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Vol. 71. Issue 4.
Pages 197-203 (July - August 2020)
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Vol. 71. Issue 4.
Pages 197-203 (July - August 2020)
Original article
DOI: 10.1016/j.otoeng.2019.06.003
Improving Surgical Results in Velopharyngeal Surgery: Our Experience in the Last Decade
Mejorando los resultados quirúrgicos de las faringoplastias: nuestra experiencia en la última década
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Paula Martínez Ruiz de Apodaca, Marina Carrasco Llatas
Corresponding author
marinacll@gmail.com

Corresponding author.
, Marta Valenzuela Gras, José Dalmau Galofre
Servicio de Otorrinolaringología, Hospital Universitario Doctor Peset, Valencia, Spain
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Figures (2)
Tables (3)
Table 1. Demographic Variables.
Table 2. AHI (Events/Hour) and Success According to Surgical Teschnique.
Table 3. Other Variables Depending on Surgical Technique.
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Abstract
Background and purpose

The surgical techniques used to treat velopharyngeal collapse in obstructive sleep apnoea patients have evolved over recent years. Our aim was to determine whether these new techniques have better surgical results.

Materials and methods

This is a retrospective study of moderate to severe obstructive sleep apnoea patients surgically treated from 2006 to 2018. Only adult patients with no compliance to positive airway pressure and without simultaneous multilevel surgery were included. During this period, 4 different techniques were performed: uvulopalatopharyngoplasty, lateral pharyngoplasty, expansion pharyngoplasty and barbed reposition pharyngoplasty. Success rates as defined by Sher, as well as postoperative AHI<10/h and mean relative AHI reduction (MRR) were compared.

Results

82 patients were included. AHI was significantly reduced from 43.4±24/h to 15.6±18.6/h. No significant changes in body mass index were observed. Hypoxaemia time, oxygen desaturation index, and Epworth sleepiness scale values improved after surgery. The best success rates were obtained performing barbed reposition pharyngoplasty (78.26% measured by Sher's criteria, 65.22% by AHI<10/h criteria and 74.1% by the MRR). The differences observed were statistically significant.

Conclusions

Barbed reposition pharyngoplasty is a recently introduced technique that showed superiority over the other palatal surgery techniques in this cohort.

Keywords:
Obstructive sleep apnoea syndrome
Pharyngeal surgical techniques
Barbed reposition pharyngoplasty
Resumen
Antecedentes y objetivo

Las técnicas quirúrgicas para tratar el colapso velofaríngeo de los pacientes con síndrome de apnea-hipopnea del sueño han evolucionado en los últimos años. Nuestro objetivo era conocer si estas nuevas técnicas proporcionan mejores resultados quirúrgicos.

Materiales y métodos

Es un estudio retrospectivo de los pacientes con síndrome de apnea-hipopnea del sueño moderado-severo tratados quirúrgicamente del 2006 al 2018. Solo los pacientes adultos sin adherencia a la CPAP y en los que no se practicó cirugía multinivel simultánea fueron incluidos. Durante este período se practicaron 4 técnicas diferentes: resección parcial del paladar, faringoplastia lateral, faringoplastia de expansión y faringoplastia de reposición con sutura barbada. La tasa de éxito se calcula según los criterios de Sher, según el criterio de IAH<10/h y mediante la reducción relativa media del IAH (RRM).

Resultados

Ochenta y dos pacientes fueron incluidos. El IAH se redujo significativamente de 43,4±24/h a 15,6±18,6/h. No se observaron cambios significativos en el índice de masa corporal. Los valores de Tc 90, el índice de desaturación y la somnolencia según la escala de Epworth mejoraron tras la cirugía. La mayor tasa de éxito se obtuvo mediante la realización de la faringoplastia de reposición con sutura barbada (78,26% según criterios Sher, 65,22% para IAH<10/h y 74,1% en RRM). Las diferencias observadas fueron estadísticamente significativas.

Conclusiones

La faringoplastia de reposición con sutura barbada es una técnica de reciente introducción que mostró superioridad sobre el resto de faringoplastias en esta cohorte.

Palabras clave:
Síndrome de apnea-hipopnea del sueño
Faringoplastias
Faringoplastia de reposición con sutura barbada

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