Clin Exp Otorhinolaryngol.  2013 Mar;6(1):18-22.

Preliminary Findings from Our Experience in Anterior Palatoplasty for the Treatment of Obstructive Sleep Apnea

• Marzetti A
• Tedaldi M
• Passali FM

Abstract

OBJECTIVES
Obstructive sleep apnea (OSA) is a common disorder affecting at least 2% to 4% of adult population characterized by the collapse of the pharyngeal airway. It is well established that retropalatal region is the most common site of obstruction. Consequently, many surgical techniques have been introduced. The purpose of this study is to present our preliminary results in the anterior palatoplasty (AP) compared with results of uvulopalatal flap (UPF).
METHODS
Thirty-eight consecutive patients with mild-moderate OSA were prospectively enrolled into a randomised surgical protocol. Surgical success was measured primarily by satisfactory reduction in snoring, as reported by snoring assessment questionnaire (SQ) of sleep partners. Secondary outcomes measures included improvement in the Epworth Sleepiness Scale (ESS) scores, changes in the magnitude of pharyngeal collapse, and postoperative pain intensity.
RESULTS
The ESS after AP improved from a preoperative value 8.5+/-3.7 to a postoperative mean of 4.9+/-3.2 (P<0.001) after UPF improved from a preoperative value of 8.1+/-3.5 to 5.2+/-3.2 postoperatively (P<0.001). The results of satisfactory reduction in the volume of snoring and response at polysomnographic data were also similar in both procedures. We reported a statistically significant difference of the collapse noted at Muller manoeuvre that improved from 2.7+/-1.0 on average, to 1.1+/-0.9 (P<0.001) after AP and with a lesser extent, (from 2.8+/-1.1 on average to 1.8+/-1.1; P<0.05), after UPF. The mean duration of pain was 10.8 days for UPF patients and 7.1 days for AP patients. The mean pain score in the first 3 days, was 6.8 in UPF patients and 5.1 in AP patients.
CONCLUSION
The subjective and objective improvements evidenced may suggest how AP is far superior to other techniques aimed at creating a palatal fibrotic scar. In the light of these results we can suggest AP procedure as more practical and comfortable when compared to UPF.

Keyword

Sleep apnea; Obstructive sleep apnea; Snoring surgery

MeSH Terms

Adult
Cicatrix
Humans
Light
Pain, Postoperative
Prospective Studies
Sleep Apnea Syndromes
Sleep Apnea, Obstructive
Snoring
Surveys and Questionnaires

Figure

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  Fig. 1 Anterior palatoplasty intraoperative pictures.

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  Fig. 2 Anterior palatoplasty postoperative picture.

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  Fig. 3 Uvulopalatal flap postoperative picture.

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  Fig. 4 Mean VASs for pain. VAS, visual analog scale; UPF, Uvulopalatal flap; AP, anterior palatoplasty.

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