Author(s): Cahali MB
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Abstract OBJECTIVE: The role of the lateral pharyngeal muscular walls in the pathogenesis of obstructive sleep apnea hypopnea syndrome (OSAHS) is crucial. My objective is to describe a surgical procedure for splinting the lateral pharyngeal walls in patients with OSAHS and report the initial results. STUDY DESIGN: Prospective randomized pilot study performed in an academic tertiary center as part of a doctoral thesis. PATIENTS AND METHODS: Ten adults with OSAHS, originally selected for treatment with uvulopalatopharyngoplasty, underwent the lateral pharyngoplasty procedure, which consists of a microdissection of the superior pharyngeal constrictor muscle within the tonsillar fossa, sectioning of this muscle, and suturing of the created laterally based flap of that muscle to the same-side palatoglossus muscle. In addition, a palatopharyngeal Z-plasty is performed to prevent retropalatal collapse. RESULTS: Lateral pharyngoplasty improved sleep and daytime symptoms related to OSAHS. After at least 6 months of follow-up, the median apnea-hypopnea index decreased from 41.2 to 9.5 (P =.009) and the median total sleep time spent in rapid eye movement (REM) sleep and in stages 3 plus 4 non-REM sleep increased from 14.1\% to 22.1\% (P =.059) and from 5.3\% to 16.3\% (P =.037), respectively. Also, there was statistically significant improvement in snoring, daytime sleepiness, and overall impact of the disease on quality of life. Swallowing disturbances lasted a median of 14.5 days after the surgeries, and all patients returned to normal subjective swallowing function in the follow-up. CONCLUSIONS: Lateral pharyngoplasty is a safe and straightforward approach to lateral pharyngeal muscles and has produced appreciable benefits for OSAHS patients.
This article was published in Laryngoscope
and referenced in Journal of Sleep Disorders & Therapy