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Anterolateral advancement palatoplasty with tonsillectomy for retropalatal obstruction in selected cases of obstructive sleep apnea

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Abstract

Purpose

This study tried to assess the surgical outcome of anterolateral advancement palatoplasty (ALP) with simultaneous tonsillectomy for the treatment of retropalatal obstruction in selected cases of obstructive sleep apnea (OSA).

Methods

In this clinical trial, 22 adult OSA patients having predominant retropalatal collapse were managed by ALP and tonsillectomy.Thirteen patients had positional OSA (PP) and 9 patients had non-positional (NPP). ALP entailed the stripping of a horizontal trapezoid area of mucosa/submucosa of the soft palate and suturing with one central simple suture and two paramedian sutures made as an anterolateral parallelogram. Uvula was not jeopardized and no lateral mucosal cuts were made.

Results

Postoperative data of the study group showed high significant improvement (p < 0.001) as regards apnea–hypopnea index (AHI), mean lowest oxygen saturation level (LO2), Epworth sleepiness scale (ESS) and snoring visual analog scale (VAS-s). The overall percentage of improvement as regards the AHI was 60%.On comparison of postoperative data of PP and NPP, significant difference was reported as regards AHI (p = 0.009), while non-significant differences were reported (p > 0.05) as regards LO2, ESS and VAS-s. Postoperative means of AHI in supine position showed a significant difference (p = 0.03). Upon comparison of means of ODI and T90% of PP and NPP, a highly significant difference was reported in both pre- and postoperative comparison (< 0.001).

Conclusion

Anterolateral advancement palatoplasty seems to be an easy, effective and low-cost procedure. More favorable outcomes were reported among positional-dependent subjects. The procedure could be employed in multilevel, single-stage surgery for patients with OSA.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Faculty of Medicine, Otorhinolaryngology, Head and Neck Surgery Department, Zagazig University, Zagazig, Egypt

    Sherif M. Askar, Mohamed E. Abd El-Bary, Mohammad E. Elshora, Ahmed F. Al Gohary, Ameer A. Abosharkh & Alaa Omar Khazbak

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  1. Sherif M. Askar
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  2. Mohamed E. Abd El-Bary
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  3. Mohammad E. Elshora
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  4. Ahmed F. Al Gohary
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  5. Ameer A. Abosharkh
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Correspondence to Alaa Omar Khazbak.

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Askar, S.M., El-Bary, M.E.A., Elshora, M.E. et al. Anterolateral advancement palatoplasty with tonsillectomy for retropalatal obstruction in selected cases of obstructive sleep apnea. Eur Arch Otorhinolaryngol 279, 2679–2687 (2022). https://doi.org/10.1007/s00405-021-07235-0

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