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CC BY-NC-ND 4.0 · Sleep Sci 2023; 16(04): e389-e398
DOI: 10.1055/s-0043-1776744
Original Article

The Impact of Clinical and Craniofacial Changes on the Surgical Outcomes of Lateral Pharyngoplasty in the Treatment of Obstructive Sleep Apnea

Nelson Solcia-Filho 
1   Clínica de Otorrinolaringologia e Cirurgia BucoMaxilo Facial, Campinas, SP, Brazil
,
Bruno Bernardo Duarte
2   Serviço de Otorrinolaringologia, Hospital PUC-Campinas, Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil
3   Faculdade de Medicina, Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil
,
Aurélio Rochael Almeida
4   Faculdade de Medicina, São Leopoldo Mandic, Campinas, São Paulo, Brazil
,
José Luis Braga de Aquino
5   Programa de Pós-Graduação em Ciências da Saúde, Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil
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Abstract

Objective To verify if maxillomandibular retrusion, obesity, and increased neck circumference are factors of worse surgical prognosis for lateral pharyngoplasty in apneic patients.

Materials and Methods We evaluated 53 patients with obstructive sleep apnea who underwent lateral pharyngoplasty. Clinical evaluation was performed before the surgical procedure and included the measurement of body mass index (BMI) in kg/m2, neck circumference in centimeters, and a clinical evaluation of the facial profile obtained through the natural position of the oriented head. The polysomnographic evaluation was performed with at a minimum of 6 months after surgery, and polysomnographic results were correlated with the preoperative clinical data.

Results The mean age of the patients was 38.8 years; the mean BMI was of 29.28kg/m2, and 84.9% of the sample was composed of men and 15.1% of women. There was a significant reduction in the mean value of the main respiratory parameters verified by polysomnography, such as apnea-hypopnea index (AHI) from 31.60 events per hour to 8.15 (p < 0.001); NadirO2 went from 81% to 85% (p = 0.002) and mean oxyhemoglobin saturation from 94% to 95% (p = 0.024). It was also observed that the greater the maxillomandibular retrusion, the lower the mean reduction of the AHI after surgery. The increase in neck circumference proved to be a factor associated with the surgical outcome, and for each 1-cm decrease in the neck circumference, the chance of surgical success increased 1.2-fold.

Conclusion Lateral pharyngoplasty is an efficient surgical obstructive sleep apnea treatment. The lower the neck circumference measurement, the greater the chances of surgical success, and clinically evaluated maxillomandibular retrusion can reduce the magnitude of improvement in respiratory parameters after lateral pharyngoplasty in apneic patients.

Keywords

craniofacial abnormalities - obstructive sleep apnea - cephalometry - polysomnography

Contributions of the Authors

All authors contributed to the manuscript writing and revision. All authors approved the final version. The corresponding author attests that all listed authors meet authorship criteria.




Publication History

Received: 29 August 2022

Accepted: 25 January 2023

Article published online:
22 November 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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