Barbed suspension pharyngoplasty for treatment of lateral pharyngeal wall and palatal collapse in patients affected by OSAHS

• Published in: European archives of oto-rhino-laryngology 2019-06, Vol.276 (6), p.1829-1835
• Main Authors: Barbieri, Marco, Missale, Francesco, Incandela, Fabiola, Fragale, Marco, Barbieri, Andrea, Roustan, Valeria, Canevari, Frank Rikki, Peretti, Giorgio
• Format: Article
• Language: English
• Subjects: Adult; Female; Head and Neck Surgery; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Miscellaneous; Neurosurgery; Oropharynx - surgery; Otorhinolaryngologic Surgical Procedures; Otorhinolaryngology; Palate, Soft - surgery; Pharynx - surgery; Polysomnography; Reconstructive Surgical Procedures; Sleep Apnea, Obstructive - surgery; Surveys and Questionnaires; Suture Techniques; Sutures; Treatment Outcome; Young Adult
• ISSN: 0937-4477; 1434-4726
• DOI: 10.1007/s00405-019-05426-4

Purpose The aim of this study is to analyze the efficacy of a new modified pharyngoplasty technique with barbed sutures: barbed suspension pharyngoplasty (BSP). Methods We enrolled patients affected by obstructive sleep apnea–hypopnea syndrome (OSAHS), having the main site of obstruction at the palatal and lateral pharyngeal walls, who refused or failed to tolerate CPAP therapy and underwent non-resective pharyngoplasty with barbed sutures between January 2014 and October 2017. Two surgical techniques with barbed sutures were used: barbed reposition pharyngoplasty (BRP) and BSP; the main characteristics of the latter are a double passage of the needle, each side, through the soft palate. Results Forty-two patients met the study inclusion criteria and were included in the analysis. Twenty-two patients underwent BRP and 20 BSP. Patients treated with both BRP and BSP achieved significant improvement in polysomnographic parameters: AHI, ODI, t90%, and daily sleepiness tested by the ESS questionnaire ( p   0.05). Outcomes were also comparable ( p  = 0.10) in the two groups; patients who underwent BSP had successful treatment in 100% of cases, compared to 86% with BRP, with a cure rate of 40% vs. 18%. Conclusions BSP is a novel surgical technique that is effective in treating oropharyngeal collapse and can be tailored for patients with high collapsibility of the soft palate who might benefit from the palatal stiffness given by multiple passages of the suture inside it.