Z-palatoplasty and Tongue Radiofrequency for Patients with Small Tonsils

Abstract

Objective To explore the feasibility and efficacy of Z-palatoplasty for the management of severe obstructive sleep apnea-hypopnea syndrome in patients with tonsils. Study Design Case series and chart review. Setting University hospital. Methods Z-palatoplasty and coblation channeling of the tongue were performed in 36 patients with body mass index <40 kg/m2 and size 1 or 2 tonsils. All patients’ tonsils were preserved. Follow-up continued for at least 1 year. Success was defined as a postoperative apnea-hypopnea index <15 events per hour and at least 50% less than the preoperative value. Results The surgical success rate was 58.3% (21/36 patients). Furthermore, 66.7% (24/36 patients) had a ≥50% reduction in the apnea-hypopnea index to less than 20 episodes per hour. There were statistically significant differences in preoperative nadir oxygen saturation, percentage of time with oxygen saturation less than 90%, microarousal index, and Friedman tongue position between those who responded to surgery and those who did not. Six patients had temporary velopharyngeal insufficiency. After 3 months, all the patients had normal deglutition. No major perioperative complications occurred. Conclusion Our findings suggest that Z-palatoplasty can improve disease-specific quality of life and sleep apnea symptoms in patients with obstructive sleep apnea-hypopnea syndrome and size 1 or 2 tonsils.