Transpalatal advancement pharyngoplasty for obstructive sleep apnea: a systematic review and meta-analysis

Volner, Keith; Dunn, Brandyn; Chang, Edward T.; Song, Sungjin A.; Liu, Stanley Yung‐Chuan; Brietzke, Scott E.; O’Connor, Peter; Camacho, Macario

doi:10.1007/s00405-016-4121-3

Cited by 11 publications

(17 citation statements)

References 45 publications

(32 reference statements)

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“…The available evidence on TPA as a standalone procedure was reviewed in a meta-analysis 8 and showed a significant reduction in AHI and LSAT. Unfortunately, they did not report on subjective sleep symptoms.…”

Section: Discussionmentioning

confidence: 99%

Causative Factors for Complications in Transpalatal Advancement

Chan

Kitpornchai

MacKay

2019

Ann Otol Rhinol Laryngol

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Introduction: Transpalatal advancement (TPA) is a procedure that is used when modern variants of uvulopharyn-gopalatoplasty are unable to provide enough anterior traction. Although successful in reduction of obstructive sleep apnea (OSA) parameters, it also comes with procedure-specific risks. Formation of an oro-nasal fistula (ONF) is a complication that results in significant morbidity and a protracted treatment course. Methods: After approval from the University of Wollongong Health Research Ethics Committee, a retrospective chart review of all cases undergoing TPA performed by a single surgeon over a 10-year period from 2008 to 2018 was performed. Patients underwent pre- and postoperative level 1 or 2 polysomnography. Factors potentially contributing to palatal complications, as well as pre- and postoperative polysomnographic parameters, subjective sleep questionnaires, and body mass index (BMI) were statistically analyzed where a P value <.05 was considered a significant result. Results: A total of 59 patients were included. Overall palatal complication rate was 25.4% (15/59), with the most common being transient velo-palatal insufficiency (VPI) (8/59, 13.6%). ONF developed in 4/59 (6.8%) of patients. None of the analyzed contributing factors for palatal complications were statistically significant, except the presence of a high-arched palate and development of ONF. All analyzed sleep parameters, as well as BMI, were significantly different when comparing pre- to postoperative results. Conclusion: This study suggests that TPA has a role in current sleep surgery paradigms and can significantly improve both objective and subjective outcome measures of OSA. Surgeons contemplating TPA on patients with high-arched hard palates should do so with caution.

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Section: Discussionmentioning

confidence: 99%

Causative Factors for Complications in Transpalatal Advancement

Chan

Kitpornchai

MacKay

2019

Ann Otol Rhinol Laryngol

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“…39,40 Transpalatal advancement pharyngoplasty can also be performed to provide further anterior re-positioning of the soft palate when required. 41…”

Section: Surgery For the Palatementioning

confidence: 99%

“…47 Hard tissue surgery Maxillo-mandibular advancement (bi-max) surgery is a proven, effective global airway procedure. 48 It is performed either as 'phase II surgery' after the above interventions or, in cases of severe skeletal deficiency, earlier in treatment paradigms. 48…”

Section: Tongue Surgerymentioning

confidence: 99%

“…48 It is performed either as 'phase II surgery' after the above interventions or, in cases of severe skeletal deficiency, earlier in treatment paradigms. 48…”

Section: Tongue Surgerymentioning

confidence: 99%

“…Hypoglossal nerve stimulation (HGNS) has been described as a surgically implantable, medically titratable device for treatment of OSA. 48,49 Commercially available HGNS has been accessible for years elsewhere in the world, 50 but remains at the clinical trials stage in Australia.…”

Section: Future Directionsmentioning

confidence: 99%

See 2 more Smart Citations

An update on the current management of adult obstructive sleep apnoea

et al. 2019

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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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Transpalatal advancement pharyngoplasty for obstructive sleep apnea: a systematic review and meta-analysis

Cited by 11 publications

References 45 publications

Causative Factors for Complications in Transpalatal Advancement

Causative Factors for Complications in Transpalatal Advancement

An update on the current management of adult obstructive sleep apnoea

International Consensus Statement on Obstructive Sleep Apnea

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