The Many Flavors of Palate Surgery Which One is Best? Edward M. - - PowerPoint PPT Presentation

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The Many Flavors of Palate Surgery Which One is Best? Edward M. - - PowerPoint PPT Presentation

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The Many Flavors of Palate Surgery Which One is Best? Edward M. Weaver, MD, MPH University of Washington Harborview Medical Center Seattle VA Medical Center Acknowledgments This material is the result of work supported in part by the

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The Many Flavors of Palate Surgery – Which One is Best?

Edward M. Weaver, MD, MPH

University of Washington Harborview Medical Center Seattle VA Medical Center

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Acknowledgments

  • This material is the result of work supported in part by

the U.S. Department of Veterans Affairs, Office of Research & Development, Clinical R&D Program.

  • Dr. Weaver is a staff physician, surgery service line,

Department of Veterans Affairs Medical Center, Seattle, Washington.

  • Grants:

– VA Epidemiologic Research & Information Center Pilot Study Grants (Weaver) – American Geriatrics Society Jahnigan Award funded by the John A. Hartford Foundation of NYC and Atlantic Philanthropies (Weaver) – NIH K23 HL068849 (Weaver)

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Disclosures

  • No industry disclosures
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Outline

  • General UPPP outcomes
  • Modern UPPP concepts

– Reconstructive – Anatomic – Functional

  • UPPP Flavors
  • Best Flavor!
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UPPP & Physiology

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Sher, Sleep 1996;19:156-177

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UPPP: Physiology

Adapted from Table 7 Sher, Sleep 1996;19:156-177 Level 4

75 33 25 20 40 60 80 100

AI RDI LSAT

Palate Obstruction

Improvement (%)

AHI

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UPPP & Quantity of Life (Survival)

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Weaver, Sleep 2004;27:A208

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Weaver, Sleep 2004;27:A208 Level 2

UPPP No Tx Survival No Tx = 116,678 UPPP = 3,977

UPPP: Quantity of Life

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UPPP & Quality of Life

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Weaver, OtoHNS 2011;144:623-31

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*p<0.001

14.3 17.2 17.5 5.0 10.0 15.0 20.0

0 mos 3 mos 6 mos FOSQ Score Time from UPPP

* *

Weaver, OtoHNS 2011;144:623-31

UPPP: Quality of Life

Level 4

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Weaver, OtoHNS 2011;144:623-31

UPPP: Symptoms

Level 4

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UPPP & Side Effect (CPAP Leak)

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Han, Sleep Breath 2006;10:37-42

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Han, Sleep Breath 2006;10:37-42

  • Classical UPPP = Excisional
  • Modified UPPP = Uvula-sparing
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Classical Modified UPPP UPPP p

(N=24) (N=7)

Severe Oral 5/24 0/7 NS Leak

Han, Sleep Breath 2006;10:37-42

Level 4

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UPPP Modifications

  • Reduce side effects

– Preserve function

  • Improve outcomes

– Address specific anatomical or functional problem

  • Multiple modifications

– Reconstructive rather than excisional

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UPPP Concepts

  • Open & stabilize all dimensions
  • f velopharynx & oropharynx
  • Address anatomy
  • Preserve function
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Normal Oral Exam

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Sample of UPPP Flavors

  • Lateral Pharyngoplasty
  • Expansion Sphincter Pharyngoplasty
  • Palatal Advancement Pharyngoplasty
  • Modified Australian UPPP
  • Relocation Pharyngoplasty
  • Suspension Palatoplasty
  • Uvulopalatal Flap
  • Z-Palatoplasty
  • Barbed Suture Palatopharyngoplasty
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Sample of UPPP Flavors

  • Lateral Pharyngoplasty
  • Expansion Sphincter Pharyngoplasty
  • Palatal Advancement Pharyngoplasty
  • Modified Australian UPPP
  • Relocation Pharyngoplasty
  • Suspension Palatoplasty
  • Uvulopalatal Flap
  • Z-Palatoplasty
  • Barbed Suture Palatopharyngoplasty
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Lateral Pharyngoplasty

Cahali, Sleep 2004;27:942-50

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UPPP vs. Lateral PP

Adapted from Tables 3 & 4

AHI 14% AHI 62% LSAT 9% LSAT 9% Delta% 25% Delta% 60% REM% 15% REM% 27%

0% 10% 20% 30% 40% 50% 60% 70% 80%

UPPP (N=12) Lateral PP (N=15) % Improvement

Level 1 Cahali, Sleep 2004;27:942-50

N3% N3%

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Thick Lateral Musculature

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Expansion Sphincter PP

Pang, OtoHNS 2007;137:110-4

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UPPP vs. ESP

Baseline, 38 Baseline, 44 Final, 20 Final, 12

5 10 15 20 25 30 35 40 45 50

UPPP (N=22) ESP (N=23) AHI

Level 1 Pang, OtoHNS 2007;137:110-4

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Lateral narrowing

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ESP post-op 4 mos

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Why Expansion Sphincter Pharyngoplasty?

  • Stabilized lateral collapse
  • Opens AP dimension
  • Can be combined with other tech
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Velopharynx Narrow AP

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Velopharynx Narrow AP

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Palatal Advancement

Woodson, OtoHNS 2005;133:211-17

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UPPP vs. Palatal Adv

Baseline 48 Baseline 48 Final 31 Final 20 Change 17 Change 29

10 20 30 40 50 60

UPPP (N=44) Pal Adv (N=30) AHI

Level 2 Adapted from Table 3 Woodson, OtoHNS 2005;133:211-17

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Retropalatal Airspace

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Why Palatal Advancement?

  • Anterior reposition
  • Can be combined with other flavors
  • Salvage palate procedure
  • Well tolerated

– Less invasive than maxillary advancement

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Best UPPP Flavor?

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Best UPPP Flavor?

  • It depends!!

– Anatomy – Pattern of obstruction – Goals – Surgeon – . . .

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What UPPP Do I Use?

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Why?

  • Opens and stabilizes airway

– Anterior-posterior (VP) – Lateral (VP, OP, HP) – Superior-inferior (uvula, lateral palate)

  • Minimizes morbidity

– Uvula / VPI – Palatal scar

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UPPP Summary

  • UPPP helps OSA
  • Modern UPPP

– Reconstructive – Anatomic – Functional

  • Many UPPP flavors
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The Many Flavors of Palate Surgery – Which One is Best?

REFERENCES Sher AE, Schechtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 1996;19(2):156-77. Weaver EM, Maynard C, Yueh B. Mortality of veterans with sleep apnea: untreated versus treated. Sleep 2004;27:A208 (Abstract). Weaver EM, Woodson BT, Yueh B, Smith T, Stewart MG, Hannley M, Schulz K, Patel MM, Witsell D. Studying life effects & effectiveness of palatopharyngoplasty (SLEEP) study: Subjective outcomes of isolated uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 2011;144(4):623-31. Han F, Song W, Li J, Zhang L, Dong X, He Q. Influence of UPPP surgery on tolerance to subsequent continuous positive airway pressure in patients with OSAHS. Sleep & Breathing 2006;10:37-42. Cahali MB, Formigoni GGS, Gebrim EMMS, Miziara ID. Lateral pharyngoplasty versus uvulopalatopharyngoplasty: a clinical, polysomnographic and computed tomography measurement comparison. Sleep 2004;27:942-50. Pang KP, Woodson BT. Expansion sphincter pharyngoplasty: a new technique for the treatment of obstructive sleep

  • apnea. Otolaryngol Head Neck Surg 2007;137:110-4.

Woodson BT, Robinson S, Lim HJ. Transpalatal advancement pharyngoplasty outcomes compared with

  • uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 2005;133:211-.

MacKay SG, Carney AS, Woods C, Antic N, McEvoy RD, Chia M, Sands T, Jones A, Hobson J, Robinson S. Modified uvulopalatopharyngoplasty and coblation channeling of the tongue for obstructive sleep apnea: a multi-centre Australian

  • trial. J Clin Sleep Med 2013;9:117-24.