Upper Airway Anatomical Changes after Velopharyngeal Surgery in Obstructive Sleep Apnea Patients with Small Tonsils

Abstract

Objective To evaluate the relationships between anatomical changes and treatment outcomes after velopharyngeal surgery in obstructive sleep apnea (OSA) patients with small tonsils (grade 0-2 on the Brodsky scale). Study Design Case series with planned data collection. Setting University medical center. Subjects and Methods Thirty-six OSA patients with small tonsils underwent velopharyngeal surgery including revised uvulopalatopharyngoplasty with uvula preservation and transpalatal advancement pharyngoplasty. Pre- and postoperative upper airway 3-dimensional computed tomography and polysomnography findings were obtained for comparison and analysis. Results The overall apnea hypopnea index (AHI) decreased from 56.8 (interquartile range, 37.5-70.1) preoperatively to 16.1 (10.8-33.5) postoperatively ( P < .001). The change in minimal cross-sectional area of the velopharynx (VmCSA) was independently associated with the change in AHI ( P = .001, R2 = 0.271). Preoperative VmCSA was the only preoperative anatomical variable that was an independent predictor of change in VmCSA ( P = .009, R2 = 0.184). Postoperative VmCSA was independently associated with postoperative AHI ( P < .001, R2 = 0.341). Conclusion In patients with small tonsils, an adequate increase in VmCSA is associated with a successful outcome after surgery. Patients with a relatively small preoperative VmCSA are more likely to have favorable anatomical changes after surgery.