Barbed Reposition Pharyngoplasty versus Expansion Sphincter Pharyngoplasty: A Meta‐Analysis

2020 ◽  
Author(s):  
Chairat Neruntarat ◽  
Kitsarawut Khuancharee ◽  
Petcharat Saengthong
Keyword(s):  
Meta Analysis ◽  
Expansion Sphincter Pharyngoplasty ◽  
Sphincter Pharyngoplasty

Expansion sphincter pharyngoplasty for the treatment of OSA: a systemic review and meta-analysis

2015 ◽  
Vol 273 (9) ◽  
pp. 2329-2333 ◽  
Author(s):  
Kenny P. Pang ◽  
Edward B. Pang ◽  
Ma Thin Mar Win ◽  
Kathleen A. Pang ◽  
B. Tucker Woodson
Keyword(s):  
Meta Analysis ◽  
Systemic Review ◽  
Expansion Sphincter Pharyngoplasty ◽  
Sphincter Pharyngoplasty

SYSTEMATIC REVIEW AND META-ANALYSIS OF THE PALATAL SURGERIES IN THE TREATMENT OF OBSTRUCTIVE SLEEP APNEA

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Amr Nabil Rabie ◽  
Ossama Mady ◽  
Ahmed Negm El-Shazly ◽  
Alaa Abouzeid
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Meta Analysis ◽  
Sleep Apnea Syndrome ◽  
Surgical Techniques ◽  
P Value ◽  
Obstructive Sleep ◽  
Expansion Sphincter Pharyngoplasty ◽  
Sphincter Pharyngoplasty ◽  
Meta Analyses

Abstract Background The first description of a patient with obstructive sleep apnea was in ‘The Posthumous Papers of the Pickwick Club’ published by English writer Charles Dickens in 18361. The first introduction of the terms ‘sleep apnea syndrome’ and ‘obstructive sleep apnea syndrome’ was by Guilleminault et al in 1967. Subsequently, Guilleminault coined the term ‘upper airway resistance syndrome’ in 19932. Objectives This paper aims to examine published articles between January 2008 and January 2019 on the different palatal surgeries performed on OSA patients and the treatment outcomes, which in turn will be used to determine two things. The first being the effectiveness of various palatal surgical techniques in treating OSAS and the second (if applicable) the most effective of the palatal surgical techniques in treating OSAS. Patients and Methods The current review followed the guidelines of preferred reporting items for systematic reviews and meta-analysis statement 2009 (PRISMA)5. The detailed steps of methods were described elsewhere as well as PRISMA checklist. The quality of relevant studies was assessed using NIH quality assessment tool for observational cohort and cross -sectional studies as well as NIH tool for quality assessment for case series studies. Results Meta-analyses of relevant studies showed that the surgical technique that achieved the best reduction on AHI was the lateral pharyngoplasty followed by the Anterior Palatoplasty, with a significant mean reduction of [(SMD= -0.848, 95% CI (-1.209 – -0.487), p-value<0.001) and (SMD= -0.864, 95% CI (-1.234 – -0.494), p-value<0.001), respectively]. The technique responsible for the best improvement in ESS was the Relocation Pharyngoplasty, with a significant mean reduction of [SMD= -0.998, 95% CI (-1.253 – -0.743), p-value<0.001]. Minimal O2 saturation level improved most with the Expansion Sphincter Pharyngoplasty, with a significant mean reduction of [SMD= 1.011, 95% CI (0.581 – 1.440), p-value<0.001]. The surgical procedure that result in the best post-operative VAS was Z-Palatoplasty, with a significant mean reduction of [SMD= -1. 551, 95% CI (-2.049 – -1.052), p-value<0.001]. soft palate length change with a significant mean reduction of [SMD= -2.219, 95% CI (-2.730 – 1.708), p-value<0.001]. Finally, meta-analyses of relevant studies showed that expansion sphincter pharyngoplasty achieved the overall highest success rate [Event rate= 77%, 95% CI (65.4%– 85.5%), p-value<0.001] Conclusion The best procedure for treating OSA varies from patient to patient and there is no universal cure-all. Careful patient selection and pre-operative evaluation are mandatory.

scholarly journals The Role of Modified Expansion Sphincter Pharyngoplasty in Multilevel Obstructive Sleep Apnea Syndrome Surgery

2018 ◽  
Vol 22 (04) ◽  
pp. 432-436 ◽  
Author(s):  
Francesco Lorusso ◽  
Francesco Dispenza ◽  
Domenico Modica ◽  
Salvatore Gallina
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Daytime Sleepiness ◽  
Sleep Apnea Syndrome ◽  
Upper Airway ◽  
Obstructive Sleep ◽  
Müller Maneuver ◽  
Expansion Sphincter Pharyngoplasty ◽  
Sphincter Pharyngoplasty ◽  
Apnea Syndrome

Introduction Obstructive sleep apnea syndrome (OSAS) is a sleep disorder caused by an excessive narrowing of the pharyngeal airway that also collapses during inspiration, with an important role played by the lateral pharyngeal wall in the development of the obstruction. Objective To describe our surgical experience with modified expansion sphincter pharyngoplasty (MESP) in the management of lateral collapse in upper airway multilevel surgery. Methods A total of 20 patients with moderate to severe OSAS were recruited in the Ear, Nose and Throat (ENT) Department of the University of Palermo, Italy. All of the enrolled patients refused the ventilatory therapy. The subjects were evaluated for snoring, and daytime sleepiness had a clinical evaluation including collection of anthropometric data and ENT examination and rhinofibroscopy with Müller maneuver. The patients undergoing upper airway multilevel surgery and we selected for MESP the patients with an oropharyngeal transverse pattern of collapse at Müller maneuver. Results In the postoperative assessment, all of the patients reported a reduction in snoring scores and daytime sleepiness. We observed a reduction in the mean apnea-hypopnea index (AHI) of 57.5% of the sample, which decreased from a mean value of 41.7 ( ± 21.5) to 17.4 ( ±  8.9) (p < 0.05), with a success rate, according to the Sher criteria, of 65%. We observed very few postoperative complications. Conclusion Modified expansion sphincter pharyngoplasty in multilevel surgical therapy preceded by a careful selection of patients has proven to be effective in treating patients with moderate to severe syndromes.

Expansion Sphincter Pharyngoplasty: A New Technique for the Treatment of Obstructive Sleep Apnea

2007 ◽  
Vol 137 (1) ◽  
pp. 110-114 ◽  
Author(s):  
Kenny P. Pang ◽  
B. Tucker Woodson
Keyword(s):  
Body Mass Index ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Body Mass ◽  
Apnea Hypopnea Index ◽  
Type I ◽  
Pharyngeal Wall ◽  
Obstructive Sleep ◽  
Expansion Sphincter Pharyngoplasty ◽  
Sphincter Pharyngoplasty

OBJECTIVE: In this study, we assessed the efficacy of a new method (expansion sphincter pharyngoplasty [ESP]) to treat obstructive sleep apnea. STUDY DESIGN: We conducted a prospective, randomized controlled trial. METHODS: Forty-five adults with small tonsils, body mass index less than 30 kg/m 2 , of Friedman stage II or III, of type I Fujita, and with lateral pharyngeal wall collapse were selected for the study. RESULTS: The mean body mass index was 28.7 kg/m 2 . The apnea-hypopnea index improved from 44.2 ± 10.2 to 12.0 ± 6.6 ( P < 0.005) following ESP and from 38.1 ± 6.46 to 19.6 ± 7.9 in the uvulopalatopharyngoplasty group ( P < 0.005). Lowest oxygen saturation improved from 78.4 ± 8.52% to 85.2 ± 5.1% in the ESP group ( P = 0.003) and from 75.1 ± 5.9% to 86.6 ± 2.2% in the uvulopalatopharyngoplasty group ( P < 0.005). Selecting a threshold of a 50% reduction in apnea-hypopnea index and apnea-hypopnea index less than 20, success was 82.6% in ESP compared with 68.1% in uvulopalatopharyngoplasty ( P < 0.05). CONCLUSION/SIGNIFICANCE: The ESP may offer benefits in a selected group of OSA patients.

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