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Variations on Soft Palate Surgery Prove Successful for OSA

1021-Sleep ApneaSeveral variations of surgery on the soft palate have been developed in recent years as a treatment for obstructive sleep apnea. The pros and cons of seven of those uvulopalatopharyngoplasty techniques were discussed September 30 in the Miniseminar “Palate Surgery in OSA: How to Choose Among the Options.”

“The goal of the session was to get thought leaders and people who have developed these procedures to share not only the process and rationale for developing them but also the evidence in terms of how they may offer benefit,” said moderator Eric J. Kezirian, MD, MPH. “They discussed how they use these different kinds of procedures in their practices to treat different kinds of patients.”

In all of the procedures, the goal is to open the airway space behind the soft palate to improve breathing, said Dr. Kezirian, Professor of otolaryngology-head & neck surgery at the Keck School of Medicine of the University of Southern California, Los Angeles, CA.

“These various approaches use combinations of repositioning and removal of tissue, and the choice of the best procedure can be different for each patient,” he said. “The phrase ‘personalized medicine’ has been thrown around quite a bit, but it has clearly been shown to be important in sleep apnea treatments. It is not just true for palate surgery, as sometimes palate surgery may need to be combined with other procedures. You tailor the treatment according to what is causing the sleep apnea.”

The Miniseminar speakers who discussed soft palate surgery procedures were:

  • Edward M. Weaver, MD, MPH, Professor of otolaryngology-head and neck surgery at the University of Washington, presented data about the original version of uvulopalatopharyngoplasty. He also explained modifications related to suturing techniques.
  • Kenny P. Pang, MD, Director at the Asia Sleep Centre, Singapore, discussed the expansion sphincter pharyngoplasty technique he developed with fellow speaker B. Tucker Woodson, MD, Professor in the Department of Otolaryngology, Division of Sleep Medicine, at the Medical College of Wisconsin, Milwaukee, WI. It involves elevating and repositioning muscle tissue on the side of the throat and has shown better results than classic uvulopalatopharyngoplasty in a randomized trial.
  • Hsueh-Yu Li, MD, Professor and Chairman at Chang Gung University, Taipei, Taiwan, reviewed the relocation pharyngoplasty he developed. It involves the removal of a small amount of tissue and relocation of tissue in the lateral pharyngeal walls.
  • Michel B Cahali, MD, of the University of Sao Paulo, Sao Paulo, Brazil, reviewed his lateral pharyngoplasty procedure. He shared some of the revisions in his technique and the randomized trial results that also showed improved outcomes compared to traditional uvulopalatopharyngoplasty.
  • Dr. Woodson reviewed his palatal advancement procedure that involves removal of hard palate bone to enable advancement of the soft palate.
  • Brian Rotenberg, MD, MPH, Associate Professor and Director of the Sleep Surgery Program in the Department of Otolaryngology-Head & Neck Surgery at Western University, London, Ontario, Canada, reviewed the Pillar Procedure. Studies have shown limited benefits in patients with sleep apnea, although the benefit may be greater in those who have undergone previous soft palate surgery.
  • Dr. Kezirian presented the Z-palatoplasty procedure for Michael Friedman, MD, Medical Director of Chicago ENT. Dr. Friedman initially used this procedure for patients who had previous uvulopalatopharyngoplasty, but has expanded its application.

“I loved this session, sharing ideas with colleagues who have been true innovators in palate surgery,” Dr. Kezirian said. “It was so enjoyable for me, and you could tell that everyone who attended the Miniseminar on the last day of the Annual Meeting felt the same way.”