Upper Airway Changes in Snorers and Mild Sleep Apnea Sufferers After Uvulopalatopharyngoplasty (UPPP): Anatomic Modifications of the UA Induced by Surgery

There was a 25% increase in the thickness (W) of the palate after surgery (from 11.5±2.7 to 13.6±3.5 mm, p>0.06). This increase was similar in both good responders and nonresponders.
Thus, the combination of thickening of the soft palate together with a greater or lesser reduction in palatal length resulted in different spatial arrangements at the oropharyngeal level (Fig 5). The position of the soft palate was critical in the nonresponders with the palate projecting into the oropharyngeal lumen resulting in a reduction in caliber of the airway. Conversely, the long axis of the soft palate tended to be more parallel to the posterior wall of the pharynx in the good responders, resulting in a wider oropharynx.
Discussion
To our knowledge, this study is the first systematic examination of the anatomy of the UAs by cephalometry and CT before and after UPPP in mild OS A sufferers and nonapneic snorers. The success rate of UPPP in this study as defined by polysomnographic criteria was low at 35%. The surgical outcome was not correlated with change in BMI but rather with the presence or absence of an increase in the size of the oropharyngeal lumen after surgery. Persistence of oropharyngeal narrowing after UPPP was linked to an increase in thickness of the soft palate combined with a change in palatal position in relation to the base of the tongue. cialis professional online

Efficacy of UPPP
The success rate of UPPP reported by the metaanalysis of Sher and colleagues was 41%, but this included patients with severe OSA. Thus, the success rate of 35% achieved in our study of mild OSA sufferers and snorers is in good agreement with the values reported in the literature. UPPP was effective in eliminating snoring in only half of our patient group. Moreover Miljeteig and colleagues showed that for their patients, this subjective improvement was not accompanied by an objective decrease in the number of snoring episodes or a significant reduction in intensity of snoring. This discrepancy between objective and subjective assessments of surgical outcome may be explained by the fact that UPPP modifies the snoring frequency making it less noticeable to the spouse.

Figure 5. Scout view in good responders (left) and nonresponders (right) after UPPP. The position of the soft palate was critical in the nonresponders with the palate projecting into the oropharyngeal lumen resulting in a reduction in caliber of the airway (left). Conversely, the long axis of the soft palate tended to be more parallel to the posterior wall of the pharynx in the good responders, resulting in a wider oropharynx (rigjtf).Figure 5. Scout view in good responders (left) and nonresponders (right) after UPPP. The position of the soft palate was critical in the nonresponders with the palate projecting into the oropharyngeal lumen resulting in a reduction in caliber of the airway (left). Conversely, the long axis of the soft palate tended to be more parallel to the posterior wall of the pharynx in the good responders, resulting in a wider oropharynx (rigjtf).

Category: Sleep Apnea

Tags: cephalometry, obstructive sleep apnea syndrome, pharyngeal CT scan, snoring, upper airway imaging, uvulopalatopharyngoplasty (UPPP)