MODIFIED EXPANSION SPHINCTER PHARYNGOPLASTY: SURGICAL TECHNIQUE AND RESULTS

Introduction Multilevel obstruction of the upper airway due to the lateral pharyngeal wall collapse is common in OSAS patients. This often causes the failure of the “classical” oropharyngeal surgical treatment even though a good selection of the patients. Expansion Sphincter Pharyngoplasty, a surgical technique introduced by Pang and Tucker Woodson in 2007, has shown a promising success rate in OSAS therapy. However, we found a high rate of post-operative complications during our initial experience with the technique. Therefore, we introduced some modifications in order to reduce complications and improve post-operative results. Objective In this study we describe our modification of the surgical technique and related results as an isolated treatment for OSAS. Methods From December 2009 to February 2012 41 patients suffering from moderate/severe OSAS underwent to this surgery. The procedure consists of bilateral supero-laterally rotation of the palatopharyngeus muscular flaps and suture on to soft palate musculature to create lateral wall tension and reduce the bulk of the lateral pharyngeal wall. The palatal muscles and the uvula are completely preserved at the end of the procedure. The inclusion criteria were a complete oropharyngeal lateral wall collapse and absence of hypopharyngeal obstruction at videosleependoscopy. The mean AHI was 33.3/h, the mean ODI was 25.4/h, the mean age was 42.7 y, the mean time of SAT<90% was 11.1%. Ten out of 41 included in the study were non compliant n-CPAP patients (24.3%). Results The polysomnografic control was performed at 3 and 6 months after surgery. The mean postoperative AHI was 11.7/h, the mean ODI was 10.6/h and the mean postoperative time of SAT< 90% was 4.6%. Selecting a threshold of AHI index inferior to 15 without co-morbidity, or AHI<5 in patients with co-morbidity, the observed success rate was 70%. No dysphagia, or swallowing disturbances were referred. Only 3 cases of bleeding from tonsillar fossa were reported. Conclusion Modified Expansion Sphincter Pharyngoplasty is a safe and effective surgical procedure in selected moderate to severe OSAS patients, characterized by lateral pharyngeal wall collapse. This procedure resulted to be of particular interest also in n-CPAP failure. Our technique modifications preserve the anatomy and function of velum and uvula with promising success rate both in AHI reduction and daytime symptoms.