Abstract
In recent years, therapeutic methods have been effective in the management of snoring and sleep apnea. Successful results have been possible through conservative and surgical approaches when the nature and site of obstruction is ascertained by careful investigation. Sagittal magnetic resonance imaging (MRI) of the upper respiratory tract has been the most valuable diagnostic tool in patients with obstructive sleep apnea. This has made it possible to measure the dimensions and distance of the hard and soft palate and tongue base to the posterior pharyngeal wall. Surgery is only indicated when a site of obstruction can be completely determined. In this study, surgical approaches and results obtained in 50 patients after surgery for sleep apnea are presented. Uvulopalatopharyngoplasty (UPPP) had a higher success rate in patients with obstruction at the level of the soft palate, but this rate decreased when it was associated with hypopharyngeal obstruction or when there was hypopharyngeal obstruction alone. UPPP was found to be beneficial in patients with central apnea. Nasal pathologies also played an important role in sleep apnea. Better results were obtained when UPPP was performed in patients who were young, not obese and an apnea-hypopnea index was below 40. Some unusual pathologies included lingual tonsil hypertrophy in the adult, sublingual dermoid cysts and angioma of soft palate and were found to be the cause of OSA. After surgical excision of these pathologies, apneic periods disappeared.
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References
Andersson L, Brattström V (1991) Cephalometric analysis of permanently snoring patients with and without obstructive sleep apnea syndrome. Int J Oral Maxillofac Surg 20: 159–162
Bacon W, Turlot J, Krieger J, Stierle J (1989) Cephalometric evaluation of pharyngeal obstructive factors in patients with sleep apnea syndrome. Angle Orthod 60: 115–122
Borowiecki B, Andrzej A, Kukwa A, Blanks R (1985) Indications for palatopharyngoplasty. Arch Otolaryngol 111: 659–663
Burgess L, Derdarian S, Morin G, Gonzalez C, Zajtchuk J (1992) Postoperative risk following uvulopalatopharyngoplasty for obstructive sleep apnea. Otolaryngol Head Neck Surg 106: 81–84
Cole P, Haight J (1984) Mechanisms of nasal obstruction in sleep. Laryngoscope 94: 1557–1559
Conway W, Fujita S, Zorick F, Sicklesteel J, Rochrs T, Witting R, Roth T (1985) Uvulopalatopharyngoplasty, one year follow-up. Chest 88: 385–389
Croft C, Golding-Wood D (1990) Uses and complications of uvulopalatopharyngoplasty. J Laryngol Otol 104: 871–875
Dickson A (1987) Treatment of obstructive sleep apnea by uvulopalatopharyngoplasty. Laryngoscope 97: 1054–1059
Dündar A, Aydin H, Gerek M, Özünlü A (1993) Obstructive sleep apnea due to sublingual dermoid cyst. Proceedings of the XV. World Congress of ORL, Head & Neck Surgery, June 20–25, Istanbul, Turkey. Multi Science Publishing, Essex, pp 923–924
Diindar A, Gerek M, Ozkaptan Y, Ozgen F, Onder T (1993) Surgical result of obstructive sleep apnea. Proceedings of the XV. World Congress of ORL, Head & Neck Surgery, June 20–25, Istanbul, Turkey. Multi Science Publishing, Essex, pp 925–928
Fairbanks D (1984) Snoring: surgical vs. nonsurgical management. Laryngoscope 94: 1188–1193
Fairbanks D (1994) Snoring: an overview with historical perspectives. In: Fairbanks DNF, Fujita S (eds) Snoring and obstructive sleep apnea, 2nd edn. Raven Press, New York, pp 1–17
Fujita S, Conway W, Sicklesteel J, Witting R, Zorick F, Roehrs T, Roth T (1985) Evaluation of the effectiveness of uvulopalatopharyngoplasty. Laryngoscope 95: 70–74
Grontved A, Jorgensen K, Petersen SV (1992) Result of uvulopalatopharyngoplasty in snoring. Acta Otolaryngol (Stockh) [Suppl] 492: 11–14
Guilleminault C, Eldridge F, Tilkian A, Simmons B, Dement W (1977) Sleep apnea syndrome due to upper airway obstruction. Arch Intem Med 137: 296–300
Katsantonis G (1994) Limitations, pitfalls, and risk management in uvulopalatopharyngoplasty. In: Fairbanks DNF, Fujita S (eds) Snoring and obstructive sleep apnea, 2nd edn. Raven Press, New York, pp 147–161
Metes A, Hoffstein V, Mateika S, Cole P, Haight J (1991) Site of airway obstructions in patients with obstructive sleep apnea before and after uvulopalatopharyngoplasty. Laryngoscope 101: 1102–1108
Petri N, Suadicani P, Wildschiodtz G, Jorgensen J (1994) Predictive value of Müller maneuver, cephalometry and clinical features for the outcome of uvulopalatopharyngoplasty. Acta Otolaryngol (Stockh) 114: 565–571
Phlip-Joet F, Rey M, J. Triglia M, Reynaud M, Saadjian A, Arnaud A (1991) Uvulopalatopharyngoplasty in snorers with sleep apneas: predictive value of presurgical polysomnography. Respiration 58: 100–105
Regestein Q, Ferber R, Johnson T, Murawski B, Strome M, Carlsson-Nordlander B, Svanborg E (1991) Long-time followup after UPPP for obstructive sleep apnea syndrome. Acta Otolaryngol (Stockh) 111: 582–590
Shepard J, Gefter W, Guilleminault C, Hoffman E, Hoffstein V, Hudgel D, Suratt P, White D (1991) Evaluation of the upper airway in patients with obstructive sleep apnea. Sleep 14: 361–371
Zohar Y, Finkelstein Y, Talmi P, Bar-Ilan Y (1991) Uvulopalatopharyngoplasty: evaluation of postoperative complications, sequel, and results. Laryngoscope 101: 775–779
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Dündar, A., Gerek, M., Özünlü, A. et al. Patient selection and surgical results in obstructive sleep apnea. Eur Arch Otorhinolaryngol 254 (Suppl 1), S157–S161 (1997). https://doi.org/10.1007/BF02439750
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DOI: https://doi.org/10.1007/BF02439750