DYNAMIC PHARYNGOSCOPY IN PREDICTING OUTCOME OF UVULOPALATOPHARYNGOPLASTY FOR MODERATE AND SEVERE OBSTRUCTIVE SLEEP-APNEA

Study objective: We sought to determine whether preoperative fiberoptic pharyngoscopy (FOP) with Muller's maneuver (dynamic FOP) could be used to establish a subgroup of obstructive sleep apnea (OSA) patients with better outcome after uvulopalatopharyngoplasty (UPPP). Design: Retrospective review of an observational cohort. Setting: Tertiary care referral center. Patients: Twenty-nine patients who underwent UPPP and nasopharyngeal surgery by one surgeon. Intervention: The patients were divided into two groups based on the findings of preoperative dynamic FOP: group 1 (11 patients) had collapse of the velopharynx and the base of the tongue-epiglottis-hypopharynx (TEH) complex and group 2 (18 patients) had velopharyngeal collapse only. Measurements and results: Surgical success was defined using a conventional definition (>50% reduction in the apnea-plus-hypopnea index [OAHI]), and a criterion for cure (>90% reduction in OAHI and postoperative OAHI <15). Both groups had a significant improvement in their OAHI. The success rate was significantly higher in patients with velopharyngeal collapse only compared with patients with additional collapse of the TEH complex (78 vs 36% with the conventional definition, and 50 vs 9% using the definition for cure, respectively). Predictive value of dynamic FOP in predicting cure failure when collapse of the TEH complex was present was 91%. Conclusions: Dynamic FOP may help establish a subgroup of OSA patients with greater likelihood of successful UPPP. The high negative predictive value of dynamic FOP when a criterion for cure is used suggests that this maneuver could best be used to exclude patients with TEH complex collapse from UPPP.