 |
|
Usefulness of Uvulopalatopharyngoplasty With Genioglossus and Hyoid Advancement in the Treatment of Obstructive Sleep Apnea
Isabel Vilaseca, MD;
Antonio Morelló, MD;
Josep María Montserrat, MD;
Joan Santamaría, MD;
Alex Iranzo, MD
Arch Otolaryngol Head Neck Surg. 2002;128:435-440.
Objective To evaluate the usefulness of uvulopalatopharyngoplasty plus mandibular
osteotomy with genioglossus and hyoid advancement in the treatment of obstructive
sleep apnea syndrome (OSAS).
Design Prospective study of 20 consecutive patients with OSAS.
Setting University medical center.
Patients and Interventions Twenty OSAS patients with multilevel upper airway obstruction who refused
continuous positive airway pressure treatment. All patients were evaluated
before and 6 months after surgery by clinical history, the Epworth Sleepiness
Scale, physical examination, fiberoptic nasopharyngoscopy combined with the
Müller maneuver, cephalometric analysis, nocturnal polysomnography, and
a second-night polysomnography with upper airway pressure recording during
sleep. Surgery procedures were uvulopalatopharyngoplasty plus mandibular osteotomy
with genioglossus and hyoid advancement. Surgical successful outcome was defined
as an apnea-hypopnea index (AHI) lower than 20 plus subjective resolution
of daytime symptoms.
Main Outcome Measure Surgical success rate.
Results Mean ± SD AHI decreased from 60.5 ± 16.5 to 44.6 ±
27 (P = .007), and CT90 (percentage of time with oxyhemoglobin
saturation below 90%) decreased from 39.5% ± 26% to 25.1% ±
26.4% (P = .002). The overall surgical success rate
was 35% but increased to 57% in patients with moderate OSAS (AHI, 41-60) and
to 100% in mild OSAS (AHI, 21-40). In the group of severe OSAS, the success
rate was 9%. Predictors of surgical outcome success were the AHI, CT90, stages
2 and 3-4 sleep percentages, and the cephalometric ANB angle (angle formed
from the deepest point on the maxillary outer contour to the nasion to the
deepest point on the outer mandibular contour).
Conclusion Patients with mild and moderate OSAS and multilevel obstruction in the
upper airway may benefit from uvulopalatopharyngoplasty plus genioglossus
and hyoid advancement.
From the Services of Otorhinolaryngology (Drs Vilaseca and Morelló),
Pneumology (Dr Montserrat), and Neurology (Drs Santamaría and Iranzo),
University of Barcelona, Hospital Clínic, Barcelona, Spain.
RELATED ARTICLE
Archives of Otolaryngology–Head & Neck Surgery Reader's Choice: Continuing Medical Education
Arch Otolaryngol Head Neck Surg. 2002;128(4):465-466.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Surgical Treatment of Obstructive Sleep Apnea: Upper Airway and Maxillomandibular Surgery
Won et al.
Proc Am Thorac Soc 2008;5:193-199.
ABSTRACT
| FULL TEXT
Hypopharyngeal surgery in obstructive sleep apnea: an evidence-based medicine review.
Kezirian and Goldberg
Arch Otolaryngol Head Neck Surg 2006;132:206-213.
ABSTRACT
| FULL TEXT
Outcomes of Hyoid Suspension for the Treatment of Obstructive Sleep Apnea
Bowden et al.
Arch Otolaryngol Head Neck Surg 2005;131:440-445.
ABSTRACT
| FULL TEXT
|
