Transpalatal advancement pharyngoplasty for obstructive sleep apnea
Identifieur interne : 004220 ( Istex/Corpus ); précédent : 004219; suivant : 004221Transpalatal advancement pharyngoplasty for obstructive sleep apnea
Auteurs : B. Tucker Woodson ; Robert J. ToohillSource :
- The Laryngoscope [ 0023-852X ] ; 1993-03.
Abstract
Uvulopalatopharyngoplasty (UPPP) is a commonly performed procedure for obstructive sleep apnea (OSA). However, results are inconsistent. Patients in whom the UPPP procedure has failed have a smaller change in airway size as compared to responders, and also many demonstrate continued obstruction at the palate. We present a modification, transpalatal advancement pharyngoplasty, that increases upper oropharyngeal and retropalatal airway size by advancing the soft palate. Eleven patients with severe OSA and multiple sites of airway narrowing were corrected by this method. Three patients had prior UPPP and 5 patients had concomitant tongue‐base procedures. Overall results demonstrate clinical enlargement of the retropalatal space. In the 6 patients who had transpalatal advancement pharyngoplasty alone, 4 (67%) were successful responders as defined by a respiratory disturbance index (RDI) of less than 20 events per hour. RDI decreased from 52.8 ± 12.2 to 12.3 ± 2.8 events per hour. For the entire group, RDI decreased from 73.3 ± 29.4 to 25.1 ± 28.2 events per hour (P<.001). There were four complications, including a transient oronasal fistula(1), transient dysphagia(2), and serous otitis media(1). Transpalatal advancement pharyngoplasty potentially may offer an alternative to increasingly aggressive resection with UPPP in an effort to increase the upper oropharyngeal and retropalatal airway and may be appropriate in carefully selected patients as part of the surgical treatment of OSA.
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DOI: 10.1288/00005537-199303000-00006
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Tucker Woodson</name><affiliation><mods:affiliation>The Department of Otolaryngology and Human Communication, The Medical College of Wisconsin, Milwaukee</mods:affiliation></affiliation><affiliation><mods:affiliation>Correspondence address: Department of Otolaryngology and Human Communication, MCW Clinic at Froedtert Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI 53226</mods:affiliation></affiliation></author><author><name sortKey="Toohill, Robert J" sort="Toohill, Robert J" uniqKey="Toohill R" first="Robert J." last="Toohill">Robert J. 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However, results are inconsistent. Patients in whom the UPPP procedure has failed have a smaller change in airway size as compared to responders, and also many demonstrate continued obstruction at the palate. We present a modification, transpalatal advancement pharyngoplasty, that increases upper oropharyngeal and retropalatal airway size by advancing the soft palate. Eleven patients with severe OSA and multiple sites of airway narrowing were corrected by this method. Three patients had prior UPPP and 5 patients had concomitant tongue‐base procedures. Overall results demonstrate clinical enlargement of the retropalatal space. In the 6 patients who had transpalatal advancement pharyngoplasty alone, 4 (67%) were successful responders as defined by a respiratory disturbance index (RDI) of less than 20 events per hour. RDI decreased from 52.8 ± 12.2 to 12.3 ± 2.8 events per hour. For the entire group, RDI decreased from 73.3 ± 29.4 to 25.1 ± 28.2 events per hour (P<.001). There were four complications, including a transient oronasal fistula(1), transient dysphagia(2), and serous otitis media(1). Transpalatal advancement pharyngoplasty potentially may offer an alternative to increasingly aggressive resection with UPPP in an effort to increase the upper oropharyngeal and retropalatal airway and may be appropriate in carefully selected patients as part of the surgical treatment of OSA.</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>B. Tucker Woodson MD</name><affiliations><json:string>The Department of Otolaryngology and Human Communication, The Medical College of Wisconsin, Milwaukee</json:string><json:string>Correspondence address: Department of Otolaryngology and Human Communication, MCW Clinic at Froedtert Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI 53226</json:string></affiliations></json:item><json:item><name>Robert J. 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Tucker</forename><surname>Woodson</surname><roleName type="degree">MD</roleName></persName><affiliation>The Department of Otolaryngology and Human Communication, The Medical College of Wisconsin, Milwaukee<address><country key="US"></country></address></affiliation><affiliation>Department of Otolaryngology and Human Communication, MCW Clinic at Froedtert Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI 53226</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Robert J.</forename><surname>Toohill</surname><roleName type="degree">MD</roleName></persName><affiliation>The Department of Otolaryngology and Human Communication, The Medical College of Wisconsin, Milwaukee<address><country key="US"></country></address></affiliation></author><idno type="istex">853DBAE85D25062C74FB44805D5D744C91561C8B</idno><idno type="ark">ark:/67375/WNG-T5XRCRDR-X</idno><idno type="DOI">10.1288/00005537-199303000-00006</idno><idno type="unit">LARY5541030306</idno><idno type="toTypesetVersion">file:LARY.LARY5541030306.pdf</idno></analytic><monogr><title level="j" type="main">The Laryngoscope</title><title level="j" type="alt">LARYNGOSCOPE</title><idno type="pISSN">0023-852X</idno><idno type="eISSN">1531-4995</idno><idno type="book-DOI">10.1002/(ISSN)1531-4995</idno><idno type="book-part-DOI">10.1002/lary.v103:3</idno><idno type="product">LARY</idno><imprint><biblScope unit="vol">103</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="269">269</biblScope><biblScope unit="page" to="276">276</biblScope><biblScope unit="page-count">8</biblScope><publisher>John Wiley & Sons, Inc.</publisher><pubPlace>Hoboken, NJ</pubPlace><date type="published" when="1993-03"></date></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><abstract xml:lang="en" style="main"><head>Abstract</head><p>Uvulopalatopharyngoplasty (UPPP) is a commonly performed procedure for obstructive sleep apnea (OSA). 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Tucker</givenNames><familyName>Woodson</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au2" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Robert J.</givenNames><familyName>Toohill</familyName><degrees>MD</degrees></personName></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="US" type="organization"><unparsedAffiliation>The Department of Otolaryngology and Human Communication, The Medical College of Wisconsin, Milwaukee</unparsedAffiliation></affiliation></affiliationGroup><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><p>Uvulopalatopharyngoplasty (UPPP) is a commonly performed procedure for obstructive sleep apnea (OSA). However, results are inconsistent. Patients in whom the UPPP procedure has failed have a smaller change in airway size as compared to responders, and also many demonstrate continued obstruction at the palate. We present a modification, transpalatal advancement pharyngoplasty, that increases upper oropharyngeal and retropalatal airway size by advancing the soft palate. Eleven patients with severe OSA and multiple sites of airway narrowing were corrected by this method. Three patients had prior UPPP and 5 patients had concomitant tongue‐base procedures. Overall results demonstrate clinical enlargement of the retropalatal space. In the 6 patients who had transpalatal advancement pharyngoplasty alone, 4 (67%) were successful responders as defined by a respiratory disturbance index (RDI) of less than 20 events per hour. RDI decreased from 52.8 ± 12.2 to 12.3 ± 2.8 events per hour. For the entire group, RDI decreased from 73.3 ± 29.4 to 25.1 ± 28.2 events per hour (<i>P</i><.001). 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Tucker</namePart><namePart type="family">Woodson</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>The Department of Otolaryngology and Human Communication, The Medical College of Wisconsin, Milwaukee</affiliation><affiliation>Correspondence address: Department of Otolaryngology and Human Communication, MCW Clinic at Froedtert Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI 53226</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Robert J.</namePart><namePart type="family">Toohill</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>The Department of Otolaryngology and Human Communication, The Medical College of Wisconsin, Milwaukee</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="miscellaneous" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-6N5SZHKN-D">article</genre><originInfo><publisher>John Wiley & Sons, Inc.</publisher><place><placeTerm type="text">Hoboken, NJ</placeTerm></place><dateIssued encoding="w3cdtf">1993-03</dateIssued><copyrightDate encoding="w3cdtf">1993</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><extent unit="figures">6</extent><extent unit="tables">3</extent><extent unit="references">26</extent></physicalDescription><abstract lang="en">Uvulopalatopharyngoplasty (UPPP) is a commonly performed procedure for obstructive sleep apnea (OSA). However, results are inconsistent. Patients in whom the UPPP procedure has failed have a smaller change in airway size as compared to responders, and also many demonstrate continued obstruction at the palate. We present a modification, transpalatal advancement pharyngoplasty, that increases upper oropharyngeal and retropalatal airway size by advancing the soft palate. Eleven patients with severe OSA and multiple sites of airway narrowing were corrected by this method. Three patients had prior UPPP and 5 patients had concomitant tongue‐base procedures. Overall results demonstrate clinical enlargement of the retropalatal space. In the 6 patients who had transpalatal advancement pharyngoplasty alone, 4 (67%) were successful responders as defined by a respiratory disturbance index (RDI) of less than 20 events per hour. RDI decreased from 52.8 ± 12.2 to 12.3 ± 2.8 events per hour. For the entire group, RDI decreased from 73.3 ± 29.4 to 25.1 ± 28.2 events per hour (P<.001). There were four complications, including a transient oronasal fistula(1), transient dysphagia(2), and serous otitis media(1). 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