Combined Expansion Pharyngoplasty and Anterior Palatoplasty for the Treatment of OSA

  • Kenny P. PangEmail author
  • Ottavio Piccin
  • Edward B. Pang
  • Kathleen A. Pang
  • Yiong Huak Chan
  • Brian W. Rotenberg
Original Article


To evaluate the success rates of combined Expansion Sphincter Pharyngoplasty and the Anterior Palatoplasty in the treatment of OSA. A two center prospective series of 73 patients with OSA. All patients were >18 years old, retro-palatal obstruction, concentric velo-pharyngeal collapse, BMI < 33, Friedman clinical stage II, with all grades of AHI. The procedure involved the anterior palatoplasty, tonsillectomy and expansion sphincter pharyngoplasty with or without nasal surgery. There were 68 men and 5 women, the mean age was 46.8 years old (range of 25–67 years), mean BMI was 25.5 (range of 20.3–31.2). All patients had pre-operative and post-operative PSG. The AHI improved in all patients, mean AHI improved from 26.3 ± 17.7 to 12.6 ± 5.8 (p < 0.001). There were 20 mild OSA, 33 moderate OSA and 20 severe OSA patients. Twenty-three patients had pre-operative DISE, and 61 patients had nose/palate surgery, while only 12 had palate surgery alone. The overall success rate (50 % reduction and AHI < 20) was 86.3 %. The mean snore scores (VAS) improved from 8.8 ± 1.2 to 2.0 ± 1.3 (p < 0.001). The mean Epworth score improved from 11.5 ± 2.2 to 2.9 ± 2.1 (p < 0.001). Lowest oxygen saturation also improved in all patients. Subjectively, all the patients felt less tiredness. Pre-operative DISE assessment did not seem to confer any advantage over the patients who had no pre-operative DISE (p = 0.027), and patients who had nose/palate surgery seemed to have better success rates compared to those who only had palate surgery (p = 0.081). This combined technique has been shown to be effective in selected group of OSA patients.

Level of evidence IV.


Expansion sphincter pharyngoplasty Anterior palatoplasty Obstructive sleep apnea 


Author contribution

KPP, OP conceived the study, collected the patients and performed the surgeries, wrote the article. KAP, EBP, BWR—wrote the article, results, conclusion and methodology. CYH—performed the statistical analysis and wrote the statistical section.

Compliance with Ethical Standards

Conflict of interest

The authors all declare that they have no competing interest.

Ethical Approval

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.

Informed Consent

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


  1. 1.
    Borowiecki BD, Sassin JF (1983) Surgical treatment of sleep apnoea. Arch Otolaryngol 109:506–512CrossRefGoogle Scholar
  2. 2.
    Terris DJ, Hanasono MM, Liu YC (2000) Reliability of the Muller maneuver and its association with sleep-disordered breathing. Laryngoscope 110:1819–1823CrossRefPubMedGoogle Scholar
  3. 3.
    Remmers JE, De Groot WJ, Sauerland EK et al (1978) Pathogenesis of upper airway occlusion during sleep. J Appl Physiol 44:931–938PubMedGoogle Scholar
  4. 4.
    Schwab RJ, Gefter WB, Hoffman EA et al (1993) Dynamic upper airway imaging during awake respiration in normal subjects and patients with sleep disordered breathing. Am Rev Respir Dis 148:1385–1400CrossRefPubMedGoogle Scholar
  5. 5.
    Cahali MB (2003) Lateral Pharyngoplasty: a new treatment for OSAHS. Laryngoscope 113:1961–1968CrossRefPubMedGoogle Scholar
  6. 6.
    Pang KP, Woodson BT (2007) Expansion sphincter pharyngoplasty: a new technique for the treatment of obstructive sleep apnea. Otolaryngol Head Neck Surg 137(1):110–114CrossRefPubMedGoogle Scholar
  7. 7.
    Orticochea M (1968) Construction of a dynamic muscle sphincter in cleft palates. Plast Reconstr Surg 41:323–327CrossRefPubMedGoogle Scholar
  8. 8.
    Christel SR, Georges B, Christel D et al (2004) Sphincter pharyngoplasty as a treatment of velopharyngeal incompetence in young people. Chest 125:864–871CrossRefGoogle Scholar
  9. 9.
    Ellis PD (1994) Laser palatoplasty for snoring due to palatal flutter: a further report. Clin Otolaryngol Allied Sci 19(4):350–351CrossRefPubMedGoogle Scholar
  10. 10.
    Mair EA, Day RH (2000) Cautery-assisted palatal stiffening operation. Otolaryngol Head Neck Surg 122(4):547–556PubMedGoogle Scholar
  11. 11.
    Pang KP, Terris DJ (2007) Modified cautery-assisted palatal stiffening operation: new method for treating snoring and mild obstructive sleep apnea. Otolaryngol Head Neck Surg 136(5):823–826CrossRefPubMedGoogle Scholar
  12. 12.
    Pang KP, Tan R, Puraviappan P, Terris DJ (2009) Anterior palatoplasty for the treatment of OSA: three-year results. Otolaryngol Head Neck Surg 141(2):253–256CrossRefPubMedGoogle Scholar
  13. 13.
    Sorrenti G, Piccin O (2013) Functional expansion pharyngoplasty in the treatment of obstructive sleep apnea. Laryngoscope 123(11):2905–2908CrossRefPubMedGoogle Scholar
  14. 14.
    Ulualp SO (2014) Modified expansion sphincter pharyngoplasty for treatment of children with obstructive sleep apnea. JAMA Otolaryngol Head Neck Surg. 140(9):817–822CrossRefPubMedGoogle Scholar
  15. 15.
    Kamami YV (1994) Outpatient treatment of sleep apnea syndrome with CO 2 laser, LAUP: laser-assisted UPPP results on 46 patients. J Clin Laser Med Surg. 12(4):215–219PubMedGoogle Scholar
  16. 16.
    Vicini C, Montevecchi F, Pang KP, Bahgat A, Dallan I, Frassineti S, Campanini A (2014) Combined transoral robotic tongue base surgery and palate surgery in obstructive sleep apnea-hypopnea syndrome: expansion sphincter pharyngoplasty versus uvulopalatopharyngoplasty. Head Neck 36(1):77–83CrossRefPubMedGoogle Scholar
  17. 17.
    Carrasco-Llatas M, Marcano-Acuña M, Zerpa-Zerpa V, Dalmau-Galofre J (2015) Surgical results of different palate techniques to treat oropharyngeal collapse. Eur Arch Otorhinolaryngol 272(9):2535-2540CrossRefPubMedGoogle Scholar
  18. 18.
    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):156–177PubMedGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2016

Authors and Affiliations

  • Kenny P. Pang
    • 1
    Email author
  • Ottavio Piccin
    • 2
  • Edward B. Pang
    • 3
  • Kathleen A. Pang
    • 3
  • Yiong Huak Chan
    • 4
  • Brian W. Rotenberg
    • 5
  1. 1.Otorhinolaryngology Head and Neck Surgery, Asia Sleep CentreParagon Medical CentreSingaporeSingapore
  2. 2.Department OtolaryngologySant’Orsola-Malpighi University HospitalBolognaItaly
  3. 3.Asia Sleep CentreSingaporeSingapore
  4. 4.Biostatistics Unit, Yong Loo Lin School of MedicineNational University SingaporeSingaporeSingapore
  5. 5.Otolaryngology Head and Neck SurgeryWestern UniversityLondonCanada

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