Relocation Pharyngoplasty for Obstructive Sleep Apnea

Objectives/Hypothesis: To investigate the efficacy of relocation pharyngoplasty as a surgical technique both to enlarge pharyngeal airspace and to decrease pharyngeal collapse in the treatment of obstructive sleep apnea (OSA). Study Design: Prospective comparative study performed in a tertiary referred sleep center. Methods: Ten adult male OSA patients (median age of 38 years, median apnea-hypopnea index [AHI] of 41.6 events/hour, and median body mass index of 25.8 kg/m(2)) with favorable oropharyngeal structure were enrolled. Principal procedures of the relocation pharyngoplasty include tonsillectomy, removal of supratonsillar mucosa and adipose tissue, splinting the lateral pharyngeal wall by suturing the placating superior pharyngeal constrictor muscle to the anterior pillar, and advancing the soft palate by suturing the posterior pillar flap cephalad laterally to the supratonsillar fossa. Results: No patients experienced swallowing disturbance or change of voice after 3 months postoperatively. The median time for patients to return to normal nourishment was 15 days. Six months after the operation, there were statistically significant improvements in snoring (P = .005) and daytime sleepiness (P = .008). Repeated polysomnography revealed significant improvement in AHI (P = .005) and rapid eye movement period (P = .037). Furthermore, reduction in AHI following relocation pharyngoplasty was found in all patients. Conclusions: In selected patients, relocation pharyngoplasty by advancing the soft palate and splinting the lateral pharyngeal wall obtains significant improvement in subjective snoring and daytime sleepiness, as well as objective adverse sleep respiratory events and sleep architecture, while retaining normal pharyngeal function.