Combining anterior palatoplasty with barbed suspension pharyngoplasty in the treatment of obstructive sleep apnea

Patheemon  Thanachaikun; Natamon  Charakorn

Authors

Patheemon Thanachaikun Nakornping Hospital, Chiangmai, Thailand
Natamon Charakorn Chulalongkorn University, Bangkok, Thailand

Keywords:

Apnea-hypopnea index, obstructive sleep apnea, palatoplasty, pharyngoplasty

Abstract

Background: Surgery is an alternative treatment to positive airway pressure therapy for obstructive sleep apnea (OSA) patients. Various palatal surgical techniques have been developed. However, medical literature has limited accounts on the use of a combination of these techniques to improve outcomes.

Objective: The aim of this study was to assess the efficacy of a combination of anterior palatoplasty (AP) and barbed suspension pharyngoplasty (BSP) in treating adult OSA.

Methods: Data of 24 OSA patients who underwent a combination of AP and BSP between July 2020 to May 2024 were retrospectively reviewed. The surgical outcomes, including apnea-hypopnea index (AHI), lowest oxygen saturation (LSAT), snoring scores, Epworth Sleepiness Scale (ESS), and post-operative complications were collected and compared between pre-operation and post-operation periods.

Results: Twenty-four patients which showed retropalatal or oropharyngeal obstruction were included in our study, with thirteen patients (54.2%) undergoing post-operative polysomnography with a mean follow-up time of 5.8 ± 2.2 months. The median (Q1–Q3) AHI decreased non-significantly from 27.3 (19.8–53.2) to 20.2 (14.4–37.0) events/h (P = 0.216) post-operatively. The median (Q1–Q3) snoring scores significantly improved from 6.0 (4.0–8.0) to 3.0 (0.0–4.0) (P < 0.001) and ESS decreased from 11.0 (9.2 –14.8) to 6.5 (4.0 –9.8) (P < 0.001). LSAT did not change significantly in this study. There were no serious post-operative complications.

Conclusion: The technique combining AP and BSP was safe and significantly improved snoring scores and reduced daytime sleepiness in OSA patients with retropalatal and oropharyngeal obstruction. Improvement in AHI was observed in some patients.

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References

Eckert DJ, Malhotra A. Pathophysiology of adult obstructive sleep apnea. Proc Am Thorac Soc 2008;5:144-53.

https://doi.org/10.1513/pats.200707-114MG

Moffa A, Giorgi L, Cassano M, Lugo R, Baptista P, Casale M. Complications and side effects after barbed pharyngoplasty: a systematic review. Sleep Breath 2023;27:31-8.

https://doi.org/10.1007/s11325-022-02585-3

Babademez MA, Gul F, Teleke YC. Barbed palatoplasty vs. expansion sphincter pharyngoplasty with anterior palatoplasty. Laryngoscope 2020;130:E275-9.

https://doi.org/10.1002/lary.28136

Mair EA, Day RH. Cautery-assisted palatal stiffening operation. Otolaryngol Head Neck Surg 2000;122:547-56.

https://doi.org/10.1067/mhn.2000.106475

Carrasco-Llatas M, Marcano-Acuna M, Zerpa-Zerpa V, Dalmau-Galofre J. Surgical results of different palate techniques to treat oropharyngeal collapse. Eur Arch Otorhinolaryngol 2015;272:2535-40.

https://doi.org/10.1007/s00405-015-3565-1

Pang KP, Piccin O, Pang EB, Pang KA, Chan YH, Rotenberg BW. Combined expansion pharyngoplasty and anterior palatoplasty for the treatment of OSA. Indian J Otolaryngol Head Neck Surg 2016;68:528-33.

https://doi.org/10.1007/s12070-016-1020-2

Barbieri M, Missale F, Incandela F, Fragale M, Barbieri A, Roustan V, et al. Barbed suspension pharyngoplasty for treatment of lateral pharyngeal wall and palatal collapse in patients affected by OSAHS. Eur Arch Otorhinolaryngol 2019;276:1829-35.

https://doi.org/10.1007/s00405-019-05426-4

Salamanca F, Costantini F, Mantovani M, Bianchi A, Amaina T, Colombo E, et al. Barbed anterior pharyngoplasty: an evolution of anterior palatoplasty. Acta Otorhinolaryngol Ital 2014;34:434-8.

Pang KP, Terris DJ. Modified cautery-assisted palatal stiffening operation: new method for treating snoring and mild obstructive sleep apnea. Otolaryngol Head Neck Surg 2007;136:823-6.

https://doi.org/10.1016/j.otohns.2006.11.014

Llewellyn CM, Noller MW, Camacho M. Cauteryassisted palatal stiffening operation for obstructive sleep apnea: A systematic review and meta-analysis. World J Otorhinolaryngol Head Neck Surg 2019;5: 49-56.

https://doi.org/10.1016/j.wjorl.2018.05.007

Pang KP, Pang EB, Pang KA, Rotenberg B. Anterior palatoplasty in the treatment of obstructive sleep apnoea - a systemic review. Acta Otorhinolaryngol Ital 2018;38:1-6.

https://doi.org/10.14639/0392-100X-1641

Pang KP, Tan R, Puraviappan P, Terris DJ. Anterior palatoplasty for the treatment of OSA: three-year results. Otolaryngol Head Neck Surg 2009;141:253-6.

https://doi.org/10.1016/j.otohns.2009.04.020

Mantovani M, Minetti A, Torretta S, Pincherle A, Tassone G, Pignataro L. The velo-uvulo-pharyngeal lift or "roman blinds" technique for treatment of snoring: a preliminary report. Acta Otorhinolaryngol Ital 2012;32:48-53.

Mantovani M, Minetti A, Torretta S, Pincherle A, Tassone G, Pignataro L. The "Barbed Roman Blinds" technique: a step forward. Acta Otorhinolaryngol Ital 2013;33:128.

Vicini C, Hendawy E, Campanini A, Eesa M, Bahgat A, AlGhamdi S, et al. Barbed reposition pharyngoplasty (BRP) for OSAHS: a feasibility, safety, efficacy and teachability pilot study. "We are on the giant's shoulders". Eur Arch Otorhinolaryngol 2015;272: 3065-70.

https://doi.org/10.1007/s00405-015-3628-3

Madkikar N, Pandey S, Ghaisas V. Multi level single stage: Barbed reposition pharyngoplasty and nasal surgery in treatment of OSA-Our experience. Indian J Otolaryngol Head Neck Surg 2019;71:309-14.

https://doi.org/10.1007/s12070-019-01694-y

Kezirian EJ, Hohenhorst W, de Vries N. Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 2011;268:1233-6.

https://doi.org/10.1007/s00405-011-1633-8

Friedman M, Salapatas AM, Bonzelaar LB. Updated friedman staging system for obstructive sleep apnea. Adv Otorhinolaryngol 2017;80:41-8.

https://doi.org/10.1159/000470859

Choi JH, Lee JY, Cha J, Kim K, Hong SN, Lee SH. Predictive models of objective oropharyngeal OSA surgery outcomes: Success rate and AHI reduction ratio. PLoS One 2017;12:e0185201.

https://doi.org/10.1371/journal.pone.0185201

Qi Y, Zhao Y, Yan Y, Wu D. Surgical failure guided by DISE in patients with obstructive sleep apnea: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024;281:3333-43.

https://doi.org/10.1007/s00405-024-08484-5

Önerci M, Ögretmenoglu O, Yücel T. Reasons for failure in surgery of obstructive sleep apnea syndrome. In: Kountakis SE, Önerci, M, editors. rhinologic and sleep apnea surgical techniques: Springer, Berlin, Heidelberg: Springer; 2007. p. 397-404.

https://doi.org/10.1007/978-3-540-34020-1_45

Schoustra E, van Maanen P, den Haan C, Ravesloot MJL, de Vries N. The role of isolated nasal surgery in obstructive sleep apnea therapy-A systematic review. Brain Sci 2022;12:1446.

https://doi.org/10.3390/brainsci12111446

Ishii L, Roxbury C, Godoy A, Ishman S, Ishii M. Does nasal surgery improve OSA in patients with nasal obstruction and OSA? a meta-analysis. Otolaryngol Head Neck Surg 2015;153:326-33.

https://doi.org/10.1177/0194599815594374

Li HY, Lee LA, Wang PC, Hsiao HR, Hsu CY, Chen NH, et al. Taste disturbance after uvulopalatopharyngoplasty for obstructive sleep apnea. Otolaryngol Head Neck Surg 2006;134:985-90.

https://doi.org/10.1016/j.otohns.2006.02.034

Askar SM, El-Anwar MW, Awad A. Modified anterior palatoplasty and double suspension sutures (with or without tonsillectomy) in selected patients with obstructive sleep apnea: a preliminary report. Sleep Breath 2018;22:789-95.

https://doi.org/10.1007/s11325-018-1671-1