Expansion sphincter pharyngoplasty: analyzing the technique based on anatomy

Area of Science:

• Otolaryngology
• Surgical Anatomy
• Airway Management

Background:

• Expansion sphincter pharyngoplasty (ESP) is a surgical technique to address oropharyngeal airway collapse.
• Different surgical modifications exist, impacting soft palate positioning and airway dimensions.

Purpose of the Study:

• To evaluate the impact of distinct ESP surgical techniques on oropharyngeal airway dimensions.
• To compare the effects of preserving versus transecting the palatopharyngeus (PP) and superior pharyngeal constrictor (SPC) muscle attachments.

Main Methods:

• Surgical techniques involving preservation and transection of the PP-SPC muscle attachment were analyzed.
• The PP muscle was transposed to the pterygoid hamulus and palatal musculature in twenty half-head specimens.

Main Results:

• Preserving the PP-SPC attachment limited PP muscle transposition, yielding comparable medial-lateral enlargement when transposed to the palatal musculature.
• Transecting the PP-SPC attachment resulted in significant anterior-posterior and medial-lateral oropharyngeal airway enlargement, regardless of PP muscle transposition site.

Conclusions:

• ESP techniques influence soft palate position and airway dimensions.
• Transection of the PP-SPC attachment is beneficial for combined anterior-posterior and lateral wall collapse.
• Preservation of the PP-SPC attachment may be suitable for isolated lateral wall collapse; clinical evaluation is warranted.