Modified anterior palatoplasty and double suspension sutures (with or without tonsillectomy) in selected patients with obstructive sleep apnea: a preliminary report

BackgroundRetropalatal region might be considered the most common site of obstruction in patients with snoring and OSA. We aimed at presentation of two combined techniques: modified anterior palatoplasty (MAP) and bilateral double suspension suture (DSS).MethodsThis prospective study was conducted on OSA patients with retro-palatal collapse only that was confirmed by nasoendoscopy during Muller's maneuver and drug induced sleep endoscopy. MAP and DSS were performed for all patients. Preoperative and 6months after surgery, all patients underwent fiber-optic nasoendoscopy using the Muller maneuver and polysomnography, snoring scores, and Epworth Sleepiness Scale (ESS) values were assessed.ResultsMean apnea hypopnea index (AHI) dropped significantly (p<0.0001) from a mean of 28.65.5 preoperatively to 8.3 +/- 2.96 postoperatively. Successful outcome was reported in 26 patients (98.65%) while 3 patients (10.35%) were responders. The mean lowest oxygen (O-2) saturation level increased significantly from 79.4 +/- 3.5 to 93.1 +/- 3.1 (p<0.0001). ESS showed significant improvement (p<0.0001) as its mean diminished from 14.5 +/- 2.4 preoperatively to 3.4 +/- 1 postoperatively. Visual analog scale of snoring was significantly (p<0.0001) decreased from 7.9 +/- 1.3 preoperatively to 1.9 +/- 1.2 postoperatively. No early or late complications were reported.ConclusionCombined MAP and DSS (+/- tonsillectomy) could be considered as simple, reliable, easily trained, effective, and safe surgical treatment option for OSA patients with predominant retropalatal obstruction. It could be employed in a single-stage, multilevel work-up.