Evolution of soft palate surgery techniques for obstructive sleep apnea patients: A comparative study for single-level palatal surgeries

Objectives: To compare the results of tissue preservation techniques of soft palate surgeries including expansion sphincter pharyngoplasty (ESP) and barbed reposition pharyngoplasty (BRP) for patients suffering from obstructive sleep apnoea (OSA) with the traditional uvulopalatopharyngoplasty (UPPP). Design: Interventional comparative study. Setting: Morgagni-Pierantoni Hospital. Participants: Seventy-five patients were included in the study, divided into three groups with 25 patients per group: UPPP, ESP or BRP. Main outcomes measures: Polysomnography was carried out for all patients pre- and postoperatively; the postoperative results were recorded at least 6 months after surgery. All patients were assessed preoperatively using drug-induced sleep endoscopy. Epworth Sleepiness Scale and body mass index (BMI) were registered for all patients before and after surgery. Results: The mean of pre- and postoperative differences of apnoea-hypopnoea index values was higher in BRP group than ESP: 15.76 ± 14.5 Vs 10.13 ± 5.3; P <.05 and UPPP groups: 15.76 ± 14.5 vs 6.08 ± 5.5; P <.0005. The mean of differences of oxygen desaturation index values was higher in BRP group than UPPP group: 15.09 ± 17.6 vs 7.13 ± 6.8; P <.0005, but not significantly higher than ESP group: 15.09 ± 17.6 vs 6.48 ± 7.9; P >.05. The mean of differences of ESS values was higher in BRP group than ESP group: 5.52 ± 4.1 vs 4.84 ± 3.3; P <.005 and UPPP groups: 5.52 ± 4.1 vs 1.36 ± 1.9; P <.005. Finally, the pre- and postoperative means of differences of lowest oxygen saturation values were not statistically significant among the three groups (P >.05). Conclusion: Barbed reposition pharyngoplasty (BRP) can be considered an effective procedure on the basis of the postoperative outcomes. ESP still proves to be a good technique especially when performed by experienced surgeons. Both techniques proved to be superior to UPPP.