Modified Z-palatoplasty with one-layer closure in one-stage multilevel surgery for severe obstructive sleep apnea

The meticulous two-layer closure is a step to complete the modified Z-palatoplasty, which has been reported to serve as an effective element in multilevel sleep surgery for patients with severe obstructive sleep apnea, especially with Friedman anatomical stages II and III diseases. A single layer closure-the suture closure as originally described in uvulopalatopharyngoplasty by Fujita et al., is an alternative of the two-layer closure, featured by simplicity while its efficacy has not been completely proved in patients with severe obstructive sleep apnea.

By apnea-hypopnea index (AHI), we investigated 7 patients with severe obstructive sleep apnea undergoing the modified Z-palatoplasty with one-layer closure in a multilevel surgery.

The mean apnea-hypopnea index is reduced from 52.9±17.1 (preoperative) to 18.4±9.7 events/h (postoperative) without any wound dehiscence or bleeding that results in an unplanned return to the operating room. In comparison, the percentage of reduction in mean apnea-hypopnea index is 65%. The improvement of apnea-hypopnea index is statistically significant with the p-value 0.004.

Our results support that one-layer closure remains the efficacy of modified Z-palatoplasty (with two-layer closure) in one-stage multilevel surgery for severe obstructive sleep apnea with an unfavorable anatomical stage.