Palatal hybrid surgery for obstructive sleep apnea-state-of-the-art annotation of uvulopalatopharyngoplasty

Hsueh-Yu Li; Ming-Shao Tsai; Li-Ang Lee; Li-Jen Hsin; Yi-Chan Lee; Wan-Ni Lin; Yi-An Lu; Shih-Chieh Shen; Wen-Nuan Cheng; Yen-Ting Chaing

Biomedical Journal (Jun 2023)

Palatal hybrid surgery for obstructive sleep apnea-state-of-the-art annotation of uvulopalatopharyngoplasty

Hsueh-Yu Li,
Ming-Shao Tsai,
Li-Ang Lee,
Li-Jen Hsin,
Yi-Chan Lee,
Wan-Ni Lin,
Yi-An Lu,
Shih-Chieh Shen,
Wen-Nuan Cheng,
Yen-Ting Chaing

Affiliations

Hsueh-Yu Li: Department of Otorhinolaryngology – Head and Neck Surgery, Sleep Center, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Corresponding author. Department of Otorhinolaryngology – Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, 5, Fu-Hsing Str., Gueishan, Taoyuan 33305, Taiwan.
Ming-Shao Tsai: College of Medicine, Chang Gung University, Taoyuan, Taiwan; Departments of Otolaryngology – Head & Neck Surgery, Chang Gung Memorial Hospital at Chayi, Chayi, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
Li-Ang Lee: Department of Otorhinolaryngology – Head and Neck Surgery, Sleep Center, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
Li-Jen Hsin: Department of Otorhinolaryngology – Head and Neck Surgery, Sleep Center, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
Yi-Chan Lee: College of Medicine, Chang Gung University, Taoyuan, Taiwan; Departments of Otolaryngology – Head & Neck Surgery, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
Wan-Ni Lin: Department of Otorhinolaryngology – Head and Neck Surgery, Sleep Center, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
Yi-An Lu: Department of Otorhinolaryngology – Head and Neck Surgery, Sleep Center, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
Shih-Chieh Shen: College of Medicine, Chang Gung University, Taoyuan, Taiwan; Departments of Otolaryngology – Head & Neck Surgery, New Taipei City Municipal Tucheng Hospital, New Taipei, Taiwan
Wen-Nuan Cheng: Department of Sports Sciences, University of Taipei, Taipei, Taiwan
Yen-Ting Chaing: Department of Otorhinolaryngology – Head and Neck Surgery, Sleep Center, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan

Journal volume & issue: Vol. 46, no. 3
p. 100568

Abstract

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Background: Surgery for obstructive sleep apnea (OSA) has changed in concept and technique that transformed from radical excision to functional reconstruction. The aim of this study was to investigate the safety and effectiveness of palatal hybrid surgery in OSA patients. Methods: Palatal hybrid surgery is a tissue-specific technique (mucosa-preservation, tonsil-excision, fat-ablation, muscle-relocation/suspension) used in treating OSA patients with velopharyngeal obstruction. The study included 46 consecutive adults OSA patients. The palatal hybrid surgery annotates uvulopalatopharyngoplasty in stereoscopic reconstruction of tonsillar fossa (pharyngoplasty), omni-suspension of the soft palate (palatoplasty) and advancement of uvula (uvuloplasty). Results: No patient experienced airway compromise, voice change or persistent nasal regurgitation following palatal hybrid surgery. One patient existed postoperative tonsillar fossa bleeding received conservative treatment. Postoperative pain in visual analogue scale (VAS) showed average score of 3, 3, 2, 0 at the 1st, 3rd, 7th, 14th day, respectively. Perioperative snoring severity (VAS) (8.7 vs 2.6) and daytime sleepiness (Epworth Sleepiness Scale) (11.3 vs 5.5) all improved significantly (p < 0.001). Posterior air space in retropalatal area increased from 8.4 to 11.1 mm (p < 0.001). Home sleep test showed that apnea–hypopnea index significantly reduced from 41.8 to 18.2 event/h and minimal oxygen saturation increased from 72.4 to 81.5% (p < 0.001). The success rate in individual Friedman stage was 100% (stage I), 63% (stage II) and 58% (stage III) with a total success rate of 63%. Conclusion: Palatal hybrid surgery using tissue-specific maneuver annotates UPPP in concept and technique. The results show that palatal hybrid surgery is mini-invasive with low morbid and is effective in improving subjective clinic symptoms, objective sleep parameters and success rate of OSA.

Published in Biomedical Journal

ISSN: 2319-4170 (Print); 2320-2890 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Medicine (General); Science: Biology (General)
Website: https://www.sciencedirect.com/journal/biomedical-journal

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