Anatomical and physiological justification of laser sculptural uvulopalatoplasty in rhonchopathy and obstructive sleep apnea syndrome

Abstract

Purpose: to study anatomical and physiological features of the soft palate in patients with rhonchopathy and obstructive sleep apnea (OSA) syndrome so as to minimize damage to tissue structures during laser uvulopalatoplasty.Material and methods. Five hundred twenty-three patients with rhonchopathy and OSA syndrome were examined using the index technique for determining neck circumference-height ratio (NHR), pharyngoscopy and endoscopy of the oral and pharyngeal cavities.Results. Obstructive sleep apnea syndrome is more often met in patients having rhonchopathy and the brachymorphic and mesomorphic type of their neck. The researchers have found a clear dependence between the increase in the number of patients having rhonchopathy and moderate and severe obstructive sleep apnea syndrome and the increase of soft palate hypertrophy combined with ptosis. A cone-shaped depression on the anterior surface of the soft palate was noted in 80-90 % of patients with normal weight (body mass index < 25); in 40–60 % of patients with grade I obesity (body mass index – 30–34.9); in 10–15 % of patients with grade II obesity (body mass index – 35–39,9); in patients with grade IIIobesity (body mass index > 40) there were no any depression in the soft palate. Patients with uncomplicated snoring have a thick area in the forma pillow at the back of their soft palate sized 1 × 0.5 × 0.5 cm, while in patients with severe OSA syndrome this «pillow» is up to 2 × 1.5 × 1 cm.Conclusion. The effectiveness of laser uvulopalatoplasty depends not only on the adequate choice of main parameters for laser irradiation, but also on the careful consideration of anatomical and functional features of the soft palate in each operated patient with rhonchopathy and obstructive sleep apnea syndrome.