Clin Exp Otorhinolaryngol.  2014 Mar;7(1):66-68.

Palatal Implants for Persistent Snoring and Mild Obstructive Sleep Apnea After Laser-Assisted Uvulopalatoplasty

• Choi JH
• Kim EJ
• Kim KW
• Ju YH
• Park EH
• Lee SH

Abstract

Laser-assisted uvulopalatoplasty (LAUP) was widely performed in 1990s as a surgical therapeutic procedure to improve snoring or mild obstructive sleep apnea (OSA). However, LAUP is not currently recommended as a treatment for OSA because the evidence for its efficacy is insufficient. Little is known about alternative minimally invasive surgery in patients who refuse continuous positive airway pressure or oral appliance after failed LAUP. We present a case of successful surgical treatment of persistent snoring and mild OSA with palatal implants after LAUP. This case suggests that palatal implants may be offered as an alternative surgical procedure for selective patients with persistent or recurrent snoring or mild OSA after LAUP.

Keyword

Obstructive sleep apnea; Snoring; Palate; Implants

MeSH Terms

Continuous Positive Airway Pressure
Humans
Palate
Sleep Apnea, Obstructive*
Snoring*
Surgical Procedures, Minimally Invasive

Figure

• 

  Fig. 1 Preoperative findings in the oral cavity and oropharynx. (A) The uvula was not observed as a result of a previous palatal surgery and the Friedman tongue position was presumed as grade 2. (B) The tonsils were hidden within the pillars.

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  Fig. 2 Preoperative and postoperative hypnogram focused on respiratory parameters. Apnea-hypopnea index (from 7.6 to 1.3 events/hour) and snoring (from 51.3% to 16.8%) were clearly improved after the palatal implant procedure.

Reference

1. Powell NB. Contemporary surgery for obstructive sleep apnea syndrome. Clin Exp Otorhinolaryngol. 2009; 9. 2(3):107–114. PMID: 19784401.

2. Kamami YV. Laser CO₂ for snoring: preliminary results. Acta Otorhinolaryngol Belg. 1990; 44(4):451–456. PMID: 2128762.

3. Kamami YV. Outpatient treatment of snoring with CO₂ laser: laser-assisted UPPP. J Otolaryngol. 1994; 12. 23(6):391–394. PMID: 7897766.

4. Aurora RN, Casey KR, Kristo D, Auerbach S, Bista SR, Chowdhuri S, et al. Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep. 2010; 10. 33(10):1408–1413. PMID: 21061864.

5. Friedman M, Schalch P, Joseph NJ. Palatal stiffening after failed uvulopalatopharyngoplasty with the Pillar Implant System. Laryngoscope. 2006; 11. 116(11):1956–1961. PMID: 17075397.

6. O'Connor-Reina C, Garcia-Iriarte MT, Casado-Morente JC, Gomez-Angel D, Rodriguez-Diaz A, Plaza-Mayor G. Snoring surgery with palatal implants after failed uvulopalatopharyngoplasty. Eur Arch Otorhinolaryngol. 2008; 6. 265(6):687–693. PMID: 18030486.

7. Friedman M, Ibrahim H, Bass L. Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg. 2002; 7. 127(1):13–21. PMID: 12161725.

8. Ferguson KA, Heighway K, Ruby RR. A randomized trial of laser-assisted uvulopalatoplasty in the treatment of mild obstructive sleep apnea. Am J Respir Crit Care Med. 2003; 1. 167(1):15–19. PMID: 12502473.

9. Metes A, Hoffstein V, Mateika S, Cole P, Haight JS. Site of airway obstruction in patients with obstructive sleep apnea before and after uvulopalatopharyngoplasty. Laryngoscope. 1991; 10. 101(10):1102–1108. PMID: 1921639.

10. Woodson BT, Wooten MR. Manometric and endoscopic localization of airway obstruction after uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg. 1994; 7. 111(1):38–43. PMID: 8028940.

11. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000; 12. 284(23):3015–3021. PMID: 11122588.