Abstract
To evaluate the relationships between anatomical changes and treatment outcomes after velopharyngeal surgery in obstructive sleep apnea (OSA) patients with small tonsils (grade 0-2 on the Brodsky scale). Case series with planned data collection. University medical center. Thirty-six OSA patients with small tonsils underwent velopharyngeal surgery including revised uvulopalatopharyngoplasty with uvula preservation and transpalatal advancement pharyngoplasty. Pre- and postoperative upper airway 3-dimensional computed tomography and polysomnography findings were obtained for comparison and analysis. The overall apnea hypopnea index (AHI) decreased from 56.8 (interquartile range, 37.5-70.1) preoperatively to 16.1 (10.8-33.5) postoperatively (P < .001). The change in minimal cross-sectional area of the velopharynx (VmCSA) was independently associated with the change in AHI (P = .001, R (2) = 0.271). Preoperative VmCSA was the only preoperative anatomical variable that was an independent predictor of change in VmCSA (P = .009, R (2) = 0.184). Postoperative VmCSA was independently associated with postoperative AHI (P < .001, R (2) = 0.341). In patients with small tonsils, an adequate increase in VmCSA is associated with a successful outcome after surgery. Patients with a relatively small preoperative VmCSA are more likely to have favorable anatomical changes after surgery.
Published Version
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