Same-stage palatopharyngeal and hypopharyngeal surgery for severe obstructive sleep apnea

To investigate surgical outcomes with two types of combined palatopharyngeal and hypopharyngeal surgery for the treatment of severe obstructive sleep apnea (OSA).

Twelve consecutive OSA patients with a respiratory disturbance index (RDI) >30/h and Fujita type II anatomy were enrolled. Patients were divided into two groups according to their fiberscopic manifestations. Six patients with obstruction at the uvulopalatal complex and tongue base (Group 1) were selected for extended uvulopalatal flap (EUPF) and midline laser glossectomy (MLG). EUPF and laser lingual tonsillectomy were performed in another six patients shown to have obstruction at the uvulopalatal complex and lingual tonsil (Group 2). Polysomnographic parameters included the RDI and minimal oxygen saturation (MSAT). Surgical success was defined as a postoperative RDI of <20/h and a >50% reduction in the preoperative RDI.

Six months postoperatively, 5 patients (83.3%) had responded successfully in Group 1 and none in Group 2. In Group 1 the mean RDI decreased from 50.7+/-12.6 to 8+/-14.3 (95% CI 23.0-62.7; p<0.01) and MSAT increased from 76.3%+/-11.6% to 88.8%+/-3.2% (95% CI -25.9-0.87; p=0.06). There was no improvement in sleep parameters in Group 2 patients. No persistent nasal regurgitation, swallowing disturbance or change in taste was noted at 1-year follow-up in either group.

EUPF combined with MLG improves OSA in Fujita type II patients. The hypertrophic lingual tonsil, although obscure the laryngeal structure, did not contribute significantly to OSA.