Anterior Palatoplasty Research Articles

Results of Anterior Palatoplasty to Treat Snoring and Obstructive Sleep Apnea

Results of Anterior Palatoplasty to Treat Snoring and Obstructive Sleep Apnea

Anterior palatoplasty as a treatment for mild and moderate obstructive sleep apnea: our experience

Abstract BACKGROUND. Obstructive sleep apnea (OSA) is characterized by frequent episodes of breathing cessation during sleep, resulting in low oxygen and high carbon dioxide levels, leading to daytime sleepnes, cognitive issues, and increased cardiovascular risk. The objective of this study was to assess the effectiveness of the anterior palatoplasty (AP) procedure in the treatment of patients with mild and moderate obstructive sleep apnea. MATERIAL AND METHODS. Sixteen patients diagnosed with mild and moderate OSA underwent AP in our clinic between 2021-2023. All patients were > 18 years old, body mass index < 30, with an apnea-hypopnea index (AHI) from 10 to 40 and disfunction of the velopharyngeal or of the retropalatal space. Patients underwent a one-night polysomnography examination prior to the surgical procedure, as well as six months after the procedure. Additionally, patients were asked to complete the Epworth Sleepiness Scale (ESS) both prior to and six months following the surgery. The procedure was done under general anaesthesia and involved AP surgery with or without reducing of the uvula. RESULTS. The average of total AHI values decreased from 28.89 per hour prior to surgery to 11.14 per hour six months after surgery. The oxygen desaturation index decreased after surgery with 2.57%. ESS scores of patients also decreased from 10.40 to 7.80 and all patients felt less tired. CONCLUSION. We believe that AP is an effective technique in the treatment of mild and moderate OSA caused by a disfunction of the velopharyngeal or retropalatal space. Additionally, we consider that AP is linked with a lower incidence of post-surgical complications compared to other surgical options.

Does Anterior Palatoplasty Performed in Addition to Expansion Sphincter Pharyngoplasty During Multilevel Surgery Affect the Results of Surgery in OSAS Patients?

Does Anterior Palatoplasty Performed in Addition to Expansion Sphincter Pharyngoplasty During Multilevel Surgery Affect the Results of Surgery in OSAS Patients?

Eustachian Tube Function Symptoms in Palatal Surgeries for OSA: 3-Month Postoperative Analysis.

To assess the influence of different soft palate surgeries for obstructive sleep apnea (OSA) on eustachian tube function symptoms, considering various potential factors. A prospective, cohort study was conducted on patients who underwent isolated palatal surgeries for OSA at a single academic medical center between 2017 and 2022. Eustachian Tube Dysfunction Questionnaire (ETDQ-7) were assessed at baseline, 1-month, 2-month, and 3-month time points. Patients with retropalatal obstruction underwent tailored surgeries: anterior palatoplasty (AP), expansion sphincter palatoplasty (ESP), or barbed palatoplasty (BP). Baseline OSA severity between baseline and follow-up time points were also examined. In this study, 96 patients with OSA were enrolled and allocated to three surgical groups: AP (n = 30), ESP (n = 32), and BP (n = 34). The mean age was 44.3 ± 10.2 years, with 86% male participants. No significant differences were found between the groups in terms of age, sex, and BMI. A two-way repeated measures ANOVA revealed a significant main effect of time on ETDQ-7 scores (p < 0.001), but no significant main effect of groups (p = 0.109) or interaction between time and groups (p = 0.082). Subgroup analysis showed a significant interaction for the 3-month change in ETDQ-7 scores by OSA severity (p = 0.046). In post hoc analysis, the BP group exhibited a higher mean ETDQ-7 score compared with the AP group at the 3-month follow-up. This study highlights the importance of considering individual patient factors, such as OSA severity and eustachian tube function symptoms, when selecting the most appropriate surgical treatment to optimize outcomes. 4 Laryngoscope, 134:2471-2477, 2024.

The Effects of the Newest Palatopharyngeal Surgery (Barbed Pharyngoplasty) on Voice Quality.

This study aimed to examine the effects of barbed pharyngoplasty (BP) on voice quality in patients with Obstructive sleep apnea syndrome (OSAS) and to compare them with the anterior palatoplasty (AP) and expansion sphincter pharyngoplasty (ESP) surgeries. The study included 329 patients who came to the Otorhinolaryngology Clinic of our hospital with symptoms of snoring and sleep apnea between January 2020 and 2022 and were referred to the sleep laboratory for polysomnography (PSG). AP surgery was recommended for those with retropalatal stenosis in the anteroposterior direction, and ESP surgery for those with lateral stenosis. BP was recommended for those with both anteroposterior and lateral retropalatal stenosis. 60 patients who met the study criteria were included in the study. All surgeries were performed under general anesthesia by the same otolaryngologist within 1 month at the latest after sleep endoscopy. Acoustic voice analysis was performed using the Praat voice analysis program preoperatively and postoperatively at 6 months. F0, jitter, shimmer, and NHR (noise-to-harmonic ratio) were compared between groups pre and postoperatively. F0 %, jitter %, shimmer %, and NHR % changes were highest in BP. Jitter, shimmer, and NHR decreased significantly in the BP group, whereas F0 increased significantly. Although the mean F0 increased in both AP and ESP groups, the greatest change was in the AP group following BP groups. Although the average jitter, shimmer, and NHR decreased in both groups, the greatest change was in the ESP group following BP groups. In patients with OSAS, BP surgery changed F0, jitter, shimmer and NHR more than AP and ESP surgeries, and effected the voice quality more positively.

The Effects of Anterior Palatoplasty and Functional Expansion Sphincter Pharyngoplasty on Voice Quality in Patients with Obstructive Sleep Apnea

We aimed to examine the effects of anterior palatoplasty (AP) and functional expansion sphincter pharyngoplasty (FESP) on voice quality in patients with OSAS and to compare them with each other. The study included 380 patients who came to the Otorhinolaryngology Clinic of our hospital with symptoms of snoring and sleep apnea between April 2020 and April 2022 and were referred to the sleep laboratory for polysomnography (PSG).Forty patients who met the study criteria and underwent AP and 26 patients who underwent FESP were included in the study. All surgeries were performed under general anesthesia by the same otolaryngologist within 1 month at the latest after sleep endoscopy. Acoustic voice analysis was performed using the Praat voice analysis program preoperatively and postoperatively at 6 months. F0, jitter, shimmer, and NHR (noise-to-harmonic ratio) were compared between the groups pre and postoperatively. There were 20 females and 20 males in the AP group, 12 females and 14 males in the FESP group, There was no statistically significant difference in sex distribution between the groups (P=0.952). The difference between the preop and postop F0, jitter, shimmer, and NHR in both the AP and FESP groups was statistically significant (P < 0.01). After AP and FESP surgeries, F0 values ​​increased, jitter, shimmer and NHR values ​​decreased (P < 0.01).F0, jitter, shimmer, and NHR changes were the greatest in the FESP group.(P < 0.01). Positive changes in F0, jitter, shimmer, and NHR were greatest in the FESP group significantly. FESP surgery affects voice quality more than AP surgery in patients with OSAS.

Polysomnographic Outcomes Before and After Modified Uvulopalatopharyngoplasty Alone or With Minimally Invasive Surgery for Patients with Obstructive Sleep Apnea

Objective: To evaluate the polysomnographic (PSG) outcomes before and after modified uvulopalatopharyngoplasty (Mod UPPP) alone or with minimally invasive surgery (MIS) for patients with obstructive sleep apnea (OSA). Materials and Methods: The present study was a retrospective study included OSA patients aged 18 years or older who underwent Mod UPPP alone or with MIS as radiofrequency (RF) ablation of the nose and tongue base, at Siriraj Hospital between January 2014 and October 2019. Those with incomplete PSG data or sleep efficiency of less than 50% were excluded. The primary outcome was the apnea-hypopnea index (AHI). Secondary outcomes were the sleep stages’ proportions, lowest oxygen saturation (LSAT), oxygen desaturation index (ODI), time with oxygen saturation of less than 90% (T90), surgical success and response rates, and postoperative complications. Results: Seventy-five 75 patients including 59 males and 16 females, with a mean age of 41.6±10.8 years old and body mass index (BMI) of 30±6 kg/m² were included in the study. The mean follow-up time of PSG was 11.5±10.2 months. The postoperative results showed mean reductions of AHI from 42.3 to 19.2 events/hour (p&lt;0.001), ODI of 4% or less from 39 to 17.4 events/hour (p&lt;0.001), T90 from 16% to 6.1% (p&lt;0.001), and an increase in LSAT from 74.1% to 81.9% (p&lt;0.001). Overall, the surgical success and response rates for Mod UPPP alone and with MIS were 33.3% and 49.3%, respectively. However, no statistical reduction of AHI was found between these groups. Secondary bleeding was found postoperatively in three patients or 4%, in which two of them required intervention for hemostasis. No serious complications, such as respiratory distress or death, were found. Conclusion: Mod UPPP alone or with MIS significantly improved the PSG outcomes with a low complication rate, suggesting it may be considered an alternative treatment for Thai patients with OSA. Keywords: Obstructive sleep apnea; Palatal surgery; Minimally invasive surgery; Modified UPPP; Anterior palatoplasty; Thai

Anterior Palatoplasty With Expansion Sphincter Pharyngoplasty for All Type of Pharyngeal Collapse.

This study was aimed to compare the efficiency of the anterior palatoplasty and expansion sphincter pharyngoplasty (APwESP) technique for all patterns of velopharyngeal obstruction (anterior-posterior [APPC], lateral [LPC], or combined circular pharyngeal collapse [CPC]). The study was designed as a randomized prospective trial at Kâtip Çelebi University, Atatürk Training, and Research Hospital. Patients only with velopharyngeal obstruction were included. Three groups were created according to the obstruction pattern (APPC, LPC, and CPC) for the study. Outcome parameters included patient's demographics, apnea-hypopnea index (AHI), lowest oxygen saturation (LOS), Stanford subjective scale of snoring (SSSS), and Epworth sleepiness scale (ESS). Thirty-one (34.1%) patients were in APPC group, while 30 (33.0%) patients were in LPC, and 30 (33.0%) were in CPC group. Preoperatively for all patients, on average, AHI was 33.4 ± 13.6, SSSS was 8.3 ± 1.0, ESS was 16.5 ± 2.6, and LOS was determined as 85.5 ± 3.6. There was a significant postoperative improvement in all parameters for all patients. There was no significant difference in outcome parameters between the groups according to obstruction pattern postoperatively. After APwESP surgery, obstruction pattern was not a significant factor for AHI (P=.234), SSSS (P=.180), and LOS (P=.280) (repeated measure analysis of variance test). The rate of surgical success was detected similarly for both of the study groups (P=.435). The rate of successful surgery for severe obstructive sleep apnea in the APPC group was 72.2%, 88.2% in the LPC group, and 75.0% in the CPC group (P=.472). A combination of APwESP surgery can manage all types of pharyngeal obstruction confidently. 3 Laryngoscope, 132:1313-1319, 2022.

3D morphometric evaluation of the dental arches in children with cleft lip and palate submitted to different surgical techniques.

This study aimed to compare dimensional alterations of dental arches in children with unilateral complete cleft lip and palate before and after different techniques of primary plastic surgeries. The sample was divided into two groups: group 1-cheiloplasty by Millard's technique and one-stage palatoplasty by von Langenbeck's technique; group 2-cheiloplasty by Millard's technique and two-stage palatoplasty: anterior palatoplasty by Hans Pichler's technique and posterior palatoplasty by Sommerlad's technique. Dental arches were evaluated before (T1), after the first phase (T2), and 1year after the second phase (T3) of primary surgeries. Linear measurements and palatal area were assessed. To analyze the method's error, interclass correlation coefficient was applied. ANOVA (followed by Tukey test), dependent, and independent t-test were used (p < 0.05). At T1, the intertuberosity distance was statistically greater in G2 (p = 0.004). At T2, the anterior length of the dental arch was statistically greater in G2 (p = 0.025), while the area of the smaller palatal segment (p = 0.001), cleft area (p = 0.014), and total area (p = 0.002) were statistically smaller in G2. At T3, the intertuberosity distance was statistically greater in G2 (p = 0.017). This study suggests that cheiloplasty and one-stage palatoplasty resulted in smaller growth of maxilla than cheiloplasty and two-stage palatoplasty in the linear measurements (T-T' and I-CC') and total area of the dental arches. Surgical protocols need to be evaluated to verify their effects aiming at improving the clinical practice of the interdisciplinary team, determining new parameters for the rehabilitation of individuals with cleft lip and palate.

SYSTEMATIC REVIEW AND META-ANALYSIS OF THE PALATAL SURGERIES IN THE TREATMENT OF OBSTRUCTIVE SLEEP APNEA

Abstract Background The first description of a patient with obstructive sleep apnea was in ‘The Posthumous Papers of the Pickwick Club’ published by English writer Charles Dickens in 18361. The first introduction of the terms ‘sleep apnea syndrome’ and ‘obstructive sleep apnea syndrome’ was by Guilleminault et al in 1967. Subsequently, Guilleminault coined the term ‘upper airway resistance syndrome’ in 19932. Objectives This paper aims to examine published articles between January 2008 and January 2019 on the different palatal surgeries performed on OSA patients and the treatment outcomes, which in turn will be used to determine two things. The first being the effectiveness of various palatal surgical techniques in treating OSAS and the second (if applicable) the most effective of the palatal surgical techniques in treating OSAS. Patients and Methods The current review followed the guidelines of preferred reporting items for systematic reviews and meta-analysis statement 2009 (PRISMA)5. The detailed steps of methods were described elsewhere as well as PRISMA checklist. The quality of relevant studies was assessed using NIH quality assessment tool for observational cohort and cross -sectional studies as well as NIH tool for quality assessment for case series studies. Results Meta-analyses of relevant studies showed that the surgical technique that achieved the best reduction on AHI was the lateral pharyngoplasty followed by the Anterior Palatoplasty, with a significant mean reduction of [(SMD= -0.848, 95% CI (-1.209 – -0.487), p-value&amp;lt;0.001) and (SMD= -0.864, 95% CI (-1.234 – -0.494), p-value&amp;lt;0.001), respectively]. The technique responsible for the best improvement in ESS was the Relocation Pharyngoplasty, with a significant mean reduction of [SMD= -0.998, 95% CI (-1.253 – -0.743), p-value&amp;lt;0.001]. Minimal O2 saturation level improved most with the Expansion Sphincter Pharyngoplasty, with a significant mean reduction of [SMD= 1.011, 95% CI (0.581 – 1.440), p-value&amp;lt;0.001]. The surgical procedure that result in the best post-operative VAS was Z-Palatoplasty, with a significant mean reduction of [SMD= -1. 551, 95% CI (-2.049 – -1.052), p-value&amp;lt;0.001]. soft palate length change with a significant mean reduction of [SMD= -2.219, 95% CI (-2.730 – 1.708), p-value&amp;lt;0.001]. Finally, meta-analyses of relevant studies showed that expansion sphincter pharyngoplasty achieved the overall highest success rate [Event rate= 77%, 95% CI (65.4%– 85.5%), p-value&amp;lt;0.001] Conclusion The best procedure for treating OSA varies from patient to patient and there is no universal cure-all. Careful patient selection and pre-operative evaluation are mandatory.

Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment.

This systematic review provides supporting evidence for the accompanying clinical practice guideline on the referral of adults with obstructive sleep apnea (OSA) for surgical consultation. The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of upper airway sleep apnea surgery or bariatric surgery to no treatment as well as studies that reported on patient-important and physiologic outcomes pre- and postoperatively. Statistical analyses were performed to determine the clinical significance of using surgery to treat obstructive sleep apnea in adults. Finally, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process was used to assess the evidence for making recommendations. The literature search resulted in 274 studies that provided data suitable for statistical analyses. The analyses demonstrated that surgery as a rescue therapy results in a clinically significant reduction in excessive sleepiness, snoring, blood pressure (BP), apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index (ODI); an increase in lowest oxygen saturation (LSAT) and sleep quality; and an improvement in quality of life in adults with OSA who are intolerant or unaccepting of positive airway pressure (PAP) therapy. The analyses demonstrated that surgery as an adjunctive therapy results in a clinically significant reduction in optimal PAP pressure and improvement in PAP adherence in adults with OSA who are intolerant or unaccepting of PAP due to side effects associated with high pressure requirements. The analyses also demonstrated that surgery as an initial treatment results in a clinically significant reduction in AHI/RDI, sleepiness, snoring, BP, and ODI and an increase in LSAT in adults with OSA and major anatomical obstruction. Analysis of bariatric surgery data showed a clinically significant reduction in BP, AHI/RDI, sleepiness, snoring, optimal PAP level, BMI, and ODI and an increase in LSAT in adults with OSA and obesity. Analyses of very limited evidence suggested that upper airway surgery does not result in a clinically significant increase in risk of serious persistent adverse events and suggested that bariatric surgery may result in a clinically significant risk of iron malabsorption that may be managed with iron supplements. The task force provided a detailed summary of the evidence along with the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations. Kent D, Stanley J, Aurora RN, etal. Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2021;17(12):2507-2531.

Systematic Review and Meta-Analysis of the Palatal Surgeries in the Treatment of Obstructive Sleep Apnea

Background: This paper aims to examine published articles between January 2008 and January 2019 on the different palatal surgeries performed on OSA patients and the treatment outcomes, which in turn will be used to determine the effectiveness of various palatal surgical techniques in treating OSAS and the most effective of the palatal surgical techniques in treating OSAS. Patients and Methods: The current review followed the guidelines of preferred reporting items for systematic reviews and meta-analysis statement 2009 (PRISMA). The quality of relevant studies was assessed using NIH quality assessment tool for observational cohort and cross-sectional studies as well as NIH tool for quality assessment for case series studies. Results: Meta-analyses of relevant studies showed that the surgical technique that achieved the best reduction on AHI (Apnea/Hypopnea Index) was the lateral pharyngoplasty followed by the Anterior Palatoplasty, with a significant mean reduction of [(SMD = −0.848, 95% CI (−1.209 - −0.487), p-value < 0.001) and (SMD = −0.864, 95% CI (−1.234 - −0.494), p-value < 0.001), respectively]. The technique responsible for the best improvement in Epworth Sleepiness Score (ESS) was the Relocation Pharyngoplasty, with a significant mean reduction of [SMD = −0.998, 95% CI (−1.253 - −0.743), p-value < 0.001]. Minimal O2 saturation level improved most with the Expansion Sphincter Pharyngoplasty, with a significant mean reduction of [SMD = 1.011, 95% CI (0.581 - 1.440), p-value < 0.001]. The surgical procedure that results in the best post-operative Visual Analogue Scale (VAS) was Z-Palatoplasty, with a significant mean reduction of [SMD = −1.551, 95% CI (−2.049 - −1.052), p-value < 0.001]. Soft palate length changes with a significant mean reduction of [SMD = −2.219, 95% CI (−2.730 - −1.708), p-value < 0.001]. Finally, meta-analyses of relevant studies showed that expansion sphincter pharyngoplasty achieved the overall highest success rate [event rate = 77%, 95% CI (65.4% - 85.5%), p-value < 0.001]. Conclusion: The best procedure for treating OSA varies from patient to patient and there is no universal cure-all. Careful patient selection and pre-operative evaluation are mandatory.

The Results of Combined Expansion Sphincter Pharyngoplasty and Anterior Palatoplasty in the Treatment of Obstructive Sleep Apnea Syndrome

Amac: Kombine ekspansiyon sfinkter faringoplasti (ESF) ve anterior palatoplasti (AP) ameliyati tikayici uyku apnesi sendromunun (TUAS) cerrahi tedavisinde uygulanan etkili bir cerrahi yontemdir. Calismamizin amaci TUAS nedeniyle kombine ESF+AP uygulanan hastalarda tedavi etkinliginin polisomnografi (PSG) sonuclari ile degerlendirilmesidir. Materyal ve Metot: Hastanemizde 2016–2019 yillari arasinda kombine ESF+AP ameliyati yapilan hastalar retrospektif dosya taramasi ile belirlendi. Preoperatif ve postoperatif 3. ay PSG yapilan hastalar belirlendi. Preoperatif PSG verilerine gore hafif TUAS’i olan 47 hasta calismaya dahil edildi. Hastalarin yas, cinsiyet, vucut kitle indeksi (VKI), pre- ve post-operatif donem apne-hipopne indeksi (AHI), Epworth uykululuk olcek skorlari ve diger PSG verileri kaydedildi. Bulgular: Hastalarin preoperatif AHI degeri 10,6±3,1; postoperatif AHI degeri 3,5±1,2 olarak rapor edildi (p<0,001). Basari kriteri AHI’deki %50 azalma olarak kabul edildiginde 41 hastada (%87,2) basari elde edildi. Hastalarin uyku latansi ve Epworth skoru degerlerinde de ameliyatla istatistiksel olarak anlamli derecede azalma tespit edildi (sirasiyla p<0,001; p=0,005). Sonuc: Kombine ESF+AP ameliyati hafif TUAS’i olan uygun hastalarda etkin bir cerrahi tedavi yontemidir.

Barbed palatoplasty vs. expansion sphincter pharyngoplasty with anterior palatoplasty.

To compare the functional outcomes and complication rates in patients who underwent expansion sphincter pharyngoplasty with anterior palatoplasty (ESPwAP) versus barbed pharyngoplasty (BP). Retrospective cohort study. A medical database was used to retrieve the records of 129 patients who had an isolated palatoplasty surgery between January 2014 and July 2018. Patients who had mild or moderate obstructive sleep apnea without a history of revision surgery and underwent ESPwAP or BP in addition to traditional tonsillectomy were included in the study. Pre- and postoperative polysomnography and Epworth Sleepiness Scale (ESS) was evaluated in the patients who completed at least a 6-month follow-up period. Forty-five and 53 patients met the inclusion, and were comprised of BP and ESPwAP groups, respectively. ESPwAP and BP significantly improved mean apnea hypopnea index (AHI) from 28.5 to 9.1 (P = .000) and 25.9 to 7.4 (P = .000), respectively. No significant statistical difference was found between the mean AHI scores of two groups. Selecting a threshold of a 50% reduction in AHI and AHI less than 20 events/h, success rates were 86.6% in BP group and 84.9% in ESPwAP group. Our study showed that both types of surgeries are effective with comparable results. The BP technique may be preferred when possible to avoid soft tissue excision and seems to be a less invasive procedure with a similar success rate when compared to ESPwAP. 4 Laryngoscope, 130:E275-E279, 2020.

Comparison of postoperative pain scores and dysphagia between anterior palatoplasty and uvulopalatal flap surgeries

Background: Dysphagia and pain are most common problems after soft palate surgery in obstructive sleep apnea (OSA) patients.Objective: The aim of this study was to compare the postoperative pain scores and presence of dysphagia in patients who underwent anterior palatoplasty (AP) or uvulopalatal flap (UPF) surgeries.Materials and methods: In this prospective study, AP or UPF was performed on the patients with mild or moderate OSA. Daytime sleepiness of all patients was evaluated with Epworth sleepiness scale (ESS). Snoring, pain and dysphagia complaint of the patients was evaluated with visual analog scale (VAS).Results: In both AP and UPF groups, VAS snoring and ESS scores decreased significantly after operation. VAS pain and dysphagia scores were determined to be significantly higher in UPF compared with the AP.Conclusion and significance: Since the success rates of surgical interventions to the soft palate are similar, preferring surgical approaches with a less damage to the life quality of patients after operations is more rational. In this regard, AP, which is technically quite simple with a short operation time and fewer postoperative complaints affecting life quality such as pain or dysphagia may be preferred in selected patients with OSA.

Palate surgery for obstructive sleep apnea: a 17-year meta-analysis.

Systematic review of palate surgery for the treatment of OSA. Independent searches to identify publications relevant to OSA treatment and upper airway palate surgery. All relevant studies published between January 2001 and February 2018 were included. Inclusion criteria were adult patients, documented airway evaluation methods and absent hypopharyngeal collapse. Outcomes included success rates of treatment, AHI, Epworth scale, QOL and snoring VAS. Fifty-nine papers with a total of 2715 patients, UPPP accounted for 16.7% of all the procedures. Evident differentiation progressing from 2001 to 2018, from 2001 to 2010, the percentage of UPPP procedures were 25.67%, from 2011 to 2018, there were only 12.6% of UPPP procedures. The average follow up was 8.18months. Meta-analysis on the AHI change for all procedures, showed the fixed effect AHI per follow-up (FU) month change was 1.45 (95% CI 1.33, 1.8), p < 0.001; while for ESS, the fixed effect AHI per FU month change was 0.61 (95% CI 0.56, 0.66), p < 0.001. The mean decrease in AHI was from 35.66 to 13.91 (p < 0.001). The mean decrease in ESS was from 11.65 to 5.08 (p < 0.001). The mean AHI change was 19.9 (p < 0.001). The mean ESS change was 5.8 (p < 0.001). The overall pooled success rate was 67.5%. Meta-analysis of the procedures, showed that the respective mean AHI reduction was 24.7 for the anterior palatoplasty (p = 0.015), 19.8 for the lateral/expansion pharyngoplasty (p = 0.046), and 17.2 for the uvulopalatopharyngoplasty (p = 0.360). Better understanding of the upper airway and objective airway evaluation diagnostic techniques and innovative palate surgeries have improved success rates of OSA surgery.

Voice and Swallowing Outcomes after Hyoid Suspension Surgery in Patients with Obstructive Sleep Apnea

Objective: The role of hyoidthyroidpexia (HTP) surgery in the management of patients with obstructive sleep apnea (OSA) is well described with good reported outcomes. The effect of HTP on other laryngeal functions is not well discussed. This study was designed to evaluate voice and swallowing outcomes after HTP. Patients and Methods: This study was applied on a selected group of OSA patients. HTP (as a sole procedure) was performed in 17 patients and 14 patients had simultaneous palatal procedures (e.g., anterior palatoplasty). Pre- and postoperative assessment of voice and swallowing were done. Results: Comparison between pre- and postoperative results of voice and swallowing measures revealed a nonsignificant difference. Conclusion: HTP (as a sole technique or as part of a multilevel intervention) could help with airway collapse and might be considered a safe, simple, and effective technique in the management of selected patients experiencing OSA. In addition, it seems to have no hazardous effect on either the voice or swallowing function of patients.

Comparison of Anterior Palatoplasty and Uvulopalatal Flap Placement for Treating Mild and Moderate Obstructive Sleep Apnea

Nasal septal perforations cause a subset of patients to suffer with significant impairments in quality of life. While smaller perforations can often be surgically repaired, perforations exceeding 2 cm are challenging to close. These repairs are highly technical, and there is a lack of consensus regarding the most effective means to do so. The authors performed a retrospective chart review of patients with perforation enlargements and have found that, in select patients, enlarging the septal perforation's edge posterior to the head of the middle turbinates has proven effective in relieving symptoms.

Comparison of anterior palatoplasty and uvulopalatal flap placement for treating mild and moderate obstructive sleep apnea.

We prospectively compared the efficacy of anterior palatoplasty and the uvulopalatal flap procedure for the treatment of patients with mild and moderate obstructive sleep apnea syndrome (OSAS). Our study group was made up of 45 patients who had been randomly assigned to undergo one of the two procedures. Palatoplasty was performed on 22 patients-12 men and 10 women, aged 28 to 49 years (mean: 39.2)-and the flap procedure was performed on 23 patients-14 men and 9 women, aged 28 to 56 years (mean: 41.3). Our primary outcomes measure was the difference in pre- and postoperative apnea-hypopnea index (AHI) as determined by polysomnography at 6 months after surgery. Surgical success was observed in 18 of the 22 palatoplasty patients (81.8%) and in 19 of the 23 flap patients (82.6%). Compared with the preoperative values, mean AHIs declined from 17.5 to 8.1 in the former group and from 18.5 to 8.6 in the latter; the improvement in both groups was statistically significant (p < 0.001). In addition, significant postoperative improvements in both groups were seen in mean visual analog scale (VAS) scores for snoring, in Pittsburgh Sleep Quality Index values, and in Epworth Sleepiness Scale scores (p < 0.001 for all). VAS scores for pain at rest were significantly lower in the palatoplasty group than in the flap group at 2, 4, and 8 hours postoperatively and on postoperative days 4 through 7 (p < 0.002). Likewise, VAS scores for pain during swallowing were significantly lower in the palatoplasty group at 2, 4, 8, and 16 hours and on days 4 through 7 (p < 0.009). We conclude that both anterior palatoplasty and uvulopalatal flap procedures are effective for the treatment of mild and moderate OSAS in patients with retropalatal obstruction. However, our comparison of postoperative pain scores revealed that anterior palatoplasty was associated with significantly less morbidity.

Anterior palatoplasty in the treatment of obstructive sleep apnoea - a systemic review.

This study seeks to determine the objective and subjective success rates of anterior palatoplasty and its variants for the treatment of obstructive sleep apnoea (OSA). A systematic review with two independent searches of Medline, PubMed, Cochrane Library and Evidence Based Medicine Reviews was performed to identify publications relevant to OSA and anterior palatoplasty. All relevant studies published before 30 June 2015 were included. Six studies were included in the systematic review. The numbers of patients in each paper ranged from 13 to 77 (total = 240), and mean age ranged from 21 to 51 years. Substantial and consistent improvement in polysomnography (PSG) outcomes were observed in patients after the anterior palatoplasty, with or without multilevel surgery. The results showed that the anterior palatoplasty technique provides significantly improvement in the post-operative Apnoea-Hypopnea Index. The mean pre-operative AHI (in the 6 papers) improved from 16.3 to 7.1, the snore visual analogue scale improved from 7.5 to 3.1 and the Epworth score reduced from 11.3 to 7.3 post-operatively. The overall pro-rated pooled success rate for all the patients was 72.5%, with a mean follow-up of 17.3 months. Anterior palatoplasty is an effective option in the management of patients with mild to moderate OSA.