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Published on: December 6, 2016
Upper airway anatomical changes after velopharyngeal surgery in obstructive sleep apnea patients with small tonsils
Junbo Zhang1, Jingying Ye, Junfang Xian
1Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Objective:
To evaluate the relationships between anatomical changes and treatment outcomes after velopharyngeal surgery in obstructive sleep apnea (OSA) patients with small tonsils (grade 0-2 on the Brodsky scale).
Study Design:
Case series with planned data collection.
Setting:
University medical center.
Subjects And Methods:
Thirty-six OSA patients with small tonsils underwent velopharyngeal surgery including revised uvulopalatopharyngoplasty with uvula preservation and transpalatal advancement pharyngoplasty. Pre- and postoperative upper airway 3-dimensional computed tomography and polysomnography findings were obtained for comparison and analysis.
Results:
The overall apnea hypopnea index (AHI) decreased from 56.8 (interquartile range, 37.5-70.1) preoperatively to 16.1 (10.8-33.5) postoperatively (P < .001). The change in minimal cross-sectional area of the velopharynx (VmCSA) was independently associated with the change in AHI (P = .001, R (2) = 0.271). Preoperative VmCSA was the only preoperative anatomical variable that was an independent predictor of change in VmCSA (P = .009, R (2) = 0.184). Postoperative VmCSA was independently associated with postoperative AHI (P < .001, R (2) = 0.341).
Conclusion:
In patients with small tonsils, an adequate increase in VmCSA is associated with a successful outcome after surgery. Patients with a relatively small preoperative VmCSA are more likely to have favorable anatomical changes after surgery.
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