PASS Palatal Ablation and Suspension Suture Technique: A Novel,Minimally Invasive UPPP Technique for Sleep Apnea

Abstract

Objective: 1) Develop a minimally invasive surgical technique to treat the palatal component of OSA. 2) Ccombine a proven ablation technology to create palatal stiffening with a novel suspension technique to relieve palatal obstruction. 3) Perform a pilot trial to determine feasibility.

Method: The PASS technique was used to treat the palatal component of obstruction for OSA. Palatal ablation was performed. Four permanent, submucosal, periosteal based sutures were placed from the hard palate to the palatopharyngeus muscle and free edge of the soft palate (bilateral). Gentle tension resulted in advancement of the palate.

Results: Twenty patients were studied. Each patient had a preoperative/postoperative PSG. The PASS technique was used for the palatal component to treat mild apnea or as a part of multilevel surgery for moderate to severe OSA. The PASS technique proved to be a consistently reliable method to advance, suspend, and stiffen the palate without mucosal/muscular (palatal) disruption to correct the palatal component of OSA. The average palatal advancement noted bilaterally at the palatal arches was 7.5 mm. Postoperatively, the mucosal sparing technique resulted in no complications of velopharyngeal insufficiency. Isolated PASS procedures for mild apnea resulted in a 70% reduction in RDI.

Conclusion: The PASS technique was proven as a functionally and anatomically superior nondestructive treatment for palatal obstruction. The PASS technique resulted in no complications of VPI. The limitations of the study are the limited number of patients and lack of a control arm with the gold standard UPPP.