Abstract
Objective: To explore the relationship between anatomical changes and treatment response in obstructive sleep apnea (OSA) patients with small tonsils (tonsil grades 0-2 according to Friedman staging system) after velopharyngeal surgery. Method: Thirty-six patients with small tonsils underwent velopharyngeal surgery that consisted of revised uvulopalatopharyngoplasty with uvula preservation (H-UPPP) and concomitant transpalatal advancement pharyngoplasty, 3-dimensional CT of upper airway, and polysomnography performed before and after surgery were obtained for comparison and analysis. Results: Overall apnea-hypopnea index (AHI) decreased from 56.8 (37.5, 70.1) to 16.1 (10.8, 33.5) ( P < .001) after surgery. The changes of several anatomical parameters differed significantly between responders and non-responders ( P < .05), and the change of minimal cross-sectional area of velopharynx (VmCSA) was independently predictive of the change of AHI ( P < .001, r2 = 0.271). The correlation analysis showed that the change of VmCSA significantly correlated with preoperative VmCSA ( r = −0.383, P = .021). Conclusion: In patients with small tonsils an increase in VmCSA is related to a good surgical response, and such patients who have a relatively smaller preoperative VmCSA are more likely to get favorable anatomical changes.
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