Causative Factors for Complications in Transpalatal Advancement
Lyndon Chan1,2, Leon Kitpornchai1,3, Stuart Mackay1,2
1Illawarra ENT Head and Neck Clinic, Wollongong, NSW, Australia.
The Annals of Otology, Rhinology, and Laryngology
|August 15, 2019
Summary
Transpalatal advancement (TPA) improves obstructive sleep apnea (OSA) but carries risks like oro-nasal fistula (ONF). Surgeons should use caution with TPA in patients who have high-arched palates.
Area of Science:
- Otolaryngology
- Sleep Medicine
- Surgical Complications
Background:
- Transpalatal advancement (TPA) is utilized for obstructive sleep apnea (OSA) when other procedures lack efficacy.
- While TPA reduces OSA parameters, it presents risks, notably oro-nasal fistula (ONF) formation, causing significant morbidity.
Purpose of the Study:
- To evaluate the efficacy and complication rates of Transpalatal Advancement (TPA) in treating OSA.
- To identify factors contributing to palatal complications, specifically oro-nasal fistula (ONF), following TPA.
Main Methods:
- A 10-year retrospective chart review (2008-2018) of TPA procedures performed by a single surgeon.
- Analysis included pre- and postoperative polysomnography, sleep questionnaires, BMI, and potential contributing factors for complications.
- Statistical analysis was performed with a significance level of P < .05.
Main Results:
- Of 59 patients, 25.4% experienced palatal complications, including transient velo-palatal insufficiency (13.6%) and ONF (6.8%).
- A high-arched palate was the only statistically significant factor associated with ONF development.
- Significant improvements were observed in both objective and subjective sleep parameters and BMI post-TPA.
Conclusions:
- Transpalatal advancement (TPA) remains a valuable surgical option for OSA, demonstrating significant improvements in patient outcomes.
- Caution is advised when performing TPA in patients with high-arched palates due to increased risk of ONF.
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