Evaluation of Oropharyngeal Structure and DISE Findings for Successful Soft Palatal Webbing Flap Pharyngoplasty

Abstract

Purpose: Lateral pharyngeal wall collapse, linked to weak pharyngeal wall stability, is characteristic of severe obstructive sleep apnea (OSA) patients. Soft palate webbing flap palatopharyngoplasty (SPWFPP) has been introduced to enhance the stability of the lateral pharyngeal wall with minimal postoperative complications by eliminating the need for tonsillectomy. This study analyzed the anatomic findings of oropharynx for determination of outcome in OSA patients requiring SPWFPP. Methods: Twenty-eight OSA patients who underwent SPWFPP combined with septoturbinoplasty were included in this study. Patient medical records, including endoscopic findings, polysomnography (PSG) data, and drug-induced sleep endoscopy (DISE), were analyzed. Results: PSG data revealed that SPWFPP provided significant improvements of AHI scores in severe OSA patients with lateral pharyngeal wall collapse, whereas AHI scores of mild and moderate OSA cases minimally declined after SPWFPP. Notably, among the patients who underwent SPWFPP, some experienced abrupt increases in AHI levels after surgery, particularly in mild OSA cases, and those patients showed collapse of the epiglottis before surgery according to DISE findings. The outcome of SPWFPP was successful in severe OSA patients whose epiglottis was not collapsible on preoperative DISE findings and in patients with palatal collapse of grade III or higher. Conclusion: SPWFPP provides good surgical outcomes even in severe OSA patients with lateral pharyngeal wall collapse. However, the surgical results may be worse in certain patients depending on epiglottis collapsibility. A close analysis of DISE findings before SPWFPP reveals important indicators for predicting better surgical results and selecting OSA patients suitable for SPWFPP. © 2024 Mutaz B. Habal, MD.