Palatopharyngeal Surgery Research Articles

Surgical Outcomes Following Combined Barbed Palato-Pharyngeal Surgery and Coblator-Assisted Midline Glossectomy for Obstructive Sleep Apnea

Surgical Outcomes Following Combined Barbed Palato-Pharyngeal Surgery and Coblator-Assisted Midline Glossectomy for Obstructive Sleep Apnea

A Novel Method to Classify the Responses of Genioglossus to Negative Pressure in OSA Patients.

This study aims to develop a novel method to classify different genioglossus (GG) responses to upper airway (UA) negative pressure in obstructive sleep apnea (OSA) patients. A single-center, prospective, cohort study. Sleep Medical Center. Patients with OSA underwent drug-induced sleep endoscopy with synchronous genioglossus electromyography (ggEMG) and UA pressure monitoring. In spontaneous obstructive apnea events, the value of epiglottis negative pressure at the end of inspiration (Pepi ) and corresponding peak phasic ggEMG were recorded as pairing data for linear regression analysis to classify GG response modes: peak phasic ggEMG-Pepi linear mode (P < .05) were classified as group 1; others (P ≥ .05) were classified as group 2. Using nasopharyngeal tube (NPT) to reopen the palatopharyngeal cavity for comparing the improvement between the OSA patients with different GG response modes. Sixty subjects were analyzed for GG response modes: 22 patients were in group 1 (r2 = 0.233-0.867), and 38 patients were in group 2. The proportion of partial (63.16% vs 59.09%) or complete (36.84% vs 22.73%) collapse rate of the tongue base in group 2 was significantly higher (χ2 = 7.823, P = .020). The improvement of the apnea-hypopnea index after NPT placement in group 2 was significantly lower than in group 1 (59.09% vs 31.58%, χ2 = 4.339, P = .037). This novel method is advantageous for distinguishing OSA patients with different GG response abilities to UA negative pressure, whose GG responses conforming to peak phasic ggEMG-Pepi linear mode might be more suitable for palatopharyngeal surgery.

A New Lighting System for Surgical Vision Optimization in Barbed Pharyngoplasty for OSA.

Obstructive sleep apnea (OSA) surgery is now a viable solution in selected patients and the "remodeling" palatopharyngeal surgery is the most common one. Recently, it has become less invasive with the introduction of barbed sutures (BS). An optimization of surgical techniques is represented by barbed pharyngoplasty (BP), which requires surgical precision and needs efficient and precise oropharyngeal visualization. Consequently, the lighting system is of pivotal importance in BP. The aim of this work is to describe the first experience on the use of a new lighting system, called KLAROTM in BP for OSA. We evaluated the KLARO™ system in 15 consecutives BP for OSA in comparison with conventional headlamp illumination. The visualization of palatopharyngeal muscle in the bottom of the tonsillar fossa, entry and exit needle, such as needle tip, were statistically better with KLAROTM than headlamp illumination for both the surgeon and resident (p < 0.05). No significant differences for the visualization of the posterior pharyngeal wall and uvula were reported. The KLAROTM lighting system allows a satisfied illumination of oral cavity and oropharynx in the majority of cases. We encourage the use of KLAROTM not only in BP for OSA, but in all oral and pharyngeal surgeries, including tonsillectomy and oncological surgery.

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.

A systematic review of the feasibility and safety of day case nasal and/or palatopharyngeal surgery in patients with obstructive sleep apnoea.

Recent guidelines suggest obstructive sleep apnoea (OSA) is not an absolute contraindication for same day discharge following surgery. The aim of this systematic review was to examine the feasibility and safety of day case nasal and/or palatopharyngeal surgery in patients with OSA. We performed a systematic search of PubMed, EMBASE and the Cochrane library. Quality assessment of included studies was performed. The protocol of this systematic review was registered with PROSPERO (CRD42021273451). A total of 1836 patients from 10 observational studies were included. There were 268 (15.4%) nasal surgeries, 738 palatopharyngeal surgeries (42.4%) and 735 (42.2%) combined nasal and palatopharyngeal surgery. The majority of patients had moderate to severe OSA. A total of 860 patients (49.8%) were successfully discharged as day cases. There were no standard criteria for daycase surgery. Post-anaesthetic respiratory events were reported in 86/1750 (4.9%) patients. Oxygen desaturation was the most common respiratory event (83.7%, n=72). There was no mortality reported. Current data suggests day surgery is feasible in carefully selected patients with OSA undergoing nasal and/or palatopharyngeal surgery. Further well-designed prospective studies with an emphasis on the systematic assessment of complications are required to establish safety and daycase criteria.

Efficacy of relocation and expansion pharyngoplasty by suspension sutures in the treatment of OSAHS with soft palate oropharyngeal obstruction

Objective: To explore the efficacy of relocation and expansion pharyngoplasty by suspension sutures in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: Seventy-three patients(including 60 males and 13 females) with OSAHS admitted to the department of otorhinolaryngology of our hospital in recent two years were retrospectively analyzed. All the patients had velopharyngeal obstructionevaluated by electronic endoscopic Müller test and were divided into control group (34 cases) and observation group (39 cases). The patients in the control group were performed modified uvulopalatopharyngoplasty, while those in the observation group were performed relocation and expansion pharyngoplasty by suspension sutures.The scores of ESS, AHI and LSaO2 before and after treatment were collected and compared. Results: The total effective rate of the observation group was 94.87%, which was significantly higher than 79.41% of the control group. The AHI was lower and LSaO2 value was higher (χ2=-1. 896,-1. 968,P<0.05)in the observation group. The sleeping symptoms and quality of life of the two groups were significantly improved. The ESS score of the observation group was decreased more significantly than that of the control group after treatment, and the difference was statistically significant (χ2=-1.451,P<0.05). The incidence of foreign body sensation in pharynx of the observation group (89.74%) was higher than that of the control group (55.88%), and the postoperative bleeding and postoperative recurrence rate (0.00%, 2.56%) was lower than that of the control group (8.82%, 14.70%)with statistical significance (χ2=4.738,4.249,4.119,P<0.05).The incidence of transient nasopharyngeal reflux in both groups was low and statistically insignificant (χ2=0.629,P>0.05). Conclusions: Preoperative strict screening of indications plays an important role in the selection of palatopharyngeal surgery methods and curative effect. Relocation and expansion pharyngoplasty by suspension sutures can improve the clinical efficacy of OSAHS with better safety and less recurrence.

Palatopharyngeal surgery in obstructive sleep apnoea-how I do it

Palatopharyngeal surgery in obstructive sleep apnoea-how I do it

Video-Assisted Palatopharyngeal Surgery: A Model for Improved Education and Training

Objective : The learning process for intraoral procedures is arguably more difficult than for other surgical procedures because of the assistant's severely limited visibility. Consequently, trainees may not be able to adequately see and follow all steps of the procedure, and attending surgeons may be less willing to entrust trainees with critical portions of the procedure. In this report, we propose a video-assisted approach to intraoral procedures that improves lighting, visibility, and potential for effective education and training. Design : Technical report (idea/innovation). Setting : Tertiary referral hospital. Patients : Children with cleft palate and velopharyngeal insufficiency requiring surgery. Interventions : Video-assisted palatoplasty, sphincteroplasty, and pharyngoplasty. Main Outcome Measures : Qualitative and semiquantitative educational outcomes, including learner perception regarding "real-time" (video-assisted surgery) and "non-real-time" (video-library-based) surgical education. Results : Trainees were strongly in favor of the video-assisted modality in "real-time" surgical training. Senior trainees identified more opportunities in which they had been safely entrusted to perform critical portions of the procedure, corresponding with satisfaction with the learning process scores, and they showed greater comfort/confidence scores related to performing the procedure under supervision and alone. Conclusions : Adoption of the video-assisted approach can be expected to markedly improve the learning curve for surgeons in training. This is now standard practice at our institution. We are presently conducting a full educational technology assessment to better characterize the effect on knowledge acquisition and technical improvement.

Changes of Taste Function after Palatopharyngeal Surgery in Obstructive Sleep Apnea Syndrome

Background and Objectives Postoperative taste changes after uvulopalatopharyngoplasty (UPPP) is regarded as an unusual and minor complication. This study aims to evaluate the objective changes of taste threshold according to time course and subjective symptoms change. Materials and Method With 45 patients who underwent UPPP and 35 patients who underwent nasal surgery as control group, we have prospectively studied postoperative taste changes using a questionnaire, and an electrogustometer (EGM) with regard to symptoms at 7th, 28th days after the surgery. EGM was measured at 5 areas. Also, we have checked pre-operatively about the serum level of zinc. Results With EGM, the threshold of taste was increased at 7th days after the surgery (p

Taste Disturbance After Palatopharyngeal Surgery for Obstructive Sleep Apnea

Taste disorder is a rare complication of uvulopalatopharyngoplasty, and may have a significant impact on quality of life. Herein, we report a case of obstructive sleep apnea syndrome in a 51-year-old man who experienced taste disturbance after palatopharyngeal surgery using electrocautery for developing a uvulopalatal flap. Gustatory function test using three-drop-method with solutions of highest concentration was implemented to assess the deficiency of four basic tastes. The results showed deficit of sweet taste associated with phantom of bitter taste. The patient reported constant spontaneous bitter taste and dysgeusia in sweet taste with poor quality of life at the 2-year follow-up. We suggest that patients are informed of the potential for taste impairment from palatopharyngeal surgery, as well as reducing the use of electrocautery in developing uvulopalatal flap to reduce damage to taste function.

Simultaneous midline laser glossectomy with palatopharyngeal surgery for obstructive sleep apnoea syndrome

We investigate the outcome of performing tongue base reduction surgery and palatopharyngeal surgery in a single stage to determine whether the same-stage midline laser glossectomy (MLG) with extended uvulopalatal flap (EUPF) for obstructive sleep apnoea syndrome (OSAS) is a safe and effective procedure. Six male patients with a history of severe OSAS were recruited into the retrospective study. They were the first patients to undergo the MLG with EUPF procedure. Patients were identified to have retropalatal and hypopharyngeal sites of obstruction on the basis of fiberoptic endoscopy with Muller's manoeuvre and three-dimensional computerised tomography. No significant adverse events occurred. The follow-up polysomnography (6-month follow-up) revealed that the mean respiratory disturbance index from 50.7 to 11.6, snoring index from 230.9 to 137.3 and the minimal oxygen saturation from 76.3 to 88.8. This study confirms that the same-stage MLG with EUPF for OSAS is a safe and effective procedure.

Combined nasal–palatopharyngeal surgery for obstructive sleep apnea: Simultaneous or staged?

Conclusions. Our data indicate that surgical outcomes in a simultaneous surgery group were equivalent to those in a staged surgery group. The simultaneous type of surgery was more cost-effective in terms of total hospitalization expenses. Objective. To compare the outcomes of two types of combined nasal–palatopharyngeal surgery (simultaneous and staged) for the treatment of obstructive sleep apnea (OSA). Material and methods. A total of 85 consecutive patients were enrolled in the study. All patients had OSA and its associated symptoms, were type I according to the Fujita classification, stage 1 or 2 according to the Friedman classification and had nasal obstruction with nasal septal deviation. A modified form of uvulopalatopharyngoplasty (extended uvulopalatal flap surgery) and septomeatoplasty were used to correct upper airway abnormalities. Patients chose to have either a simultaneous (n=55) or staged (n=30) type of operation. All patients underwent overnight polysomnography at baseline and ≥6 months after completion of the operations. Surgical results (reduction of OSA), patient satisfaction, complications and hospitalization expenses were compared between the two groups. Results. The two groups comprised body mass index- and respiratory disturbance index (RDI)-matched cohorts (p>0.05). Postoperative decreases in RDI were significant in both groups (p<0.001), and postoperative RDI was indistinguishable between the two groups (p=0.77). Incidences of surgical complications, including tonsillar bleeding, nasal septal hematoma, nasal regurgitation and the sensation of a lump in the throat, were similar in the two groups (p=0.35). The simultaneous surgery group incurred lower total hospitalization expenses than the staged surgery group (p<0.001).

Use of Morphological Indicators to Predict Outcomes of Palatopharyngeal Surgery in Patients with Obstructive Sleep Apnea

There is no consensus on how to quantify the abnormality of upper airway structures in patients with obstructive sleep apnea (OSA). This research aimed to use morphological indicators as clinical predictors to correlate morphological stage and surgical results in OSA patients. One hundred and five patients with OSA received palatopharyngeal surgery, i.e. extended uvulopalatal flap (EUPF). Morphological indicators including modified Mallampati grade (MMP), tonsil size, and body mass index were used to stage OSA patients preoperatively. Change of respiratory disturbance index (RDI) was used to monitor change of sleep apnea events. Success rates were compared among patients of different morphological stages. One year after EUPF, the success rates of EUPF in stage I, II, and III patients were 100, 92.9 and 61.4%, respectively. Change of RDI was significantly correlated with MMP and tonsil size. MMP and tonsil size were predictive of the change of RDI (R² = 0.29). Morphological stage may serve as a reliable selection criterion for patients undergoing EUPF surgery and can significantly predict the change of sleep apnea events following EUPF surgery.

Same-stage nasal and palatopharyngeal surgery for obstructive sleep apnea: is it safe?

The study goal was to determine the safety of performing same-stage nasal and palatopharyngeal surgery for the treatment of obstructive sleep apnea syndrome (OSAS). We conducted a retrospective review of 91 consecutive patients who underwent surgery for OSAS at tertiary care facilities. Patients were divided into 2 groups: group 1 had same-stage nasal and palatopharyngeal surgery (n = 63), whereas group 2 had palatopharyngeal surgery at a stage separate from the nasal surgery (n = 28). Patient demographics, severity of OSAS, type of surgery, perioperative care, and postoperative complications were reviewed. There were 55 men and 8 women in group 1, with an average age of 48 years. Group 2 consisted of 20 men and 8 women, with an average age of 45 years. The mean respiratory disturbance index was 36.5 and 33.5 for group 1 and 2, respectively. The mean lowest arterial Oxygen saturation for group 1 was 82%, whereas that of group 2 was 81%. Patients in both groups were observed in a hospital setting for a minimum of 1 day. They were admitted to a room close to the nurse's station, with continuous pulse oximeter monitoring. There were 3 complications reported for group 1: pneumonia (1 patient, postoperative day 4), tonsil bleed (1 patient, postoperative day 6), and septal hematoma (1 patient). One patient in group 2 had a tonsil bleed (postoperative day 8). There were no incidents of airway compromise or cardiopulmonary events in the immediate postoperative period. Same-stage nasal and palatopharyngeal surgery for OSAS is safe. Patients could be monitored with continuous pulse oximetry and managed outside of an intensive care unit setting in the immediate postoperative period.

Tratamiento multinivel en el síndrome de apnea obstructiva del sueño: estudio comparativo de cuatro técnicas quirúrgicas del paladar

Palatopharyngeal surgery is a therapeutic option for Obstructive Sleep Apnea Syndrome. This surgery is based on the assumption that the soft palate is the principal apneogenic area of the upper airway. We report a comparison of four techniques of palatopharyneal surgery. In the other hand, the effectiveness of palatopharyngeal surgery for correcting other obstructions when present, was also evaluated.