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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

Abstract

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.

Keywords

Expansion sphincter pharyngoplasty Anterior palatoplasty Obstructive sleep apnea 

Notes

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.

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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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