Anterolateral Advancement Pharyngoplasty: A New Technique for Treatment of Obstructive Sleep Apnea

作者：Emara Tarek Abdelzaher^*; Hassan Mostafa Hasan; Mohamad Abdelraoof Saeed; Anany Ahmad Mohamad; Ebrahem Ahmad Elsayed

来源：Otolaryngology - Head and Neck Surgery, 2016, 155(4): 702-707.

DOI：10.1177/0194599816648127

• anterolateral advancement pharyngoplasty
• obstructive sleep apnea palatopharyngeus muscle
• levator veli palatine muscle

Objective To investigate the efficacy of anterolateral advancement pharyngoplasty to enlarge pharyngeal airspace and to decrease palatal and lateral pharyngeal wall collapse in the treatment of obstructive sleep apnea (OSA).
Study Design Prospective study.
Setting University medical hospital.
Subjects and Method Forty-one patients underwent an anterolateral advancement pharyngoplasty procedure according to the following criteria: body mass index <30 kg/m(2), Friedman stage II or III, type I Fujita, nocturnal polysomnography diagnostic of OSA, retropalatal and lateral pharyngeal collapse, and diagnosis with flexible nasoendoscopy during a Muller's maneuver based on a 5-point scale. Patients with retroglossal airway collapse were excluded from the study. The principle of this technique is to advance and fix the palatopharyngeus muscle with the superior pharyngeus constrictor muscle without transecting any of their fascicules anterolateral to the pterygomandibular raphe and anterosuperior to the levator veli palatine muscle.
Results Pre- and postoperative polysomnography findings (mean SD) showed significant statistical differences: apnea hypopnea index (AHI) decreased from 42.1 +/- 16.34 to 16.3 +/- 10.3 (P .001); percentage of time with oxyhemoglobin saturation <90% decreased from 18.5% +/- 4.2% to 10.1% +/- 1.3% (P .001); and lowest oxygen saturation level increased from 79.9% +/- 14.8% to 89.3% +/- 11.1% (P .05). The mean time for patients to return to a normal diet was 12.2 days. There was no postoperative bleeding, velopharyngeal insufficiency, speech alternations, or taste loss. Based on a threshold of a 50% reduction in AHI and AHI <20, surgical success was 86.8%.
Conclusion Anterolateral advancement pharyngoplasty appears to be an effective technique with a high surgical success rate in the treatment of OSA patients with lateral pharyngeal wall collapse.

• 出版日期2016-10