Surgical treatment of obstructive sleep apnea. Technical variations

Y. Zohar, Y. Finkelstein, M. Strauss and Y. Shvilli
Department of Otolaryngology and Head and Neck Surgery, Golda Medical Center, Hasharon Hospital, Petah-Tiqva, Israel.

OBJECTIVE: To determine the effectiveness of the two basic surgical types of uvulopalatopharyngoplasty (UPPP), as classified by us. The two basic surgical variations of UPPP differ for the width of the anteroposterior palatal resection, being 1 to 2 cm (type 1) and 0.5 to 1.0 cm (type 2). DESIGN: Randomized, retrospective study. PATIENTS: Eighty-seven patients with obstructive sleep apnea hospitalized in our department from 1983 to 1991. All patients had a complete preoperative and postoperative polysomnographic evaluation. RESULTS: The operation was found to be an effective treatment of obstructive sleep apnea in most patients. Snoring improvement was found in 95% (29/31) of patients with type 1 UPPP and in 96% (54/56) of the patients with type 2 UPPP, whereas, apnea index improvement was detected in 65% (20/31) of the patients with type 1 UPPP vs 64% (36/56) of the patients with type 2 UPPP. Postoperative dysphagia was found in 94% (29/31) vs 79% (44/56), P = .0025; nasal reflux was found in 81% (25/31) vs 11% (6/56), P = .0001; and hypernasality was found in 100% (31/31) vs 13% (7/56), P = .0001, in type 1 and type 2 UPPP operations, respectively. Chi-square analysis shows highly significant differences. CONCLUSIONS: Type 2 UPPP is the recommended surgical procedure of obstructive sleep apnea, mainly due to the minimal postoperative morbidity.