Transpalatal Advancement Pharyngoplasty for Obstructive Sleep Apnea Syndrome: Results and Analysis of Failures

Abstract

Objective To assess the polysomnographic outcomes of patients with obstructive sleep apnea undergoing transpalatal advancement pharyngoplasty for retropalatal collapse and to compare responders with nonresponders to surgery. Design Retrospective medical record review. Setting Tertiary referral teaching hospital and private practice. Patients Sixty patients undergoing transpalatal advancement pharyngoplasty alone at a single sitting with preoperative and postoperative sleep studies were reviewed. Intervention Transpalatal advancement pharyngoplasty. Main Outcome Measures Preoperative and postoperative polysomnographic data were analyzed and comparisons were assessed between responders and nonresponders. Results Following surgery, the mean (SD) respiratory disturbance index (RDI) decreased from 37.2 (20.4) to 15.4 (12.3), with an overall change of 21.8 (21.8) (95% confidence interval [CI], 16.2-27.4). Similarly, the mean (SD) arterial oxygen saturation nadir after transpalatal advancement pharyngoplasty surgery improved from 83.9% (5.4%) to 87.4% (4.3%), with an overall change of 3.5% (5.9%) (95% CI, 2.0%-5.0%). Between the traditional Gothic arch incision (n = 31) and the propeller incision (n = 29) an observed 31% (95% CI, 7%-51%) difference in success rate in favor of the latter was noted. Conclusions Transpalatal advancement pharyngoplasty appears to be an effective and safe treatment option in selected patients. No preoperative variable was associated with surgical success in this study. The association of the propeller incision and surgical success requires further analysis.