The authors have no funding, financial relationships, or conflicts of interest to disclose.
Lateral oropharyngeal wall and supraglottic airway collapse associated with failure in sleep apnea surgery†
Article first published online: 17 JAN 2012
Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 122, Issue 2, pages 473–479, February 2012
How to Cite
Soares, D., Sinawe, H., Folbe, A. J., Yoo, G., Badr, S., Rowley, J. A. and Lin, H.-S. (2012), Lateral oropharyngeal wall and supraglottic airway collapse associated with failure in sleep apnea surgery. The Laryngoscope, 122: 473–479. doi: 10.1002/lary.22474
- Issue published online: 23 JAN 2012
- Article first published online: 17 JAN 2012
- Manuscript Accepted: 28 OCT 2011
- Manuscript Revised: 27 OCT 2011
- Manuscript Received: 28 AUG 2011
- Lateral oropharyngeal wall collapse;
- supraglottic collapse;
- obstructive sleep apnea-hypopnea syndrome;
- surgical failure;
- Level of Evidence: 4
To identify patterns of airway collapse during preoperative drug-induced sleep endoscopy (DISE) as predictors of surgical failure following multilevel airway surgery for patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).
Retrospective clinical chart review.
Medical records of patients who underwent site-specific surgical modification of the upper airway for treatment of OSHAS were reviewed. Patients were included in this study if they had a preoperative airway evaluation with DISE as well as preoperative and postoperative polysomnography. Airway obstruction on DISE was described according to airway level, severity, and axis of collapse. Severe airway obstruction was defined as >75% collapse on endoscopy. Surgical success was described as a postoperative apnea-hypopnea index (AHI) of <20 and a >50% decrease in preoperative AHI.
A total of 34 patients were included in this study. The overall surgical success rate was 56%. Surgical success (n = 19) and surgical failure (n = 15) patients were similar with regard to age, gender, body mass index, preoperative AHI, Friedman stage, adenotonsillar grades, and surgical management. DISE findings in the surgical failure group demonstrated greater incidence of severe lateral oropharyngeal wall collapse (73.3% vs. 36.8%, P = .037) and severe supraglottic collapse (93.3% vs. 63.2%, P = .046) as compared to the surgical success group.
The presence of severe lateral pharyngeal wall and/or supraglottic collapse on preoperative DISE is associated with OSAHS surgical failure. The identification of this failure-prone collapse pattern may be useful in preoperative patient counseling as well as in directing an individualized and customized approach to the treatment of OSHAS.