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The New Generation of Palate Surgery for Obstructive Sleep Apnea

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Barbed Pharyngoplasty and Sleep Disordered Breathing

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Abstract

Objectives: To describe the new generation of palate surgery based on the systematic review. Methods: Searches to identify publications relevant to OSA treatment and upper airway palate surgery, published between January 2001 and February 2018 were included. All adult OSA patients, with documented airway evaluation methods and absent hypopharyngeal collapse. Post-operative outcomes measures included success rates of treatment, AHI, Epworth scale, QOL, and snoring VAS. Results: A total of 2715 patients who had palate surgery were identified in 59 papers; UPPP accounted for 16.7% of all the procedures. The percentage of UPPP procedures were 25.67%, from 2011 to 2018, there were only 12.6% of UPPP procedures. The average follow-up was 8.18 months. Meta-analysis on the AHI change for all procedures showed the fixed effect AHI per follow-up (FU) month change was 1.45 (95% CI 1.33, 1.8), p < 0.001, while for ESS, the fixed effect AHI per FU month change was 0.61 (95% CI 0.56, 0.66), p < 0.001. The overall mean decrease in AHI was from 35.66 to 13.91 (p < 0.001) and the overall mean decrease in ESS was from 11.65 to 5.08 (p < 0.001). The mean AHI change was 19.9 (p < 0.001). The mean ESS change was 5.8 (p < 0.001). The overall pooled success rate was 67.5%. Meta-analysis of the procedures showed that the respective mean AHI reduction was 24.7 for the anterior palatoplasty (p = 0.015), 19.8 for the lateral/expansion pharyngoplasty (p = 0.046), and 17.2 for the uvulopalatopharyngoplasty (p = 0.360). Conclusions: Upper airway surgery has evolved to more reconstructive surgery. With more enhanced objective airway evaluation diagnostic techniques, the success rates of palate surgery have improved as well.

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Authors and Affiliations

  1. Otolaryngology, Asia Sleep Centre, Paragon, Singapore

    Kenny P. Pang & Scott B. Pang

  2. Otolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain

    Plaza Guillermo

  3. Otolaryngology, Clinica Universidad de Navarra, Pamplona, Navarra, Spain

    Peter M. Baptista

  4. ENT, Hospital Quiron Salud Marbella and Campo de Gibraltar, Cádiz, Spain

    Carlos O’Connor Reina

  5. Faculty of Medicine, University of Glasgow, Glasgow, Scotland, UK

    Edward B. Pang

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Editors and Affiliations

  1. Department of Otolaryngology and Head-Neck Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy

    Claudio Vicini

  2. Department of Otolaryngology and Head-Neck Surgery, Humanitas University, Milan, Italy

    Fabrizio Salamanca

  3. Department of ‘Organi di Senso’, University “Sapienza”, Rome, Italy

    Giannicola Iannella

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Pang, K.P., Guillermo, P., Baptista, P.M., O’Connor Reina, C., Pang, E.B., Pang, S.B. (2022). The New Generation of Palate Surgery for Obstructive Sleep Apnea. In: Vicini, C., Salamanca, F., Iannella, G. (eds) Barbed Pharyngoplasty and Sleep Disordered Breathing. Springer, Cham. https://doi.org/10.1007/978-3-030-96169-5_2

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