Abstract
Purpose
Velopharyngoplasty and palatine tonsillectomy are at the very heart of the surgical treatment of obstructive sleep apnea syndrome (OSAS) care. In cases of major tonsil hypertrophy, we evaluated the relevance of associating soft palate surgery with palatine tonsillectomy, independent of the soft palate length.
Methods
We conducted a retrospective single-center study in OSAS patients with grade III or IV tonsils treated with tonsillectomy. Preoperative assessment included an upper airway examination performed while the patient was awake, a polysomnography and a drug-induced sedation endoscopy (DISE). Surgical efficacy was assessed on postoperative polysomnography. Success was considered when the postoperative apnea-hypopnea index (AHI) was less than 20 events/h with a 50% reduction. We compared palatine tonsillectomy efficacy alone (group A) and associated with soft palate surgery (group B).
Results
We analyzed 33 patients who had undergone surgery between December 2006 and May 2018. Their preoperative mean BMI and mean AHI were 27.3 ± 7.5 kg/m2 and 38.6 ± 21.4 events/h, respectively. The two groups (A, n = 18 and B, n = 15) were clinically comparable. The success rate was 72.2% in group A and 60% in group B. There was no statistically significant difference between the two groups (p > 0.1).
Conclusions
According to this study, in our institution, in cases of major tonsillar hypertrophy, simultaneous soft palate surgery had no significant impact on the success rate, regardless of soft palate length. Associating soft palate surgery with palatine tonsillectomy does not seem mandatory to increase the success rate.
Level of evidence
III. Retrospective comparative study
Similar content being viewed by others
Abbreviations
- OSAS:
-
obstructive sleep apnea syndrome
- DISE:
-
drug-induced sleep endoscopy
- AHI:
-
Apnea-Hypopnea Index
- /h:
-
per hour
- CPAP:
-
continuous positive airway pressure
- UPPP:
-
uvulopalatopharyngoplasty
- MAS:
-
mandibular advancement splint
- ESS:
-
Epworth Sleepiness Scale
- BMI:
-
body mass index
References
Weaver TE, Grunstein RR (2008) Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc 5(2):173–178
Bizieux-Thaminy A, Gagnadoux F, Binquet C, Meslier N, Person C, Racineux JL (2005) Long term use of nCPAP therapy in sleep apnoea patients. Rev Mal Respir 22(6):951–957
Rotenberg BW, Vicini C, Pang EB, Pang KP (2016) Reconsidering first-line treatment for obstructive sleep apnea: a systematic review of the literature. J Otolaryngol Head Neck Surg 45(1)
Ikematsu T (1964) Study of snoring, 4th report. Ther J Jpn Oto-Rhino-Laryngol:434–435
Fujita S, Conway W, Zorick F, Roth T (1981) Surgical correction of anatomic azbnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol-Head Neck Surg Off J Am Acad Otolaryngol Head Neck Surg 89(6):923–934
Epstein LJ, Kristo D, Strollo PJ, Friedman N, Malhotra A, Patil SP et al (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med JCSM Off Publ Am Acad Sleep Med 5(3):263–276
Blumen M, Crampette L, Fischler M, Galet de Santerre O, Jaber S, Larzul J-J et al (2010) Surgical treatment of obstructive sleep apnea syndrome. Rev Mal Respir 27(3):157–165
Fleetham J, Ayas N, Bradley D, Ferguson K, Fitzpatrick M, George C, Hanly P, Hill F, Kimoff J, Kryger M, Morrison D, Series F, Tsai W (2007) Practice guidelines of the Canadian Thoracic Society on the diagnosis and treatment of sleep respiratory problems of adults. Can Respir J 14(1):31–36
Rombaux P, Hamoir M, Bertrand B, Aubert G, Liistro G, Rodenstein D (2003) Postoperative pain and side effects after uvulopalatopharyngoplasty, laser-assisted uvulopalatoplasty, and radiofrequency tissue volume reduction in primary snoring. Laryngoscope 113(12):2169–2173
Friedman M, Ibrahim H, Bass L (2002) Clinical staging for sleep-disordered breathing. Otolaryngol--Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg 127(1):13–21
(1997) Practice parameters for the indications for polysomnography and related procedures. Polysomnography Task Force, American Sleep Disorders Association Standards of Practice Committee. Sleep. 20(6):406–422
Kezirian EJ, Hohenhorst W, de Vries N (2011) Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 268(8):1233–1236
Johnson DM, Soose RJ (2017) Updated nasal surgery for obstructive sleep apnea. Adv Otorhinolaryngol 80:66–73
Sher AE, Schechtman KB, Piccirillo JF (1996) The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 19(2):156–177
Kezirian EJ, Weaver EM, Criswell MA, de Vries N, Woodson BT, Piccirillo JF (2011) Reporting results of obstructive sleep apnea syndrome surgery trials. Otolaryngol-Head Neck Surg 144(4):496–499
Smith MM, Peterson E, Yaremchuk KL (2017) The role of tonsillectomy in adults with tonsillar hypertrophy and obstructive sleep apnea. Otolaryngol-Head Neck Surg 157(2):331–335
Camacho M, Li D, Kawai M, Zaghi S, Teixeira J, Senchak AJ, Brietzke SE, Frasier S, Certal V (2016) Tonsillectomy for adult obstructive sleep apnea: a systematic review and meta-analysis: adult tonsillectomy for OSA. Laryngoscope 126(9):2176–2186
Maurer JT (2009) Update on surgical treatments for sleep apnea. Swiss Med Wkly 139(43–44):624–629
Ulualp S (2014) Modified expansion sphincter pharyngoplasty for treatment of children with obstructive sleep apnea. JAMA Otolaryngol Head Neck Surg 140(9):817–822
Vroegop AV, Vanderveken OM, Boudewyns AN, Scholman J, Saldien V, Wouters K, Braem MJ, van de Heyning PH, Hamans E (2014) Drug-induced sleep endoscopy in sleep-disordered breathing: report on 1,249 cases. Laryngoscope 124(3):797–802
Kezirian EJ, White DP, Malhotra A, Ma W, McCulloch CE, Goldberg AN (2010) Interrater reliability of drug-induced sleep endoscopy. Arch Otolaryngol Head Neck Surg 136(4):393–397
Zerpa Zerpa V, Carrasco Llatas M, Agostini Porras G, Dalmau Galofre J (2015) Drug-induced sedation endoscopy versus clinical exploration for the diagnosis of severe upper airway obstruction in OSAHS patients. Sleep Breath 19(4):1367–1372
Kotecha B, De Vito A (2018) Drug induced sleep endoscopy: its role in evaluation of the upper airway obstruction and patient selection for surgical and non-surgical treatment. J Thorac Dis 10(1):S40–S47
Victores AJ, Olson K, Takashima M (2017) Interventional drug-induced sleep endoscopy: a novel technique to guide surgical planning for obstructive sleep apnea. J Clin Sleep Med 13(02):169–174
Hsu Y-S, Jacobowitz O (2017) Does sleep endoscopy staging pattern correlate with outcome of advanced palatopharyngoplasty for moderate to severe obstructive sleep apnea? J Clin Sleep Med 13(10):1137–1144
Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Ward SLD, Tangredi MM (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. J Clin Sleep Med Internet
Rashwan MS, Montevecchi F, Cammaroto G, Badr El Deen M, Iskander N, El Hennawi D et al (2018) Evolution of soft palate surgery techniques for obstructive sleep apnea patients: a comparative study for single-level palatal surgeries. Clin Otolaryngol 43(2):584–590
Pang KP, Woodson BT (2007) Expansion sphincter pharyngoplasty: a new technique for the treatment of obstructive sleep apnea. Otolaryngol Head Neck Surg 137(1):110–114
Cahali MB (2003) Lateral pharyngoplasty: a new treatment for obstructive sleep apnea hypopnea syndrome. Laryngoscope 113(11):1961–1968
Mantovani M, Carioli D, Torretta S, Rinaldi V, Ibba T, Pignataro L (2017) Barbed snore surgery for concentric collapse at the velum: the Alianza technique. J Cranio-Maxillofac Surg 45(11):1794–1800
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical standards
Informed consent was obtained from all individual participants included in the study.
Conflict of interest
The authors declare that they have no conflicts of interest.
Statement
All authors have seen and approved the manuscript.
Additional information
Comment
In this article, the addition of UPPP to tonsillectomy does not seem to add anything to tonsillectomy alone. These results must be put in the correct perspective, as the sample size is small, and nowadays there are other types of pharyngoplasties that may add something to tonsillectomy.
Marina Carrasco-Liatas
Valencia, Spain
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Baudouin, R., Blumen, M., Chaufton, C. et al. Adult sleep apnea and tonsil hypertrophy: should pharyngoplasty be associated with tonsillectomy?. Sleep Breath 23, 917–923 (2019). https://doi.org/10.1007/s11325-019-01864-w
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11325-019-01864-w