Clin Exp Otorhinolaryngol.  2010 Sep;3(3):141-146.

The Effect of Uvula-Preserving Palatopharyngoplasty in Obstructive Sleep Apnea on Globus Sense and Positional Dependency

• Kwon M
• Jang YJ
• Lee BJ
• Chung YS

Abstract

OBJECTIVES
This study investigated the outcomes of uvula-preserving palatopharyngoplasty (UPPPP) in patients with obstructive sleep apnea syndrome (OSAS).
METHODS
Twenty men with obstructive sleep apnea syndrome received the UPPPP operation at our institution. We measured symptom changes after UPPPP using a visual analog scale (VAS), and all patients were examined with polysomnography pre- and post-operatively. 'Surgical success' was defined as reduction in apnea-hypopnea index (AHI) to below 20 events per hour and more than 50% post-operative reduction.
RESULTS
Snoring decreased significantly (6.7+/-2.3 to 3.7+/-2.9 on VAS, P=0.002) but the postoperative globus sense did not differ from that preoperatively (2.0+/-2.4 to 2.1+/-2.7 on VAS, P=0.79). Apnea and apnea-hypopnea indices were significantly reduced after UPPPP (34.7+/-20 to 24.2+/-17.2 events/hour, P=0.029). The surgical success rate was 40% regardless of Friedman stage. There was significant reduction in the AHI on supine sleep in both surgically successful and unsuccessful patient groups.
CONCLUSION
UPPPP may minimize postoperative globus sense and other complications, with a success rate comparable to that of previously reported surgical methods in OSAS patients. In addition, it may reduce the apnea-hypopnea index in the supine sleep position.

Keyword

Obstructive sleep apnea; Uvulopalatopharyngoplasty; Polysomnography; Position

MeSH Terms

Apnea
Dependency (Psychology)
Humans
Male
Polysomnography
Sleep Apnea, Obstructive
Snoring

Figure

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  Fig. 1 Illustration of uvula-preserving palatopharyngoplasty. (A, B) Axial view of the operation field. (A) The classical suture method of uvulopalatopharyngoplasty is associated with a higher rupture risk because of deadspace formation. (B) In our study, the tonsil bed is sutured together and plicated for prevention of deadspace formation. (C) Coronal view of the operation field. Soft tissues are retracted not only anteroposteriorly but also laterally by the tensile force developed in the suture technique.

• 

  Fig. 2 Photographs of uvula-preserving palatopharyngoplasty. (A) Suturing of the anterior pillar, the tonsil fossa, and the posterior pillar with Vicryl (colored purple) is performed after tonsillectomy. The tonsil fossa is sutured for prevention of rupture caused by deadspace formation. (B) Soft tissues are retracted not only anteroposteriorly but also laterally by the tensile force developed in the suture technique. The preserved uvula will become smaller by contraction of scar tissue on both sides of the musculus palatouvularis and at the lower margin of the tensor palati.

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