Expansion sphincter pharyngoplasty with cartilage implant in uvulopalatal flap for treatment of obstructive sleep apnea

Background: Uvulopalatopharyngoplasty and its modifications, including expansion sphincter pharyngoplasty, are the most common surgical interventions for obstructive sleep apnea. Objective: To introduce a novel surgery technique in which expansion sphincter pharyngoplasty was performed accompanied by inserting a cartilage implant into the palate. Methods: Adult patients required septoplasty and pharyngoplasty were selected. In intervention group, expansion sphincter pharyngoplasty was performed with the insertion of a cartilage implant, obtained from their septum into the uvulopalatal flap site. In control group, similar procedures were performed except for cartilage insertion. Surgery outcome was assessed at the 3rd and 6th month post-operation by STOP-Bang Questionnaire (SBQ), Epworth Sleepiness Scale (ESS), and snoring level. Results: Thirty-one individuals with a mean age of 36.9 +/- 9.0 years, consisting of 27 (87.1 %) men, were recruited. At follow-ups sessions of intervention group (n = 16), the SBQ decreased from 3.94 +/- 1.39 to 2.33 +/- 1.11 and 1.80 +/- 1.21 (p < 0.001), ESS decreased from 10.31 +/- 5.52 to 5.20 +/- 2.83 and 3.33 +/- 1.76 (p < 0.001), and snoring level decreased from 2 to 1 and 1 (p < 0.001). In control group (n = 15), the SBQ decreased from 4.23 +/- 0.60 to 2.38 +/- 0.96 and 2.08 +/- 1.11 (p < 0.001), ESS decreased from 13.08 +/- 5.88 to 7.69 +/- 4.27 and 5.69 +/- 4.05 (p < 0.001), and snoring level decreased from 3 to 2 and 1 (p < 0.001). Between group comparison indicated that ESS was marginal at the second follow-up (p = 0.051), and the snoring level was significantly different at first (p = 0.019) and second (p = 0.031) follow-ups. Conclusion: Performing expansion sphincter pharyngoplasty with a cartilage implant in selected individuals improved surgery outcome.