Role of transpalatal advancement pharyngoplasty in management of lateral pharyngeal wall collapse in OSA.

INTRODUCTION: Non-response to palatal surgery for OSA is a problem. Residual lateral wall hypopharyngeal collapse is the proposed mechanism of failure. OBJECTIVE: This study aims to evaluate the role of transpalatal advancement pharyngoplasty in non-responders to primary palatal surgery with residual lateral wall hypopharyngeal collapse. METHODS: This is a retrospective study that was conducted on patients who underwent transpalatal advancement pharyngoplasty for residual lateral wall hypopharyngeal. Inclusion criteria were age greater than 18-years, OSA proved by the polysomnography with apnea hypopnea index >15, lateral wall collapse at the level of hypopharynx as proved by drug-induced sleep endoscopy and had a previous tonsillectomy or previous palatal surgery for OSA. Exclusion criteria were those with no history of tonsillectomy or any other surgery for OSA and those with a missed followup. Data of included patients were collected and included gender, age, polysomnographic data like the apnea hypopnea index, oxygen desaturation and the calculated preoperative Epworth sleepiness scale. The early outcome included symptom improvement as measured by Epworth sleepiness scale score and lateral pharyngeal wall evaluation by nasopharyngoscopic examination in the first postoperative month. Late outcome measurement was performed by the 6-month postoperative polysomnography. Data were analyzed using SPSS program. RESULTS: The study included 37 patients with a mean age of (40.43 ±â€¯6.51). The study included 26 men and 11 women. There was a statistically significant improvement of apnea hypopnea index from 37.8 ±â€¯9.93 to 9.9 ±â€¯2.55. In addition, a statistically significant improvement of lowest oxygen saturation from 78.9 ±â€¯3.39 to 83.3 ±â€¯3.31 was encountered. The patients improved clinically, and this improvement was measured by statistically significant improvement of Epworth sleepiness scale score and snoring visual analogue scale. CONCLUSION: Transpalatal advancement pharyngoplasty widens the retropalatal airway and has a great role in the management of the vertical palate phenotype. In addition, it can have a role in the management of lateral walls, especially lateral wall hypopharyngeal collapse.

Role of transpalatal advancement pharyngoplasty in management of lateral pharyngeal wall collapse in OSA / Papel da faringoplastia com avanço transpalatino no tratamento do colapso da parede lateral da faringe na AOS

Abstract Introduction Non-response to palatal surgery for OSA is a problem. Residual lateral wall hypopharyngeal collapse is the proposed mechanism of failure. Objective This study aims to evaluate the role of transpalatal advancement pharyngoplasty in non-responders to primary palatal surgery with residual lateral wall hypopharyngeal collapse. Methods This is a retrospective study that was conducted on patients who underwent transpalatal advancement pharyngoplasty for residual lateral wall hypopharyngeal. Inclusion criteria were age greater than 18-years, OSA proved by the polysomnography with apnea hypopnea index >15, lateral wall collapse at the level of hypopharynx as proved by drug-induced sleep endoscopy and had a previous tonsillectomy or previous palatal surgery for OSA. Exclusion criteria were those with no history of tonsillectomy or any other surgery for OSA and those with a missed followup. Data of included patients were collected and included gender, age, polysomnographic data like the apnea hypopnea index, oxygen desaturation and the calculated preoperative Epworth sleepiness scale. The early outcome included symptom improvement as measured by Epworth sleepiness scale score and lateral pharyngeal wall evaluation by nasopharyngoscopic examination in the first postoperative month. Late outcome measurement was performed by the 6-month postoperative polysomnography. Data were analyzed using SPSS program. Results The study included 37 patients with a mean age of (40.43 ± 6.51). The study included 26 men and 11 women. There was a statistically significant improvement of apnea hypopnea index from 37.8 ± 9.93 to 9.9 ± 2.55. In addition, a statistically significant improvement of lowest oxygen saturation from 78.9 ± 3.39 to 83.3 ± 3.31 was encountered. The patients improved clinically, and this improvement was measured by statistically significant improvement of Epworth sleepiness scale score and snoring visual analogue scale. Conclusion Transpalatal advancement pharyngoplasty widens the retropalatal airway and has a great role in the management of the vertical palate phenotype. In addition, it can have a role in the management of lateral walls, especially lateral wall hypopharyngeal collapse.

Resumo Introdução A ausência de resposta à cirurgia palatina para AOS é um problema. O colapso residual da parede lateral da hipofaringe é um mecanismo de falha proposto. Objetivo Avaliar o papel da faringoplastia com avanço transpalatino em pacientes que não responderam à cirurgia palatina primária com colapso residual da parede lateral da hipofaringe. Método Estudo retrospectivo que será feito em casos que receberam faringoplastia com avanço transpalatino para parede lateral da hipofaringe residual. Os critérios de inclusão foram idade maior que 18 anos, AOS comprovada por polissonografia com índice de apneia e hipopneia > 15, colapso da parede lateral ao nível da hipofaringe comprovado por endoscopia do sono induzido por drogas e submetidos a amigdalectomia ou cirurgia palatina anterior para AOS. Os critérios de exclusão foram pacientes sem histórico de amigdalectomia ou qualquer outra cirurgia para AOS e aqueles com perda de seguimento. Os dados dos pacientes incluídos foram coletados e incluíram sexo, idade, dados polissonográficos, como índice de apneia e hipopneia, dessaturação de oxigênio e a escala de sonolência de Epworth calculada no pré‐operatório. O desfecho inicial incluiu melhoria dos sintomas medida pelo escore da escala de sonolência de Epworth e avaliação da parede lateral da faringe por exame nasofaringoscópico no primeiro mês do pós‐operatório. A medida do desfecho tardio foi feita pela polissonografia pós‐operatória de 6 meses. Os dados foram analisados no programa SPSS. Resultados O estudo incluiu 37 pacientes com média de 40,43 ± 6,51 anos. O estudo incluiu 26 homens e 11 mulheres. Houve uma melhoria estatisticamente significante do índice de apneia e hiponeia de 37,8 ± 9,93 para 9,9 ± 2,55. Além disso, foi encontrada uma melhoria estatisticamente significante da menor saturação de oxigênio de 78,9 ± 3,39 para 83,3 ± 3,31. Os pacientes melhoraram clinicamente e essa melhoria foi medida pela melhoria estatisticamente significante no escore da escala de sonolência de Epworth e na escala escala visual analógica do ronco. Conclusão A faringoplastia com avanço transpalatino alarga a via aérea retropalatina e tem um papel importante no manejo do fenótipo do palato vertical. Além disso, ela pode ter um papel no manejo das paredes laterais, especialmente no colapso da parede lateral da hipofaringe.