Transpalatal advancement pharyngoplasty outcomes compared with uvulopalatopharygoplasty

Uvulopalatopharyngoplasty (UPPP) success rates in patients classified with Friedman stage 3 is reported as 8%. Surgical failure may result from persistent obstruction at the palate, which may be addressed by pharyngoplasty with palatal advancement (PA). The effectiveness of PA versus UPPP was evaluated by using polysomnographic outcomes in a retrospective cohort of patients classified with Friedman stage 3.

Surgical records were reviewed for PA (n = 47) and UPPP (n = 124). Clinical records were reviewed and reclassified by Friedman stage. Respiratory data were collected from overnight polysomnography. Statistical analysis was conducted of continuous variables (ANOVA), categorical variables (chi2), and adjusted odds ratios by using logistic regression.

PA (n = 30) and UPPP (n = 44) did not differ in baseline apnea hypopnea index (AHI), age, or BMI. Both PA (48.3 +/- 24.6 to 19.8 +/- 16.8 events per hour, P < 0.000) and UPPP (47.9 +/- 30.0 to 30.9 +/- 24.2 events per hour, P < 0.000) improved with surgery. In the PA group, final AHI was lower (17.1 +/- 30.1 versus 28.5 +/- 25.6, P < 0.04) and postoperative change was greater (30.9 +/- 24.2 versus 19.8 +/- 16.8, P < 0.02). For patients with Friedman stage 3, odds ratio of having an AHI of <20 events per hour and a greater than 50% reduction with PA compared with UPPP was 3.80 (95% CI, 1.41-10.29, P < 0.013). Adjusted for age, body mass index, preoperative apnea severity, and tongue-base surgery, OR was 5.77 (95% CI of 1.80-17.98).

Polysomnographic outcomes using AHI support the use of palatopharyngoplasty using palatal advancement as an effective treatment of obstructive sleep apnea. PA may offer benefit over UPPP alone in patients classified with Friedman stage 3.