Uvulopalatopharyngoplasty In Patients Research Articles

Effectiveness of Tonsillectomy vs Modified Uvulopalatopharyngoplasty in Patients With Tonsillar Hypertrophy and Obstructive Sleep Apnea

Modified uvulopalatopharyngoplasty (mUPPP) is a surgical treatment for selected adults with obstructive sleep apnea (OSA). Tonsillectomy (TE) alone is a less extensive alternative treatment. To investigate whether mUPPP is more effective than TE alone in treating adult patients with tonsillar hypertrophy and moderate to severe OSA. This blinded randomized clinical trial compared the effectiveness of mUPPP with TE alone before surgery and 6 months postsurgery in adults with tonsillar hypertrophy (sizes 2, 3, or 4 according to the Friedman staging) and moderate to severe OSA in a university hospital in Stockholm, Sweden. Participants underwent surgery from January 2016 to February 2021; the last postsurgery follow-up was completed in September 2021. Data analyses were performed from January to September 2022. mUPPP vs TE alone. Between-group differences on the apnea-hypopnea index (AHI) and Epworth sleepiness scale (ESS). The study cohort comprised 93 patients (mean [SD] age, 41.6 [9.4] years; 80 [86%] men; race/ethnicity were not considered) with a mean (SD) body mass index of 29.0 (2.8), calculated as weight in kg divided by height in m2. Of these, 90 participants (97%) completed the protocol (mUPPP, n = 45; TE, n = 45). The mean (SD) AHI score (number of events per hour [events/h]) for the mUPPP group decreased by 43%, from 51.0 (22.6) to 28.0 (20.0) events/h; and for the TE group, 56%, from 56.9 (25.1) to 24.7 (22.6) events/h. The mean between-group difference in AHI score was 9.2 events/h (95% CI, 0.5 to 17.9), with a small effect size (Cohen d = 0.44) in favor of TE. For ESS scores, the between-group difference was also small, only 1.1 (95% CI, -1.3 to 3.4; Cohen d = 0.21). Neither difference was considered to be clinically relevant. This randomized clinical trial demonstrated that mUPPP was not more effective than TE alone in treating patients with tonsillar hypertrophy and moderate to severe OSA. However, there was a small difference in favor of TE. Because TE alone is less extensive, it could be considered as an alternative to mUPPP in this selected group of patients with OSA. ClinicalTrials.gov Identifier: NCT02523248.

Bariatric surgery may provide better protection than uvulopalatopharyngoplasty against major adverse cardiovascular events in obese patients with obstructive sleep apnea.

The major adverse cardiovascular events (MACE) risk is unclear among Asian obese patients with obstructive sleep apnea (OSA) who undergo bariatric surgery (BS) or uvulopalatopharyngoplasty (UPPP). We aimed to evaluate differences between Asian obese patients with OSA who underwent BS or UPPP regarding MACE. The Longitudinal Health Insurance Database, a subset of the NHI Research Database (NHIRD) originated from the National Health Insurance (NHI) program in Taiwan, which comprises information from 2 million randomly sampled individuals between 2000 and2015. Participants aged 18-55 years whose diagnoses corresponded with codes in the International Classification of Diseases, Ninth Revision, Clinical Modification for BS, UPPP, obesity, and OSA were included in this population-based, matched cohort study of Taiwan's insurance claims data gathered between 2000 and 2015. Obese patients with OSA who underwent BS or UPPP were propensity score matched; the study's outcome was MACE. A total of 1336 patients, comprising 668 in each of the BS and UPPP cohorts, were enrolled. After a mean follow-up period of 8.51 years, 166 patients, comprising 52 in the BS cohort and 114 in the UPPP cohort, experienced MACE. The adjusted hazard ratio (aHR) for MACE was .592 (95% confidence interval [CI] = .324-.789; P < .001). The BS cohort had lower risks of stroke (aHR = .663; 95% CI = .312-.890; P < .001), myocardial infarction (aHR = .116; 95% CI = .052-.135; P < .001), and mortality (aHR = .779; 95% CI = .423-.948; P = .001) than the UPPP cohort. BS may provide greater protection against MACE than UPPP in Asian obese patients with OSA. Additional mechanistic research is needed to clarify differences between BS and UPPP in these patients.

Eight-Year Follow-up of Modified Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea.

To investigate whether modified uvulopalatopharyngoplasty (UPPP) for treatment of obstructive sleep apnea (OSA) remained effective after 8 years. Prospective intervention study. Sixty-five patients with OSA were offered re-evaluation with polysomnography and the Epworth Sleepiness Scale (ESS) 8 years after UPPP. Results were compared with baseline and with a previous 2-year follow-up. Baseline predictors were analyzed with regression analyses. The dropout rate at the 8-year follow-up was 28%. The mean decrease in apnea-hypopnea index (AHI) between baseline and the 8-year follow-up was significant, 14.0 events/hour (from 52.9 to 38.9), 27% (P < .001). The mean increase in AHI between the 2-year and the 8-year follow-up was significant, 14.7 events/hour (from 24.2 to 38.9), 61% (P < .0001). Overweight at baseline predicted an AHI at the 8-year follow-up that was 22.9 events higher compared to patients with normal weight (P = .015). An increase in body mass index (BMI) of 1 kg/m2 between baseline and the 8-year follow-up predicted a mean AHI increase of 3.8 events/hour (P = .015). The median decrease in ESS between baseline and the 8-year follow-up was significant, 7 (from 13.0 to 6.0), 54% (P < .0001). The median increase in ESS between the 2-year and the 8-year follow-up was not significant, 1.0 (from 5.0 to 6.0), 20%. Modified UPPP was effective as a long-term treatment for OSA in selected patients, although the effect on AHI decreased over time. Daytime sleepiness remained improved even in the long term. High BMI at baseline and an increase in BMI predicted a reduced long-term respiratory outcome. 3 Laryngoscope, 131:E307-E313, 2021.

The Results of Uvulopalatopharyngoplasty in Patients with Moderate Obstructive Sleep Apnea Syndrome Having Cardiac Arrhythmias

Objectives: The goal of this practice was to explore whether the changes in arrhythmias after uvulopalatopharyngoplasty (UPPP) in patients with moderate obstructive sleep apnea syndrome (OSAS) who continued cardiac arrhythmias despite the use of antiarrhythmic drugs and those who could not tolerate the continuous positive airway pressure (CPAP) device. In addition, we evaluated the correlation between arrhythmias before and after UPPP. Methods: This retrospective study included patients who have OSAS and cardiac arrhythmias, between 2008 - 2017 by the cardiology clinic and consulted by the ear, nose, and throat (ENT) clinic. Thirty eight patients were selected and underwent UPPP operation. The rhythm Holter follow-ups of the patients in the 1st month before UPPP (pre-UPPP) and after UPPP (post-UPPP) 6th month were performed. The recordings were transferred to the computer and evaluated with the Holter program, then visually examined and the parasitic regions were excluded. Sinus bradycardia (SB), atrioventricular block (AVB), atrial premature beat (APB), supraventricular tachycardia (SVT), and ventricular extrasystole (VES) parameters were recorded for arrhythmia. Results: Statistically significant differences were observed in the changes in SB, AVB, APB, SVT and VE arrhythmia values in pre-UPPP and post-UPPP periods. Also, in one case the values of arrhythmia in the pre-UPPP period had a positive correlation with the values of the same arrhythmia in the post-UPPP period (P &lt; 0.001). Conclusions: In this study, new information about the effects of UPPP which is one of OSAS treatment methods on cardiac arrhythmias is presented. According to our results, UPPP reduces the rate of SB, AVB, APB, SVT and VES arrhythmias in OSAS patients.

Retraction: Analgesic properties of dexmedetomidine infusion after uvulopalatopharyngoplasty in patients with obstructive sleep apnea.

[This retracts the article on p. 150 in vol. 5, PMID: 21804794.].

Complete concentric collapse at the soft palate in sleep endoscopy: what change is possible after UPPP in patients with CPAP failure?

The aim of this work was to assess whether uvulopalatopharyngoplasty in patients with failure for positive airway pressure not only reduces the degree of obstructive sleep apnea but also to determine as well if it changes the collapse pattern of the soft palate and thereby fulfills the qualifications for implementing upper airway stimulation (UAS) as an adjunctive solution. Fifteen patients with intolerance for positive airway pressure were included in this retrospective cohort study. Polygraphy and drug-induced sleep endoscopy were used in order to evaluate the reduction of the apnea-hypopnea index (AHI), as well as the change of collapse pattern at the soft palate level before and about 3months after uvulopalatopharyngoplasty and tonsillectomy (TE-UPPP). In 93% of the patients, a postoperative change of the initially complete concentric palatal collapse pattern could be found during drug-induced sleep endoscopy. In one patient, no obstruction at all was seen at the soft palatal level. Only one patient still presented with a complete concentric collapse at velum level. AHI decreased from mean 34.7 events per hour to 20.2/h and oxygen desaturation index from 25.3 events per hour to 16.1/h. Patients seeking for positive airway pressure alternatives could not only benefit from reduction of AHI by TE-UPPP postoperatively; additionally, by changing the collapse pattern at the soft palate, they might also fulfill criteria for upper airway stimulation (UAS) in case of persistent OSA of at least moderate degree.

Healthcare usage after uvulopalatopharyngoplasty – Impact of analgesic regimen

Outcome objectives1) Analyze differences in healthcare usage between subjects receiving different perioperative analgesic medications after uvulopalatopharyngoplasty (UPPP) surgery. 2) Comment on the impact of perioperative analgesic medication on length of hospital stay and complications after UPPP. MethodsA retrospective cohort study of 120 UPPPs conducted by a single surgeon in the past 5years was conducted. Subjects were grouped based on perioperative pain medication regimen into three groups; narcotics alone (n=83), narcotics with gabapentin (n=27), or narcotics with ketorolac tromethamine (n=10). The primary outcome variable was total number of clinic/emergency room and/or telephone encounters related to post-UPPP pain. Secondary outcomes included length of post-operative hospital stay, number of telephone and/or clinical encounters in which the patient complained specifically of pain or requested a refill for analgesics, and post-operative complications. ResultsNo significant difference was found between the three analgesic regimens in post-operative hospital stay length (p=0.28, median stay 23.5h), number of clinic or telephone encounters related to pain (p=0.26, mean value 0.71 encounters), or post-operative complication rate (p=0.82, 5.9% complication rate). ConclusionThis study shows no significant difference in post-operative healthcare usage between patients with peri-operative analgesic regimens including narcotics alone, gabapentin with narcotics, or ketorolac with narcotics. Post-operative complication rate and length of stay did not differ between groups. These data suggest that these three medication regimens have similar impact on post-operative course for UPPP patients. Therefore, the most affordable or simplest options have equivalent effects on post-operative healthcare usage.

Analysis of sleep quality after uvulopalatopharyngoplasty in patients with obstructive sleep apnea based on cardiopulmonary coupling analysis

Analysis of sleep quality after uvulopalatopharyngoplasty in patients with obstructive sleep apnea based on cardiopulmonary coupling analysis

Risk of Cerebrovascular Diseases After Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea

Little was known about the beneficial effects of uvulopalatopharyngoplasty (UPPP) on the outcomes after obstructive sleep apnea (OSA). The aim of this study is to investigate the effects of UPPP on reducing risk of cerebrovascular diseases in patients with OSA.Using Taiwan's National Health Insurance Research Database, we conducted a retrospective cohort study of 10,339 patients with new OSA between January 1, 2004, and December 31, 2009. The incident cerebrovascular disease was identified during the 1-year follow-up period in patients with and without receiving UPPP. The rate ratios (RRs) and 95% confidence intervals (CIs) of cerebrovascular disease associated with receiving UPPP in patients with OSA were calculated in multivariate Poisson regression.The 1-year incidences of cerebrovascular disease for OSA patients with and without UPPP were 1.06% and 5.14%, respectively. Patients with OSA receiving UPPP had lower risk of cerebrovascular disease compared with those without UPPP (RR, 0.45; 95% CI, 0.33–0.61). The decreased risk of cerebrovascular disease following UPPP was observed in both sexes and all age groups. In the stratified analysis of medical conditions, the RR of cerebrovascular disease associated with UPPP for patients with 0, 1, ≥ 2 medical conditions were 0.28 (95% CI 0.12–0.68), 0.39 (95% CI 0.21–0.73), and 0.63 (95% CI 0.43–0.93), respectively.Patients with OSA who received UPPP had lower risk of cerebrovascular disease within 1 year after surgery compared with patients not receiving UPPP. Clinical physicians could have more evidence to persuade patients to receive surgical intervention, especially those who have severe OSA symptoms or do not acquire adequate symptom relief under conservative treatments.

Abstract 870: 16S rRNA saliva analysis unveils microbiome biomonitors linked to human papilloma virus and oropharyngeal squamous cell carcinoma

Abstract Microbiota markers in saliva able to distinguish HPV positive from HPV negative Head and Neck Squamous Cell Carcinoma (HNSCC) patients, as well as HNSCC patients from controls, will enable increases in treatment options, reductions in treatment costs and improvements in survival rates. In the present study we compared the microbiota present in saliva DNA from HPV positive and HPV negative oropharyngeal cancer (OPSCC) patients to saliva DNA from uvulopalatopharyngoplasty (UPPP) patients, used as normal oral mucosa controls. PCR amplification of the 16S rRNA V3-V5 gene region was performed using the 357F/926R primer set. Amplified fragments were multiplexed on the Roche/454 GS Junior sequencing platform. Data were screened for chimeric sequences and contaminant chloroplast DNA after pre-processing. Passing sequences were characterized for diversity and taxonomic composition using QIIME and R before cross-tabulation analyses were performed. Bacteroidetes, Firmicutes, and Proteobacteria dominated the microbiome in our sample set with less frequent presence of Actinobacteria and Fusobacteria members. At lower taxonomic levels, the most abundant genera observed were Streptococcus, Prevotella and Veillonella. We found statistically significant associations in the alpha-diversity estimators of UPPP and OPSCC patients. Specifically, the microbiota communities present in UPPP are significantly enriched in the observed_species category (P&amp;lt;0.001). The raw number of operational taxonomic units (OTUs) was also significantly higher in UPPP when compared to OPSCC patients (p=0.02). Specifically, a threshold of 80 OTUs was enough to discriminate UPPP from OPSCC patients. At the phylum level, we did not detect a significant difference in taxa of UPPP and OPSCC patients. Yet at the family level, the taxon Fusobacteriales_Leptotrichiaceae is dramatically enriched in UPPP samples when compared to OPSCC (p=0.02) and is present in very high numbers in all UPPP samples. A threshold of 10 sequences assigned to Fusobacteriales_Leptotrichiaceae discriminated UPPP from OPSCC patients. At the genera level we found that the genus Tannerella is exclusively observed in UPPP patients (p=0.03). At the class level, Bacteroidetes_Flavobacteria appears significantly enriched in HPV- when compared to HPV+ OPSCC patients (p=0.02). A threshold of 5 sequences assigned to Flavobacteria discriminated HPV+ from HPV- OPSCC patients. At the class level, we also observed enrichment of the taxon Bacteroidetes_Flavobacteria in UPPP relative to OPSCC HPV+ patients (p=0.03). And at the genus level, the low-level presence of Aerococcaceae_Abiotrophia discriminated UPPP from OPSCC HPV+ patients (p=0.02). Our preliminary results suggest that the microbial diversity and taxonomic composition of the microbiota in saliva may be useful diagnostic and early detection biomonitors for OPSCC. Citation Format: Rafael E. Guerrero-Preston, Christina Michailidi, Anne Jedlicka, Rajagowthamee Thangavel, Tal Hadar, Maartje G. Nordhuis, William Westra, Wayne Koch, Joseph Califano, David Sidransky. 16S rRNA saliva analysis unveils microbiome biomonitors linked to human papilloma virus and oropharyngeal squamous cell carcinoma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 870. doi:10.1158/1538-7445.AM2014-870

Does a patient's Mallampati score predict outcome after maxillomandibular advancement for obstructive sleep apnoea?

The Mallampati airway classification has been used to estimate the success of uvulopalatopharyngoplasty in patients with obstructive sleep apnoea (OSA) but its predictive value in maxillomandibular advancement has not been proved. We aimed to explore the association between preoperative Mallampati scores and surgical outcome after bimaxillary advancement for OSA. We retrospectively analysed data on 50 patients who had maxillofacial operations for OSA at our hospital and stratified them into two groups based on Mallampati scores: high (class III/IV) and low (class I/II). We compared pre- and postoperative apnoea/hypopnoea indices (AHIs), Epworth sleepiness scores, and lowest recorded oxygen saturation in both groups. The postoperative values for all three outcome measures were not significantly different when patients were stratified according to the Mallampati classification (mean (SD) AHI was 41(19) before and 7 (6) after operation in the low group, and 42 (15) before and 9 (7) after in the high group). Success rates (AHI less than 15 postoperatively) were similar in both low and high score groups (p>0.05). Maxillomandibular advancement alleviates obstruction at multiple levels and our study has shown comparable surgical outcomes in both groups. The Mallampati score can be used to optimise patient selection for surgeons considering single-level procedures for OSA. Our study suggests that the Mallampati classification is less useful for the prediction of surgical outcome after maxillomandibular advancement surgery.

Quality‐of‐Life Assessment before and after Uvulopalatopharyngoplasty Patients with Syndrome Diagnosis of OSA

Objectives: Quality of life is dependent on socioeconomic, cultural, and health variables. Obstructive sleep apnea syndrome (OSAS) is an important and prevalent disease associated with poor quality of life in many patients. There are few studies in the literature discussing the surgical treatment for OSA with quality of life. The Short Form-36 (SF-36) is an instrument for measuring quality of life. It has been applied in various situations with good sensitivity. 1) Describe the quality of life in patients with OSA before and after performing uvulopalatopharyngoplasty. 2) Extend the literature on the relationship between uvulopalatopharyngoplasty and quality of life of patients with OSA. Methods: A descriptive study, conducted between August and December 2012. We applied the SF-36 questionnaire before and after uvulopalatopharyngoplasty in 11 patients (10 males and 1 female) between 27 and 67 years old, diagnosed with mild, moderate, or severe OSA (believing in the positive influence of such surgery on quality of life of these patients). Results: 11 patients showed improvement in the overall assessment of quality of life. There was improvement in functional capacity in 6 (54.4%) patients; limitation on the physical aspects in 4 (36.36%), the pain in 7 (63.63%), the general state of health in 9 (81.81%), vitality in 5 (45.45%), social aspects in 5 (45.45%), emotional aspects in 5 (45.5%), and mental health in 5 (45.5%), and there was no worsening in any domain (P &lt; 0.05 in all domains). Conclusions: In addition to polysomnographic analysis and the AHI, the questionnaires about quality of life may be relevant in assessing the therapeutic outcome for OSAS.

Long-term efficacy of submucosal uvulopalatopharyngoplasty for obstructive sleep apnea syndrome

The objective of the study was the assessment of the long-term efficacy of submucosal uvulopalatopharyngoplasty in patients with obstructive sleep apnea syndrome. Thirty-two of 156 patients who underwent UPPP between January 2001 and March 2007 with a follow-up period of 36-96 months (mean, 56 months) were included in the study conducted at the university affiliated center. Preoperative and postoperative snoring evaluation forms and Epworth Sleepiness Scale (ESC) scores were used for subjective analysis. Preoperative and postoperative respiratory distress index (RDI) levels were evaluated objectively. Patients who had 50% or more reduction in RDI levels postoperatively were named as responders to the procedure. The other patients were named as non-responders. Body mass index (BMI) was also analyzed preoperatively and postoperatively. Snoring disappeared in 83% of the patients, did not change in 13% and deteriorated in 4% of the patients (p < 0.001). Excessive daytime sleepiness decreased in 22 patients (68%) and ESC values decreased from 14.6 ± 3.7 to 6.5 ± 3.9 (p = 0.0001). RDI decreased by more than 50% of the preoperative values in 15 (46.9%) of 32 patients forming the responders and the mean RDI decreased from 33.3 ± 22.9 to 23.7 ± 22.8 (p = 0.027). BMI increased over years (p = 0.0001) evidencing a preponderance in non-responder patients. Submucosal uvulopalatopharyngoplasty is an effective tool in treating patient's subjective symptoms of OSAS. Objective findings suggest that smUPPP is inadequate in treating OSAS. It cannot abolish OSAS, though it can decrease the intensity of the condition in nearly half of the patients. Weight gain decreases the success of the procedure over the years.

Modified Genioglossus Advancement and Uvulopalatopharyngoplasty in Patients with Obstructive Sleep Apnea

To describe modification of the originally described genioglossus muscle advancement and its clinical assessment in the treatment of patients with obstructive sleep apnea. Prospective study. University medical hospital. Twenty-three patients with obstructive sleep apnea underwent modified genioglossus muscle advancement with uvulopalatopharyngoplasty. All patients were evaluated before and 6 months after surgery by history taking, clinical examination, Epworth Sleepiness Scale evaluation, fiber-optic nasopharyngoscopy, cephalometry, panoramic X-ray, and nocturnal polysomnography. Postoperative mean ± SD apnea-hypopnea index (AHI) decreased from 40.7 ± 17.4 to 15.4 ± 10.7 (P = .00; 95% confidence interval [CI], 18.4 to 32.27). With a success rate defined as AHI <20 and a 50% decrease in AHI of the preoperative value, the surgical success rate was 86.9%. Cephalometry analysis showed a significant difference between preoperative and postoperative findings, including a posterior airway space that increased a mean ± SD from 8.1 ± 2.5 to 12.3 ± 3.7 mm (P = .00; 95% CI, -5.89 to -3.0), position of the mandible to the cranial base (SNB degree) that increased from 77.3 ± 2.7 to 78.5 ± 1.3 (P = .005; 95% CI, -2.11 to -0.4), and improved palatal parameters. The mean (SD) average depth of the osteotomy and genioglossus advancement was 11.8 ± 2.6 mm. None of the 23 patients had mandible fracture, aesthetic changes of the chin, or detachment of the advanced genioglossus muscle. The modification described in this technique permits complete and safe capture and advancement of the whole genioglossus muscle, leading to satisfactory expansion of the retrolingual airway without stripping, detachment of the advanced genioglossus muscle, mandible fracture, or aesthetic changes of the chin.

Overnight hemoglobin-oxygen saturation monitoring the first day following revised uvulopalatopharyngoplasty in patients with obstructive sleep apnea hypopnea syndrome

To investigate the characteristics of overnight arterial oxygen saturation (SaO2) the first day after upper airway reconstruction surgery in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). One hundred and thirteen subjects with OSAHS underwent revised uvulopalatopharyngoplasty (H-UPPP), among them, 46 subjects underwent same phase transpalatal pharyngoplasty under general anesthesia. After transferred to general ward from intensive care unit the first day after operation they received an overnight hemoglobin-oxygen saturation monitoring. Twelve subjects (10.2%) had lower lowest SaO2 than preoperative value. ≥ 0.03 oxygen desaturation index (ODI3) decreased in an median of 36.9 [16.9; 52.2] events/hour compared with preoperative values (Z = -9.221, P < 0.001). One subjects (0.8%) had increased ODI3. No hemorrhages, cardiovascular complications or airway obstruction occurred. The subjects with any two of the following conditions (n = 51) had lower average SaO2, lowest SaO2 and higher ODI3 than the others (n = 62, Z were -3.084, -4.083 and -4.593, P < 0.001). The three subjects were: (1) BMI ≥ 27.0 kg/m(2); (2) Lowest SaO2 < 0.600; (3) AHI ≥ 60.0 events/h. Some OSAHS patients had a decreased LSaO2 than preoperative values the first day after operation. As part of a patient safety initiative, SaO2 monitoring for those who have high risk for hypoxemia is necessary.

Effect of Uvulopalatopharyngoplasty on Retropalatal Region

Objective: Retropalatal region is a part of upper airway contributing to obstructive sleep apnea (OSA). We aimed to demonstrate the changes in the retropalatal surface area (RPSA) after uvulopalatopharyngoplasty (UPPP) in an attempt to exhibit enlargement as a predictor of surgical treatment. Method: Twenty patients with OSA who underwent UPPP were retrospectively evaluated. Pre and postoperative respiratory disturbance index (RDI), RPSA measurements were studied. Retropalatal region photos were captured at the base of uvula during fiber optic nasopharyngolaryngoscopy to measure RPSAs using AutoCad2004. RDI levels, RPSA measurements were compared using paired t test. Results: The RPSA measurements in the preoperative subjects were between 20 and 72 (mean 44.18). The RPSA measurements in the postoperative patients were between 37 and 107 (mean 72.82). The RPSA significantly increased in postoperative patients ( P = .001). The mean RDI decreased from 27.5 ± 22.2 to 14.6 ± 12.4 ( P &gt; .05). Conclusion: RPSA increases in UPPP patients postoperatively with evidence of an enlarged retropalatal region. Decreased RDI levels indicate amelioration in OSA. RPSA measurements can be used to predict UPPP surgical treatment success.

Analgesic properties of a dexmedetomidine infusion after uvulopalatopharyngoplasty in patients with obstructive sleep apnea

Background:Dexmedetomidine is an alpha2 -adrenergic agonist with sedative and analgesic properties. This study aimed to investigate if the use of a continuous dexmedetomidine infusion with i.v. morphine patient-controlled analgesia (PCA) could improve postoperative analgesia while reducing opioid consumption and opioid-related side effects.Methods:In this prospective randomized, double-blinded, controlled study, 39 patients with obstructive sleep apnea syndrome undergoing uvulopalatopharyngoplasty were assigned to two groups. Group D (dexmedetomidine group) received a loading dose of dexmedetomidine 1 μg.kg-1 i.v., 30 minutes before the anticipated end of surgery, followed by infusion at 0.6 μg.kg-1 h-1 for 24 hours. Group P (placebo group) received a bolus and infusion of placebo. In both groups, postoperative pain was initially controlled by i.v. morphine titration and then PCA with morphine. Cumulative PCA morphine consumption, pain intensities, sedation scores, cardiovascular and respiratory variables and opioid-related adverse effects were recorded for 48 hours after operation.Results:Compared with placebo group, patients in the dexmedetomidine group required 52.7% less PCA morphine during the first 24 hours postoperatively, with significantly better visual analogue scale scores, less incidence of respiratory obstruction (5 vs. 12 patients, respectively; P = .037) and longer time to first analgesic request (21 (11) vs. 9 (4) minutes; P = .002). Fewer patients in group D experienced nausea and vomiting than those in group P (7 vs. 24 patients, respectively; P < .05).Conclusion:Continuous dexmedetomidine infusion may be a useful analgesic adjuvant for patients susceptible to opioid-induced respiratory depression.

Comparison of Posterior Pharyngeal Airway Space at Sitting and Supine Positions in the PACU after Uvulopalatopharyngoplasty in Patients with Obstructive Sleep Apnea Syndrome

Background: Uvulopalatopharyngoplasty (UPPP) is one of the most common treatments for patients with obstructive sleep apnea syndrome (OSAS) who suffer from repetitive apnea and oxygen desaturation during sleep. It is important to properly manage the patient's airway in the PACU after surgery in order to prevent potential airway-related postoperative complications. Methods: 20 patient cases of ASA I or II who were over 20 years old and had undergone UPPP under general anesthesia were reviewed. In PACU, Posteri or pharyngeal airway space (PAS) was measured on a lateral cranial radiograph at both supine and sitting positions and the blood pressure and oxygen saturation were measured. Results: PAS significantly increased in the sitting position (avg. 11.7 mm in supine, 15.7 mm in sitting, P ＜ 0.05) but there was no influence on the blood pressure or oxygen saturation. Conclusions: PAS is associated with the patency of the airway and the increase of PAS in patients in the sitting position while in the PACU is helpful to airway management following UPPP. (Korean J Anesthesiol 2008; 54: 180∼4)

Comparison of Uvulopalatopharyngoplasty, Laser-Assisted Uvulopalatoplasty and Cautery-Assisted Uvulopalatoplasty in the Treatment of Primary Snoring

Objective: Our aim was to compare the postoperative pain and surgical results of uvulopalatopharyngoplasty (UPPP), laser-assisted uvulopalatoplasty (LAUP), and cautery-assisted uvulopalatoplasty (CAUP) procedures in the treatment of primary snoring. Methods: 54 patients were stratified according to a modified Friedman staging system (MFSS) for sleep-disordered breathing. Tonsil size (1, 2, 3) and palatal position scale (grade 1–2) and body mass index <30 according to the MFSS were included for standardization. Three workgroups consisting of 18 patients each were formed and UPPP, LAUP and CAUP procedures were performed. The success of the surgical procedures was evaluated by applying the Epworth Sleepiness Scale to the patients, and the patients’ bed partners were asked to evaluate the snoring level preoperative and 45 days after the operation to determine any improvement in snoring complaints. Patients were followed for postoperative pain, secondary infection, bleeding, permanent velopharyngeal insufficiency and nasopharyngeal stenosis. Results: Snoring was relieved in 83.3% of UPPP and CAUP groups and in 88.8% of LAUP 45 days after operation. The mean pain duration was 5.71 days for the UPPP patients, 6.28 days for the LAUP patients and, 4.12 days for the CAUP patients. The mean pain score was 2.1 for the UPPP patients, 2.38 for the LAUP patients, and 1.6 for the CAUP patients. Only 1 patient was hospitalized due to pain in the LAUP group. Conclusion: The effectiveness of UPPP, LAUP and CAUP procedures were found to be similar (more than 83%). Postoperative pain was mostly seen in LAUP and UPPP cases. The CAUP procedure was easy and the least painful.

Differential expression of CD44 isoforms in head and neck squamous cell carcinoma

Problem: CD44 is a trans-membrane molecule comprising multiple isoforms. These isoforms result from alternative splicing of a variant exon region. Several isoforms occur normally while others, termed CD44 variants (CD44v), are expressed in tumors. Specific isoforms CD44v3–10 and CD44 standard exist in normal keratinocytes. Isoform CD44v3 has been identified in tumor tissue. We hypothesize that total CD44 RNA transcripts are differentially expressed in head and neck squamous cell carcinoma (HNSCC) tissues compared to normal controls and that isoform CD44v3 is overexpressed in tumor tissue. Methods: Five samples of microdissected mucosa from uvulopalatopharyngoplasty patients and 5 samples of HNSCC tissue from various sites were examined. We performed RNA extraction and reverse transcriptase polymerase chain reaction (RT-PCR) using primers that amplify the alternative splicing region followed by gel electrophoresis. We performed quantitative PCR using a junction primer strategy that only amplifies isoform CD44v3 and western blot analysis using an antibody to total CD44. Results: RT-PCR results suggest that at least 3 of 5 tumors and only 1 of 5 normals contain more than 3 CD44 isoforms. The 3 isoforms seen consistently in both normal and tumor tissues correspond to specific isoforms CD44 standard, CD44v3, and CD44v3–10 by base-pair analysis. Quantitative PCR demonstrated that 4 of 5 tumor samples showed greater expression of isoform CD44v3 than all the normal samples. Western blot suggests that there are CD44 isoforms present in tumor that are not present or expressed at low levels in normals. Conclusion: These results support the hypothesis that isoforms of CD44 are differentially expressed in HNSCC compared to normals. We plan to study more tissues at the transcript and protein level and characterize additional specific isoforms using cloning and sequencing. Significance: Understanding CD44 isoform expression in HNSCC tissue compared to normal upper aerodigestive tract mucosa may establish CD44 as a tumor marker. Support: This work was supported by funding from the Flight Attendant Medical Research Institute and the Sylvester Comprehensive Cancer Center.