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Modified anterior palatoplasty and double suspension sutures (with or without tonsillectomy) in selected patients with obstructive sleep apnea: a preliminary report

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Abstract

Background

Retropalatal region might be considered the most common site of obstruction in patients with snoring and OSA. We aimed at presentation of two combined techniques: modified anterior palatoplasty (MAP) and bilateral double suspension suture (DSS).

Methods

This prospective study was conducted on OSA patients with retro-palatal collapse only that was confirmed by nasoendoscopy during Muller’s maneuver and drug induced sleep endoscopy. MAP and DSS were performed for all patients. Preoperative and 6 months after surgery, all patients underwent fiber-optic nasoendoscopy using the Muller maneuver and polysomnography, snoring scores, and Epworth Sleepiness Scale (ESS) values were assessed.

Results

Mean apnea hypopnea index (AHI) dropped significantly (p < 0.0001) from a mean of 28.6 ± 5.5 preoperatively to 8.3 ± 2.96 postoperatively. Successful outcome was reported in 26 patients (98.65%) while 3 patients (10.35%) were responders. The mean lowest oxygen (O2) saturation level increased significantly from 79.4 ± 3.5 to 93.1 ± 3.1 (p < 0.0001). ESS showed significant improvement (p < 0.0001) as its mean diminished from 14.5 ± 2.4 preoperatively to 3.4 ± 1 postoperatively. Visual analog scale of snoring was significantly (p < 0.0001) decreased from 7.9 ± 1.3 preoperatively to 1.9 ± 1.2 postoperatively. No early or late complications were reported.

Conclusion

Combined MAP and DSS (± tonsillectomy) could be considered as simple, reliable, easily trained, effective, and safe surgical treatment option for OSA patients with predominant retropalatal obstruction. It could be employed in a single-stage, multilevel work-up.

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Authors and Affiliations

  1. Otorhinolaryngology, Head and Neck Surgery, Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Omar Bin El-Khattab street, Zagazig City, Sharkia Governorate, Egypt

    Sherif M. Askar, Mohammad W. El-Anwar & Ali Awad

Authors
  1. Sherif M. Askar
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  2. Mohammad W. El-Anwar
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  3. Ali Awad
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Correspondence to Sherif M. Askar.

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The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The institutional review board (IRB) approved the research methodology.

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Informed consent was obtained from all individual participants included in the study.

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Askar, S.M., El-Anwar, M.W. & Awad, A. Modified anterior palatoplasty and double suspension sutures (with or without tonsillectomy) in selected patients with obstructive sleep apnea: a preliminary report. Sleep Breath 22, 789–795 (2018). https://doi.org/10.1007/s11325-018-1671-1

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  • DOI: https://doi.org/10.1007/s11325-018-1671-1

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