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. 2018 Mar 9;8(1):4224.
doi: 10.1038/s41598-018-22710-1.

Suspension Palatoplasty for Obstructive Sleep Apnea- A Preliminary Study

Hsueh-Yu Li  1   2 , Li-Ang Lee  3   4 , Eric J Kezirian  5 , Meiho Nakayama  6
Affiliations

Suspension Palatoplasty for Obstructive Sleep Apnea- A Preliminary Study

Hsueh-Yu Li et al. Sci Rep. .

Abstract

Suspension palatoplasty, a new surgical technique to treat obstructive sleep apnea (OSA), has been developed to correct the retropalatal obstruction in patients with small tonsils (grade I/II) and anterior-posterior palatal (A-P) obstruction. The objecteive of this preliminary study was to investigate the effectiveness and change in retropalatal airway dimensions after suspension palatoplasty. This retrospective case series study included 25 consecutive male adults with OSA. Unique technical features of suspension palatoplasty are exposure of pterygomandibular raphe and suspension of palatopharyngeus muscle to the raphe. Six months after suspension palatoplasty, apnea-hyponea index significantly reduced from 39.8 to 15.1 (effect size = 1.6). None experienced postoperative bleeding and velopharyngeal insufficiency 1 month following surgery. Subjective snoring severity (visual analogue scale) and daytime sleepiness (the Epworth Sleepiness Scale) significantly improved (8.7 vs 2.0 and 10.2 vs 4.9, respectively). A-P dimension of the retropalatal airspace widened significantly on perioperative endoscopy (23.0 units vs 184.6 unites) as well as posterior air space in cephalometry (7.6 mm vs 10.2 mm). Our preliminary findings show that suspension palatoplasty seems to be an effective OSA surgery in the specific patient population with minimal complications, however, further studies including a large number of patients are required to confirm the findings.

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Conflict of interest statement

Dr. Eric J. Kezirian’s research has been funded by Inspire Medical Systems. The funding source has no role in the conceptualization, design, data collection, analysis, decision to publish, and preparation of the manuscript. He also has received compensation as a member of the advisory board, consultant, and shareholder of ReVENT Medical, Nyxoah, Pillar Palatal, Gerard Scientific, Split Rock Scientific, and Cognition Life Sciences; a member of the advisory board of Berendo Scientific; and a patent ownership of Magnap. Drs. Hsueh-Yu Li, Li-Ang Lee, and Meiho Nakayama declare no potential conflict of interest.

Figures

Figure 1
Figure 1
Postoperative pain profile and change of apnea-hyponea index. Postoperative pain assessment reveals that mild-to-moderate wound pain significantly improved at the 7th day and completely subsided at the 14th day (A).Comparison of apnea-hypopnea index indicated a significant reduction of the disease severity 6 months after suspension palatoplasty (B).
Figure 2
Figure 2
Surgical procedure of suspension palatoplasty. Linear mucosal incision, exposure of supratonsillar adipose tissue (A). Removal of supratonsillar fat, tonsillectomy, and exposure of pterygomandibular raphe (B). Suture of the raphe as anchor then suture the palatopharyngeus muscle for suspension (C). Repeated suspensions, closure of tonsillar fossa, mattress suture of posterior and anterior pillar, partial uvulectomy (D).
Figure 3
Figure 3
Changes of the upper airway after suspension palatoplasty. Perioperative intraoral view (A,B) and transnasal view of velopharyngeal airway (C,D) and lateral cephalometry (E,F) before (E) and one month after (F) suspension palatoplasty.
See this image and copyright information in PMC

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