Faringoplastía de reposición con suturas barbadas como tratamiento quirúrgico en pacientes con síndrome de apnea-hipopnea obstructiva del sueño / Barbed sutures reposition pharyngoplasty as surgical treatment in obstructive sleep apnea-hypopnea syndrome

INTRODUCCIÓN: La planificación de cirugías para el manejo del síndrome de apneahipopnea obstructiva del sueño (SAHOS) ha incrementado su precisión desde la introducción de la endoscopía del sueño inducido por fármacos (DISE). OBJETIVO: Evaluar la técnica de faringoplastía de reposición con suturas barbadas (BRP) para el colapso velofaríngeo y/o de paredes laterales orofaríngeas evaluado mediante DISE en pacientes con SAHOS. MATERIAL Y MÉTODO: Ochenta y ocho pacientes fueron evaluados para cirugía mediante antropometría, escala de somnolencia de Epworth (ESS) y poligrafía respiratoria. Veinte y seis de 88 pacientes fueron seleccionados. De los 26, 14 accedieron al tratamiento quirúrgico, el que se seleccionó en base a la DISE. En todos los casos, se realizó BRP. RESULTADOS: A los 3 meses de la cirugía hubo mejoría en 10/14 pacientes (criterios de Sher, disminución del índice de apnea-hipoapnea a <20 o 50% del basal). La ESS bajó en promedio de 12 a 5 puntos (p <0,05). No se reportaron incidentes en el posoperatorio y no han ocurrido eventos adversos. CONCLUSIÓN: La técnica de BRP es una técnica sencilla y útil para la expansión anterior y lateral del paladar blando y orofaringe, con una tasa de éxito similar en esta cohorte a la reportada internacionalmente.

INTRODUCTION: Surgical planning for the management of obstructive sleep apneahypopnea syndrome (OSAHS) has changed since the introduction of drug induced sleep endoscopy (DISE). AIM: To evaluate the technique of barbed sutures reposition pharyngoplasty (BRP) for velopharyngeal collapse and/or oropharyngeal lateral walls after DISE evaluation in OSAHS patients. MATERIAL AND METHOD: 88 patients were evaluated for surgery by anthropometry, Epworth sleepiness scale (ESS) and respiratory polygraphy. 26 of 88 patients were selected. Of the 26, 14 agreed to surgical treatment, which was selected on DISE findings. In all cases, BRP was performed. RESULTS: Three months after surgery there was improvement in 10/14 patients (Sher criteria, apnea-hypopnea index reduction at <20 or 50% of baseline). The ESS improved on average 12 to 5 (p <0.05). No incidents were reported in the post-operative period and no adverse events were reported. CONCLUSION: The BRP technique is a simple and useful technique for the anterior and lateral expansion of the soft palate and oropharynx, with a similar success rate in this cohort to that internationally reported.

Características posoperatorias de la faringoplastia combinada con amigdalectomía en comparación con la amigdalectomía en niños con síndrome obstructivo de apnea del sueño / Postoperative characteristics of combined pharyngoplasty and tonsillectomy versus tonsillectomy in children with obstructive sleep apnea syndrome

Objetivo. Identificar las ventajas posoperatorias de la amigdalectomía en conjunto con la faringoplastia en comparación con la amigdalectomía sola en niños con apnea obstructiva del sueño. Métodos. En un estudio prospectivo observacional, los pacientes que cumplían con los criterios del estudio fueron asignados aleatoriamente a dos grupos: el grupo de amigdalectomía y faringoplastia, y el grupo de solo amigdalectomía. En ambos grupos, también se practicó adenoidectomía a los pacientes con vegetaciones. Se compararon los procesos de cicatrización en la herida faríngea y las proporciones hemorrágicas. Además, se evaluó la función velofaríngea posoperatoria. Resultados. La faringoplastia junto con la amigdalectomía se practicó en 328 niños con apnea obstructiva del sueño debido a hipertrofia amigdalina, y la amigdalectomía sola, en 275 niños. Estas cohortes no mostraban diferencias demográficas significativas. Por otro lado, se encontró que la pérdida de sangre fue significativamente menor en el grupo que recibió amigdalectomía y faringoplastia (p < 0,01), y el proceso de cicatrización fue notablemente más breve. La función velofaríngea posoperatoria no resultó afectada. Conclusiones. En comparación con la amigdalectomía, la amigdalectomía junto con la faringoplastia redujeron la duración del proceso de cicatrización y la pérdida de sangre; no obstante, las complicaciones posoperatorias no aumentaron. En nuestra opinión, la combinación de faringoplastia y amigdalectomía reúne un gran potencial en el tratamiento de los niños con apnea obstructiva del sueño.

Purpose. The study aims to identify the postoperative advantages of tonsillectomy in conjunction with pharyngoplasty and tonsillectomy alone in children with obstructive sleep apneas. Methods. In a prospective observational study, patients who met the study criteria were randomly divided into two groups: tonsillectomy and pharyngoplasty group, and tonsillectomy alone group. In both groups, adenoidectomy was also performed in patients with adenoid hypertrophy. Differences in their healing processes in the pharyngeal wound and their hemorrhage proportions were compared. Furthermore, postoperative velopharyngeal function was also assessed. Results. Pharyngoplasty together with tonsillectomy was performed in 328 children with obstructive sleep apnea from tonsillar hypertrophy, and tonsillectomy was performed in 275 children. These cohorts did not reveal any significant demographic differences between groups. Furthermore, blood loss was found to be significantly decreased in the tonsillectomy and pharyngoplasty group (P <0.01), and the healing process was markedly shorter. Postoperative velopharyngeal function was not affected. Conclusions. Tonsillectomy in conjunction with pharyngoplasty reduced the duration of the healing process and blood loss, compared with tonsillectomy alone; however, postoperative complications did not increase. We consider pharyngoplasty in conjunction with tonsillectomy has great potential in the treatment of children with obstructive sleep apnea.

Surgical treatment of velopharyngeal insufficiency

Velopharyngeal insufficiency (VPI) is a common complication after primary palatoplasty. Although the several surgical treatments of VPI have been introduced, there is no consensus guide to select the optimal surgical treatment for VPI patients. The selection of surgical treatment for VPI depends on a multimodal patient evaluation, such as perceptual speech evaluation, nasometery and nasoendoscopy. We can provide more adequate treatment for VPI through the deeper understanding of anatomy and physiology in VPI.

Investigation of postoperative hypernasality after superiorly based posterior pharyngeal flap / 대한악안면성형재건외과학회지

BACKGROUND: Velopharyngeal insufficiency that accompanies speech resonance and articulation disorders can be managed through several intervention methods such as speech-language therapy, prosthetic aids, and surgery. However, for patients with severe hypernasality, surgical interventions are highly recommended. Among available surgical techniques, the posterior pharyngeal flap is most common. CASE PRESENTATION: Two adult males with high nasalance scores underwent superiorly based posterior pharyngeal flap surgery, followed by speech testing by an expert speech-language therapist. Nasalance scores and articulation accuracy were assessed up until 1 year after the surgery. Nasalance scores were measured five times using a nasometer, after which the average value was calculated. CONCLUSIONS: Consistent declines in hypernasality over time are not easy to explain since the pedicled pharyngeal flap narrowed over time, secondary to cicatrization. However, scar tethering of the soft palate in a posterior direction could reduce the velopharyngeal port size over time. Therefore, long-term follow-up with intensive speech therapy is suggested for patients with severe hypernasality.

The development of techniques served to widen the lateral velopharyngeal space for treating OSAHS / 临床耳鼻咽喉头颈外科杂志

Since Fujita first described uvulopalatopharyngoplasty(UPPP)in 1981,UPPP and its modified procedures have been widely used to treat obstructive sleep apnea and hyponea syndrome(OSAHS).However,despite of its wide application,the success rates was uncertain,ranging from 20% to 80%,with patients of varing Friedman stages.It is well known that the principle of UPPP is to remove the redundant tissue of palate,elongated uvula and hypertrophic tonsils in order to widen the anteroposterior space at the level of palate.But recently,surgeons have found that not only the collapse of soft palate but also the collapse of lateral wall at the palate level can contribute to the obstruction of upper airway at the level of palate.As a result,many surgeries which can widen the lateral velopharyneal space have sprung up in these years.This review focuses on the development of techniques that emphasize the enlargement of lateral velopharyneal space in patients with OSAHS.

A Rare Case of Subcutaneous Emphysema following Lateral Pharyngoplasty for Obstructive Sleep Apnea

Lateral pharyngoplasty is a surgical option for treatment of obstructive sleep apnea (OSA). Here, we present a case involving a 40-year-old healthy man who underwent surgery, including lateral pharyngoplasty and robotic tongue base resection, for OSA. There were no intraoperative or immediate postoperative complications. However, on postoperative day 3, the patient presented with swelling in the temporal and buccal areas and was diagnosed with subcutaneous emphysema, later confirmed by computed tomography. The patient was carefully monitored under conservative care and discharged without complications. Although subcutaneous emphysema following tonsillectomy is a rare complication and usually resolves with conservative management, in certain cases, it might require surgical intervention. Lateral pharyngoplasty involves tonsillectomy and additional incision along the tonsillar fossa, which makes it susceptible to pharyngeal wall defects and, consequently, subcutaneous emphysema. Additionally, lateral pharyngoplasty and robotic tongue base resection cause pain and might thus contribute to the increase in intrapharyngeal pressure, which might aggravate subcutaneous emphysema. Lateral pharyngoplasty should be performed with meticulous dissection of the superior pharyngeal constrictor muscle. Healthcare providers should be aware of these complications and, upon suspicion of the same, place the patient under close observation to prevent life-threatening situations.

Upper airway changes after H-uvulopalatopharyngoplasty combined with transpalatal advancement pharyngoplasty in patients with obstructive sleep apnea hypopnea syndrome / 中国医师进修杂志

Objective To compare the upper airway changes after H-uvulopalatopharyngoplasty (H-UPPP) combined with transpalatal advancement pharyngoplasty (PA) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods Eighty-six patients with OSAHS were selected,39 patients were treated with H-UPPP alone (control group),and 47 patients were treated with H-UPPP combined with PA (observation group).The upper airway changes were measured by CT and apnea hypopnea index (AHI) change in the 2 groups were compared before and after operation.Results The surgery effective rate in observation group was 80.9％ (38/47),in control group was 56.4％ (22/39),there was statistical difference (P ＜ 0.05).The AHI depressed value before and after operation in observation group and control group were (40.5 ± 14.6) times/h and (16.7 ± 12.0) times/h respectively,the hard palate length depressed value were (5.5 ± 3.2) mm and (1.6 ± 0.2) mm respectively,the anteroposterior diameter incremental value of hard palate were (3.6 ± 2.3) mm and (-1.6 ± 3.4) mm respectively,the anteroposterior diameter incremental value of palate and pharynx were (1.6 ± 1.2) mm and (-1.2 ± 1.8) mm respectively,the above indexes in observation group were significantly better than those in control group,there were statistical differences (P ＜ 0.05).The minimum diameter incremental value of retropalatal airway in control group was (13.2 ± 3.1) mm,in observation group was (4.9 ± 1.6) mm,there was statistical difference (P ＜ 0.05).Conclusion H-UPPP combined with PA offers benefit over H-UPPP alone in patients with OSAHS,which may be achieved by increasing anteroposterior diameter of palate and pharynx.

Descripción de características clínicas del síndrome velocardiofacial / Velo-cardio-facial syndrome: a description of its clinical characteristics

Uno de los síndromes más frecuentes asociados a fisura palatina es el síndrome Velocardiofacial. Sus características involucran aspectos faciales, cardiológicos, psicológicos, ligüísticos y de aprendizaje, que deben ser abordados por equipos multiprofesionales. Internacionalmente el estudio de este síndrome se ha hizo masificando en forma progresiva. En nuestro país son escasos los grupos que manejan e intervienen en esta población. En este contexto es que se hace necesaria una revisión bibliográfica actualizada, que resuma los hallazgos clínicos y algunos aspectos de manejo multiprofesional, desde una perspectiva fonoaudiológica.

Velo-cardio-facial syndrome (VCFS) is one of the most frecuently associated syndromes to cleft palate. It comprises facial, cardiological, psychological, and linguistic disorders as well as learning difficulties which all must be addressed by a multi-professional team. The study of this syndrome has been systematically carried out around the world. In Chile, however, there are only few health-related professionals who work with this patient population. The present article aims at providing an up-to-date review, from a speech pathology point of view, on the clinical finding and on some aspects involved in the clinical management of VCFS.

Longitudinal outcome of pharyngoplasty

Although early complication of airway obstruction following pharyngoplasty is well recognised, there have been few reports of late modifications following this procedure. We retrospectively review cases with late complications which have required either revision or division of an existing pharyngoplasty at the Australian Craniofacial Unit over the last twenty-five years. We assess the outcome of further surgical intervention in each case, with case note and nasendoscopy video review. Fourteen cases were identified where records were complete. There were 12 males and 2 females. The cases are a heterogeneous group of cleft lip and palate patients and include three cases with a diagnosis of Pierre-Robin sequence and one case with a cleft palate as part of an underlying syndrome. Those cases requiring flap division had undergone either superiorly or inferiorly based pharyngeal flaps in contrast to dynamic (Orticochea) pharyngoplasties which required revision. This series of cases demonstrates the need for thorough assessment and planned tailoring of the pharyngoplasty procedure, with ongoing review of speech and airway function. This management philosophy results in the acceptance that a pharyngoplasty may only be required for a limited period of time and ultimately may be redundant.