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Duan X, Zhu M, Zhang C, Li M, Cai Y, Chen S, Zheng H. Evaluation of modified coblation endoscopic lingual lightening in multilevel surgery for obstructive sleep apnea hypopnea syndrome: an open intervention study. Sleep Breath 2024; 28:647-656. [PMID: 37843682 PMCID: PMC11136828 DOI: 10.1007/s11325-023-02912-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/30/2023] [Accepted: 09/04/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE To evaluate the efficacy and safety of modified coblation endoscopic lingual lightening to address retrolingual obstruction in multilevel surgery for obstructive sleep apneae (OSA). METHODS Patients with OSA due to retropalatal and retrolingual obstructions were enrolled. Group 1 consisted of patients who underwent modified coblation endoscopic lingual lightening combined with H-uvulopalatopharyngoplasty, while group 2 comprised patients treated by H-uvulopalatopharyngoplasty alone. Objective parameters and subjective evaluations were recorded preoperatively and at 6 months postoperatively. RESULTS The mean (standard deviation) apnea-hypopnea index (AHI) declined from 51.5 (18.9) to 14.3 (7.2) in group 1, and from 51.7 (15.8) to 28.5 (16.9) in group 2. The mean (standard deviation) percentage change in AHI was higher in group 1 than in group 2 (73.2 [10.9] vs. 48.9 [22.4], P < 0.01). The surgical response rate differed significantly between groups 1 and 2 (88.5 [23/26] vs. 46.7 [14/30], P < 0.01). Other outcomes, including the lowest oxygen saturation, Epworth Sleepiness Scale score, snoring visual analog scale score, and subjective improvement rate, were also significantly better in group 1 than in group 2. CONCLUSION Without increasing complications, modified coblation endoscopic lingual lightening significantly improved surgical outcomes as part of multilevel surgery in patients with OSA due to multilevel obstruction.
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Affiliation(s)
- Xiangqiang Duan
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Naval Medical University, No. 168, Changhai Rd, Shanghai City, 200433, China
| | - Minhui Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Naval Medical University, No. 168, Changhai Rd, Shanghai City, 200433, China
| | - Caiyun Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Naval Medical University, No. 168, Changhai Rd, Shanghai City, 200433, China
| | - Meng Li
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Naval Medical University, No. 168, Changhai Rd, Shanghai City, 200433, China
| | - Yupeng Cai
- Department of Medical Imaging, The First Affiliated Hospital of Naval Medical University, Shanghai City, China
| | - Shicai Chen
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Naval Medical University, No. 168, Changhai Rd, Shanghai City, 200433, China
| | - Hongliang Zheng
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Naval Medical University, No. 168, Changhai Rd, Shanghai City, 200433, China.
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Amali A, Erfanian R, Amirzargar B, Sadeghi M, Saedi B, Emami H, Heidari R, Mirashrafi F, Golparvaran S. Polysomnographic Findings Versus Degree of Obstruction During Drug-Induced Sleep Endoscopy and Muller's Maneuver. Indian J Otolaryngol Head Neck Surg 2023; 75:2769-2776. [PMID: 37974875 PMCID: PMC10645862 DOI: 10.1007/s12070-023-03871-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 05/06/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE To investigate associations between polysomnographic findings and the severity of upper airway obstructions during Muller's Maneuver (MM) and Drug-Induced Sleep Endoscopy (DISE) in patients with obstructive sleep apnea syndrome (OSAS). METHODS This was a prospective cohort study. Adult patients newly diagnosed with OSAS in a tertiary sleep center were included consecutively and evaluated by polysomnography and MM. They then underwent DISE in an operating room. The associations between polysomnographic findings and the severity of upper airway obstructions during MM and DISE were assessed. Also, the degree and pattern of obstructions were compared using a modified VOTE questionnaire. RESULTS 145 patients (mean age 41.5 ± 10.1 years) were enrolled. There were no associations between Respiratory Disturbance Index (RDI), mean and lowest O2 saturation, and body mass index on the one hand, and obstruction degree in MM and DISE (p > 0.05). However, a significant positive correlation was observed between RDI and total VOTE scores in DISE and MM (r = 0.179, p = 0.031 and r = 0.221, p = 0.008 respectively). There were no differences between MM and DISE in diagnosing the degree of obstruction in the velum area (p = 0.687) and the epiglottis (p = 0.50). However, a significant difference was observed between the two techniques in the oropharynx lateral wall (p < 0.001) and tongue base (p = 0.017). CONCLUSION Although there was no association between polysomnographic findings and the severity of obstruction in MM and DISE for the separate levels of the upper airway, obstruction severity may be assessed more accurately by total VOTE score, which is representative of RDI severity.
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Affiliation(s)
- Amin Amali
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Otorhinolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Erfanian
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Otorhinolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Behrooz Amirzargar
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Otorhinolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadeghi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Otorhinolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Saedi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Otorhinolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Emami
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Otorhinolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Reihaneh Heidari
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Otorhinolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Mirashrafi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Otorhinolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Golparvaran
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Otorhinolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran
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Suspension-expansion pharyngoplasty: a modified technique for oropharyngeal collapse in obstructive sleep apnea. Eur Arch Otorhinolaryngol 2023; 280:1343-1351. [PMID: 36284008 DOI: 10.1007/s00405-022-07688-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/04/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Lateral pharyngeal wall (LPW) collapse plays a fundamental role in the pathogenesis of obstructive sleep apnea (OSA) and might determine the severity of the disease. This study presents the suspension/expansion pharyngoplasty (SEP) for the treatment of selected cases of OSA. The procedure aimed to splint LPW collapse via supporting and lateralization of both superior constrictor muscle (SCM) and palatopharyngeal muscle (PPM) individually and in two different planes. METHODS Twenty-one adult patients with single-level OSA who showed a lateral pattern of collapse at the oropharyngeal region had the modified procedure (SEP). The basic steps are the individual dissection of the muscular components of the lateral pharyngeal wall: SCM which was sutured anteriorly to the anterior tonsillar pillar and the PPM which was suspended to the pterygomandibular raphe. The supra-tonsillar fat was preserved. RESULTS At 9-12 months, highly significant improvement was reported as regards the mean Apnea hypopnea index and the mean lowest oxygen saturation (p < 0.000). The Epworth Sleepiness Scale and VAS-snoring showed a significant (p < 0.05) reduction. The oxygen desaturation index showed significant improvement. Non-significant improvements were reported as regards the percentage of total sleep time with oxygen saturation below 90%. According to Sher criteria, successful outcomes were reported in 17 patients. CONCLUSION SEP could widen the pharyngeal airway and could support the collapsible lateral pharyngeal wall guarding against soft tissue collapse. In selected subjects, SEP had reported subjective and objective favorable outcomes with no significant comorbidities. The procedure could be combined with other procedures in multilevel surgery. LEVEL OF EVIDENCE: 4
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Optimal application of soft-palate webbing flap pharyngoplasty combined with nasal surgery for surgical treatment of primary snoring and obstructive sleep apnea. Sleep Breath 2022; 26:1963-1971. [DOI: 10.1007/s11325-022-02563-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/28/2021] [Accepted: 01/05/2022] [Indexed: 11/25/2022]
Abstract
Abstract
Background
Excessive collapse of the soft palate and lateral pharyngeal wall narrowing are established causes of loud snoring and sleep apnea in subjects with obstructive sleep apnea (OSA). Therefore, delicate surgical techniques are needed to reshape the soft palate and create sufficient tension in the lateral pharyngeal wall. This study aimed to determine the therapeutic outcome and favorable indications of soft-palate webbing flap pharyngoplasty in subjects with OSA and primary snoring.
Methods
A total of 174 subjects who underwent soft-palate webbing flap pharyngoplasty combined with uvulopalatal flap and septoturbinoplasty from August 2015 to February 2020 were included in this study. Medical records, including pre- and postoperative sleep parameters, were retrospectively reviewed. The primary outcome measure was the degree of improvement in AHI after surgery. Other outcomes were differences in surgical response rates, subjective visual analog score (VAS) for snoring, sleep quality, and complications.
Results
Polysomnographic results showed that apnea–hypopnea index (AHI) scores were significantly reduced from 39.6 ± 6.1 to 22.9 ± 3.6 following soft-palate webbing flap pharyngoplasty in 59 subjects, and overall success and response rates of this technique were analyzed with 71%. We found that the successful outcomes were observed in 50% of mild (n = 12) and 56% of moderate (n = 16) subjects with OSA subjects due to lateral pharyngeal wall collapse. The success rate of soft-palate webbing flap pharyngoplasty was relatively higher in subjects with mild and moderate OSA than those with severe OSA. Additionally, the mean VAS snoring scale was 4.7 and subjects’ primary snoring intensity significantly improved to 2.9 after soft-palate webbing flap pharyngoplasty. Subjective symptoms such as daytime sleepiness and sleep quality also showed improvement. Most complications were found to be minimal and improved by 1 month after the operation.
Conclusion
Our data demonstrate that soft-palate webbing flap pharyngoplasty is an effective treatment for OSA and primary snoring and may be a promising technique to reduce lateral pharyngeal wall collapse.
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Askar SM, El-Bary MEA, Elshora ME, Gohary AFA, Abosharkh AA, Khazbak AO. Anterolateral advancement palatoplasty with tonsillectomy for retropalatal obstruction in selected cases of obstructive sleep apnea. Eur Arch Otorhinolaryngol 2022; 279:2679-2687. [DOI: 10.1007/s00405-021-07235-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/17/2021] [Indexed: 11/29/2022]
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Drug Induced Sleep Endoscopy Versus Awake Endoscopy in Retrolingual Obstruction Assessment in Obstructive Sleep Apnea Patients: A Comparative Study. J Craniofac Surg 2021; 33:e499-e503. [PMID: 34930877 DOI: 10.1097/scs.0000000000008421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/25/2021] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT The aim of this study is to evaluate the correlation of retrolingual obstruction determined by drug induced sleep endoscopy (DISE) and awake endoscopy evaluation of Muller maneuver (MM) and lingual tonsil hypertrophy (LTH) in patients with obstructive sleep apnea.A prospective cohort of 100 patients with obstructive sleep apnea who underwent DISE was assessed. The inclusion criteria were age between 18 and 70 years, and apnea-hypopnea index higher than 5. Friedman staging, LTH and MM were determined by awake endoscopy, as other physical findings. The authors evaluated the correlation of retrolingual obstruction determined by DISE using velum oropharynx tongue, epiglottis (VOTE) and nose, oropharynx, hypopharynx, larynx (NOHL) classification.When retrolingual MM was assessed, significant changes between awake and DISE were observed (P = 0.000). Conversely, Friedman stage had no significant changes to DISE retrolingual findings (P = 0.868). Analyzing LTH and DISE retrolingual findings according to NOHL and VOTE, if a cutoff value was established at 50%, DISE findings differ from awake: NOHL (P < 0.001) and VOTE (P = 0.004). Nevertheless, if a restrictive cutoff at 75% was attached, DISE findings were similar to awake: NOHL (P = 0.124) and VOTE (P = 0.123).This study demonstrates that awake endoscopy determining LTH and Friedman stage is a mild predictor of collapse at retrolingual level, showing significant correlation to DISE only when severe retrolingual collapse is present. Our findings suggest that in-office awake endoscopy may have certain predictive value to select surgical patients.
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Sun J, Hu X, Peng S, Peng CK, Ma Y. Automatic classification of excitation location of snoring sounds. J Clin Sleep Med 2021; 17:1031-1038. [PMID: 33560203 DOI: 10.5664/jcsm.9094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
STUDY OBJECTIVES For surgical treatment of patients with obstructive sleep apnea-hypopnea syndrome, it is crucial to locate accurately the obstructive sites in the upper airway; however, noninvasive methods for locating the obstructive sites have not been well explored. Snoring, as the cardinal symptom of obstructive sleep apnea-hypopnea syndrome, should contain information that reflects the state of the upper airway. Through the classification of snores produced at four different locations, this study aimed to test the hypothesis that snores generated by various obstructive sites differ. METHODS We trained and tested our model on a public data set that comprised 219 participants. For each snore episode, an acoustic and a physiological feature were extracted and concatenated, forming a 59-dimensional fusion feature. A principal component analysis and a support machine vector were used for dimensional reduction and snore classification. The performance of the proposed model was evaluated using several metrics: sensitivity, precision, specificity, area under the receiver operating characteristic curve, and F1 score. RESULTS The unweighted average values of sensitivity, precision, specificity, area under the curve, and F1 were 86.36%, 89.09%, 96.4%, 87.9%, and 87.63%, respectively. The model achieved 98.04%, 80.56%, 72.73%, and 94.12% sensitivity for types V (velum), O (oropharyngeal), T (tongue), and E (epiglottis) snores. CONCLUSIONS The characteristics of snores are related to the state of the upper airway. The machine-learning-based model can be used to locate the vibration sites in the upper airway.
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Affiliation(s)
- Jingpeng Sun
- Institute of Automation, Chinese Academy of Sciences, Beijing, People's Republic of China.,University of Chinese Academy of Sciences, Beijing, People's Republic of China.,Division of Interdisciplinary Medicine and Biotechnology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Xiyuan Hu
- School of Computer Science and Engineering, Nanjing University of Science and Technology, Nanjing, People's Republic of China
| | - Silong Peng
- Institute of Automation, Chinese Academy of Sciences, Beijing, People's Republic of China.,University of Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Chung-Kang Peng
- Division of Interdisciplinary Medicine and Biotechnology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Yan Ma
- Division of Interdisciplinary Medicine and Biotechnology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Gasparini G, Saponaro G, Todaro M, Ciasca G, Cigni L, Doneddu P, Azzuni C, Foresta E, De Angelis P, Barbera G, Parcianello RG, Hreniuc HV, Moro A. Functional Upper Airway Space Endoscopy: A Prognostic Indicator in Obstructive Sleep Apnea Treatment with Mandibular Advancement Devices. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052393. [PMID: 33804517 PMCID: PMC7967765 DOI: 10.3390/ijerph18052393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 02/06/2023]
Abstract
Purpose: The use of a mandibular advancement device (MAD) in the treatment of obstructive sleep apnea (OSA) is a consolidated therapy. This study aimed to evaluate the predictive value of awake upper airways (UA) functional endoscopy in identifying the outcome of MAD therapy. Methods: This observational prospective study included 30 adult OSA patients, all patients underwent pre-treatment awake UA functional endoscopy, during the exam subjects were instructed to advance their mandible maximally, and they were divided into three different groups according to the response of the soft tissue, group A (expansion), group B (stretch), group C (unchanged). The results of this test were used in combination with other noninvasive indexes to predict the treatment outcome in terms of apnea-hypopnea index (AHI) reduction. Results: We found that a substantial AHI reduction occurred in group A and group B while e slight AHI reduction was measured in group C. Conclusion: Based on our experience the awake UA endoscopy is a valid prognostic exam for discriminating responder and non-responder patients; in addition our results indicate the possibility of predicting a range of post-treatment AHI index values.
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Affiliation(s)
- Giulio Gasparini
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Gianmarco Saponaro
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Mattia Todaro
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
- Correspondence:
| | - Gabriele Ciasca
- Dipartimento di Neuroscienze, Sezione di Fisica, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy;
| | - Lorenzo Cigni
- Department of Odonto-Stomatology, Azienda Ospedaliera Valtellina e Valchiavenna, 23100 Sondrio, Italy;
| | - Piero Doneddu
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Camillo Azzuni
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Enrico Foresta
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Paolo De Angelis
- Departement of Head, Division of Oral Surgery and Implantology, Neck and Sensory Organs, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy;
| | - Giorgio Barbera
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Roberta Gaia Parcianello
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Horia Vasile Hreniuc
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy;
| | - Alessandro Moro
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
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Askar SM, El-Anwar MW, Quriba AS. Positional awake nasoendoscopic pattern-based surgical decision for correction of retropalatal obstruction in OSA. Eur Arch Otorhinolaryngol 2021; 278:901-909. [PMID: 33386971 DOI: 10.1007/s00405-020-06559-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/10/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate differential surgical interventions for obstructive sleep apnea (OSA) patients with single-level retropalatal based on the preoperative topographical diagnosis using nasoendoscopy with Müller's maneuver during supine position (MM-P). SUBJECTS AND METHODS This case series included adult patients with OSA who showed a predominant single-level retropalatal collapse on MM-P. An anteroposterior pattern of collapse was managed by an anterior advancement procedure, while a transverse pattern of collapse was managed by lateral/anterolateral advancement procedures (double suspension sutures). A combined procedure was provided to the concentric type of collapse. All patients underwent evaluation of the polysomnography, Epworth Sleepiness Scale (ESS) values and snoring scores both preoperatively and 6-8 months after surgery. RESULTS Among 102 patients, the most commonly reported pattern of collapse at the retropalatal level was the concentric pattern (48.04%) followed by the transverse pattern (27.45%). The AP-pattern of collapse was reported in 24.51%. In the postoperative follow-up visits, no early or late complications were reported. All included groups showed significant improvement in polysomnographic data (mean AHI and lowest O2 saturation level). Significant improvement of VAS of snoring was reported. The overall success rate was ˃90%. CONCLUSION Preoperative differential diagnosis of OSA with MM-P allows for tailored surgical management. Tailored procedures could yield good surgical outcomes when patients are properly selected and the technique is chosen according to preoperative topographical diagnostic assessment. This study might provide an available less-costly and effective preoperative planning for OSA intervention. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Sherif Mohammad Askar
- Head and Neck Surgery, Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Othman Bin Affan St., Zagazig, Sharkia Governorate, Egypt.
| | - Mohammad Waheed El-Anwar
- Head and Neck Surgery, Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Othman Bin Affan St., Zagazig, Sharkia Governorate, Egypt
| | - Amal Saeed Quriba
- Phoniatric Unit, Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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