Evaluation of oropharyngeal structure and DISE findings for successful soft palatal webbing flap pharyngoplasty in obstructive sleep apnea

Abstract

Soft palate webbing flap palatopharyngoplasty (SPWFPP) has been introduced to enhance the stability of the lateral pharyngeal wall with minimal post-operative complications by eliminating the need for tonsillectomy in obstructive sleep apnea (OSA) patients. We analyzed the anatomic findings of oropharynx for determination of outcome in OSA patients requiring SPWFPP. Twenty-eight OSA patients who underwent SPWFPP combined with septoturbinoplasty were included in this study. Patient medical records, including endoscopic findings, polysomnography (PSG) data, and drug-induced sleep endoscopy (DISE), were analyzed. PSG data revealed that SPWFPP provided significant improvements of AHI score in severe OSA patients with lateral pharyngeal wall collapse, whereas AHI scores of mild and moderate OSA cases minimally declined following SPWFPP. Notably, some experienced abrupt increase in AHI level after surgery particularly in mild OSA cases, and those patients showed collapse of the epiglottis before surgery according to DISE findings. The outcome of SPWFPP was successful in severe OSA patients whose epiglottis was not collapsible on preoperative DISE findings and in patients with palatal collapse of grade III or higher. Therefore, a close analysis of DISE findings before SPWFPP reveals important indicators for predicting better surgical results and selecting OSA patients suitable for SPWFPP.