients who received TORS with and without IOU assistance. Results From 2016 to 2019, this study enrolled 80 OSA patients who underwent TORS in BOT: 57 in the IOU(+) and 23 in IOU(−) groups. The TORS with IOU presented with shorter operative time, less blood loss, and greater excised BOT volume. The IOU(+) group had greater improvement in the AHI and subjective questionnaire evaluation. The excised volume of BOT was significantly associated with the change in AHI. Conclusion The IOU could improve outcomes in BOT reduction surgery without raising the risk of surgical complications. Level of Evidence 4 Laryngoscope, 132:1125–1131, 2022

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Section: Discussionmentioning

confidence: 83%

“…Greater volume of BOT removed was predictive of surgical success 37 . In patients who received UPPP, AHI reduction was significantly greater when the resected tonsil volume was greater 38 . Langin et al also confirmed the correlation between greater oropharynx space in images and improvement in the AHI following UPPP 39 .…”

Section: Discussionmentioning

confidence: 93%

Quantification of the Impact of Intraoperative Ultrasound in Transoral Robotic Tongue Base Reduction

Hsu

Hsiao

et al. 2021

The Laryngoscope

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“…A PT grading scale has been used to predict OSA severity and the efficacy of tonsillectomy in treating OSA. A higher grade, which corresponds with larger and more exophytic tonsils, corresponds with higher preoperative AHI values and a more significant reduction in AHI after removal 1669,1671 . A small series noted improvement in AHI in selected patients with small tonsils after tonsillectomy 1672 .…”

Section: Surgical Treatment For Osamentioning

confidence: 97%

International Consensus Statement on Obstructive Sleep Apnea

Chang

Goldberg

Alt

et al. 2023

Int Forum Allergy Rhinol

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Background: Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). Methods: Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidencebased review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. Results: The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. Conclusion:This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Tonsil size and outcome of uvulopalatopharyngoplasty with tonsillectomy in obstructive sleep apnea

Cited by 14 publications

References 23 publications

Quantification of the Impact of Intraoperative Ultrasound in Transoral Robotic Tongue Base Reduction

Quantification of the Impact of Intraoperative Ultrasound in Transoral Robotic Tongue Base Reduction

International Consensus Statement on Obstructive Sleep Apnea

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

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