Abstract
Objectives:
Determine the relationship between surgical success and both preoperative drug-induced sleep endoscopy (DISE) airway caliber changes and volumetric magnetic resonance imaging (MRI) in patients with obstructive sleep apnea (OSA) undergoing transoral robotic assisted posterior glossectomy and uvulopalatopharyngoplasty (OSA-TORS).
Methods:
From 2009 to present, as part of a nonrandomized prospective trial, patients with OSA undergoing OSA-TORS had preoperative DISE and pre- and postoperative volumetric MRI of the upper airway. Quantitative analysis of the endoscopy and MRI were compared with surgical success based upon pre- and postoperative polysomnogram, with success defined as postoperative apnea-hypopnea index (AHI) <20 and AHI decrease ≥50%. Preoperative MRI volumes were also compared against DISE changes.
Results:
Thirty-five apneics undergoing OSA-TORS underwent DISE, 21 received MRIs. DISE data showed that patients with surgical success had a smaller percentage decrease in overall airway collapse in the retroepiglottic (P = .045) and retroglottic regions (P = .08) compared with nonsuccesses. Larger preoperative MRI retroglottic airway volumes correlated with increased retroglottic (P = .05) and retroepiglottic (P = .03) lateral airway collapse on DISE, however, differences in pre- and postoperative MRI airway volumes did not correlate with surgical success.
Conclusions:
Larger retroglottic airway volume on MRI correlated with greater lateral airway collapse during DISE, but not with surgical success. Successes after OSA-TORS had significantly smaller airway collapse in the retroepiglottic regions than nonsuccesses during DISE, possibly due to better baseline muscle tone, allowing for better ability to benefit from the relatively small change in airway volume that OSA-TORS provides. Preoperative quantitative DISE could be used to identify patients more likely to succeed after OSA-TORS.
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