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Adult sleep apnea and tonsil hypertrophy: should pharyngoplasty be associated with tonsillectomy?

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Abstract

Purpose

Velopharyngoplasty and palatine tonsillectomy are at the very heart of the surgical treatment of obstructive sleep apnea syndrome (OSAS) care. In cases of major tonsil hypertrophy, we evaluated the relevance of associating soft palate surgery with palatine tonsillectomy, independent of the soft palate length.

Methods

We conducted a retrospective single-center study in OSAS patients with grade III or IV tonsils treated with tonsillectomy. Preoperative assessment included an upper airway examination performed while the patient was awake, a polysomnography and a drug-induced sedation endoscopy (DISE). Surgical efficacy was assessed on postoperative polysomnography. Success was considered when the postoperative apnea-hypopnea index (AHI) was less than 20 events/h with a 50% reduction. We compared palatine tonsillectomy efficacy alone (group A) and associated with soft palate surgery (group B).

Results

We analyzed 33 patients who had undergone surgery between December 2006 and May 2018. Their preoperative mean BMI and mean AHI were 27.3 ± 7.5 kg/m2 and 38.6 ± 21.4 events/h, respectively. The two groups (A, n = 18 and B, n = 15) were clinically comparable. The success rate was 72.2% in group A and 60% in group B. There was no statistically significant difference between the two groups (p > 0.1).

Conclusions

According to this study, in our institution, in cases of major tonsillar hypertrophy, simultaneous soft palate surgery had no significant impact on the success rate, regardless of soft palate length. Associating soft palate surgery with palatine tonsillectomy does not seem mandatory to increase the success rate.

Level of evidence

III. Retrospective comparative study

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Abbreviations

OSAS:

obstructive sleep apnea syndrome

DISE:

drug-induced sleep endoscopy

AHI:

Apnea-Hypopnea Index

/h:

per hour

CPAP:

continuous positive airway pressure

UPPP:

uvulopalatopharyngoplasty

MAS:

mandibular advancement splint

ESS:

Epworth Sleepiness Scale

BMI:

body mass index

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Authors

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Correspondence to Robin Baudouin.

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

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The authors declare that they have no conflicts of interest.

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All authors have seen and approved the manuscript.

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Comment

In this article, the addition of UPPP to tonsillectomy does not seem to add anything to tonsillectomy alone. These results must be put in the correct perspective, as the sample size is small, and nowadays there are other types of pharyngoplasties that may add something to tonsillectomy.

Marina Carrasco-Liatas

Valencia, Spain

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Baudouin, R., Blumen, M., Chaufton, C. et al. Adult sleep apnea and tonsil hypertrophy: should pharyngoplasty be associated with tonsillectomy?. Sleep Breath 23, 917–923 (2019). https://doi.org/10.1007/s11325-019-01864-w

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  • DOI: https://doi.org/10.1007/s11325-019-01864-w

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