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Abstract

Objectives

To investigate the safety and outcomes of Z-palatopharyngoplasty (ZPPP) combined with endoscopic Coblator open tongue base resection (Eco-TBR) for the treatment of severe obstructive sleep apnea/hypopnea syndrome (OSAHS).

Study Design

Review of a prospective database.

Setting

Academic tertiary medical center.

Methods

Thirty-nine patients with severe OSAHS who had multilevel obstruction, failed continuous positive airway pressure therapy, and then underwent ZPPP plus Eco-TBR were enrolled in this study. The subjective symptoms and objective polysomnography parameters were collected preoperatively and at a minimum of 12 weeks postoperatively. Statistical analysis was determined by the Wilcoxon signed rank test.

Results

Thirty-five patients, consisting of 3 female and 32 male patients (mean age, 42 years), had completed data for final analysis. None of the patients had perioperative or postoperative serious complications. The classical success rate was 62.9% (22/35). Three months postoperatively, the Epworth Sleepiness Scale decreased from 11.0 ± 4.2 to 8.7 ± 4.3 (P = .0006). The mean apnea/hypopnea index decreased from 50.6 ± 16.6 to 26.5 ± 23.5 events/h, the lowest oxygen saturation (%) improved from 70.4 ± 9.9 to 80.1 ± 11.3, and the snoring visual analog scale (0-10) as assessed by bed partner decreased from 9.86 ± 0.69 to 3.27 ± 1.96 (P < .0001 for all variables).

Conclusion

This study shows the significant benefits of ZPPP plus Eco-TBR in patients with severe OSAHS.

Keywords

sleep apnea obstructive sleep apnea/hypopnea syndrome snoring Z-palatopharyngoplasty uvulopalatopharyngoplasty tongue base surgery

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References

Friedman

Ibrahim

Lee

. Combined uvulopalatopharyngoplasty and radiofrequency tongue base reduction for treatment of obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg. 2003;129:611-621.

Kao

Shnayder

Lee

. The efficacy of anatomically based multilevel surgery for obstructive sleep apnea. Otolaryngol Head Neck Surg. 2003;129:327-335.

Lin

Friedman

Chang

. Z-palatopharyngoplasty plus radiofrequency tongue base reduction for moderate/severe obstructive sleep apnea/hypopnea syndrome. Acta Otolaryngol. 2010;130:1070-1076.

Lin

Friedman

Chang

. The efficacy of multilevel surgery of the upper airway in adults with obstructive sleep apnea/hypopnea syndrome. Laryngoscope. 2008;118:902-908.

Sher

Schechtman

Piccirillo

. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep. 1996;19:156-177.

Friedman

Ibrahim

Vidyasagar

. Z-palatoplasty (ZPP): a technique for patients without tonsils. Otolaryngol Head Neck Surg. 2004;131:89-100.

Yin

Zhang

. Z-palatopharyngoplasty for obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg. 2009;140:640-645.

Lin

Friedman

Chang

Shao

Pulver

Chen

. Effects of obstructive sleep apnea surgery on middle ear function. Arch Otolaryngol Head Neck Surg. 2011;137:373-376.

Sun

Chen

. Z-palatopharyngoplasty plus genioglossus advancement and hyoid suspension for obstructive sleep apnea hypopnea syndrome. Otolaryngol Head Neck Surg. 2011;144:469-473.

10.

Kezirian

Maselli

Vittinghoff

. Obstructive sleep apnea surgery practice patterns in the United States: 2000 to 2006. Otolaryngol Head Neck Surg. 2010;143:441-447.

11.

Fujita

Woodson

Clark

. Laser midline glossectomy as a treatment for obstructive sleep apnea. Laryngoscope. 1991;101:805-809.

12.

Prinsell

. Maxillomandibular advancement surgery in a site-specific treatment approach for obstructive sleep apnea in 50 consecutive patients. Chest. 1999;116:1519-1529.

13.

DeRowe

Gunther

Fibbi

. Tongue-base suspension with a soft tissue-to-bone anchor for obstructive sleep apnea: preliminary clinical results of a new minimally invasive technique. Otolaryngol Head Neck Surg. 2000;122:100-103.

14.

Neruntarat

. Genioglossus advancement and hyoid myotomy: short-term and long-term results. J Laryngol Otol. 2003;117:482-486.

15.

Hormann

Baisch

. The hyoid suspension. Laryngoscope. 2004;114:1677-1679.

16.

Hou

Jiang

. Tongue coblation via the ventral approach for obstructive sleep apnea-hypopnea syndrome surgery. Laryngoscope. 2012;11:2582-2586.

17.

Maturo

Mair

. Submucosal minimally invasive lingual excision: an effective, novel surgery for pediatric tongue base reduction. Ann Otol Rhino Laryngol. 2006;115:624-630.

18.

Friedman

Soans

Gurpinar

Lin

Joseph

. Evaluation of submucosal minimally invasive lingual excision technique for treatment of obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg. 2008;139:378-384.

19.

Woodson

. Innovative technique for lingual tonsillectomy and midline posterior glossectomy for obstructive sleep apnea. Oper Techn Otolaryngol Head Neck Surg. 2007;18:20-28.

20.

Rechtschaffen

Kales

. A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. Los Angeles, CA: UCLA Brain Information Service, Brain Research Institute; 1968.

21.

Kushida

Littner

Morgenthaler

. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005;28:499-521.

22.

American Academy of Sleep Medicine. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22:667-689.

23.

Friedman

Tanyeri

La Rosa

. Clinical predictors of obstructive sleep apnea. Laryngoscope. 1999;109:1901-1907.

24.

Friedman

Ibrahim

Bass

. Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg. 2002;127:13-21.

25.

Gunawardena

Robinson

MacKay

. Submucosal lingualplasty for adult obstructive sleep apnea. Otolaryngol Head Neck Surg. 2013;148:157-165.

26.

Woodson

Laohasiriwong

. Lingual tonsillectomy and midline posterior glossectomy for obstructive sleep apnea. Oper Techn Otolaryngol Head Neck Surg. 2012;23:155-161.

27.

Suh

. Evaluation of open midline glossectomy in the multilevel surgical management of obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg. 2013;148:166-171.

28.

Robinson

Ettema

Brusky

Woodson

. Lingual tonsillectomy using bipolar radiofrequency plasma excision. Otolaryngol Head Neck Surg. 2006;134:328-330.

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Z-palatopharyngoplasty Combined with Endoscopic Coblator Open Tongue Base Resection for Severe Obstructive Sleep Apnea/Hypopnea Syndrome

Abstract

Objectives

Study Design

Setting

Methods

Results

Conclusion

Keywords

Get full access to this article

References

Supplementary Material