HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Palatal Procedures for Obstructive Sleep Apnea

Friedman and colleagues 25 performed a prospective randomized study whereby pa- tients received implants or a placebo. The pillar palatal treatment group’s AHI signifi- cantly improved compared with the placebo group (7.9 7.7 vs 0.9 4.3). A different study randomized 100 patients to palatal implants or placebo. A success ratemeasured by a 50% decrease and less than 20 AHI occurred in the implant group compared with the sham group (26%vs 10%, P 5 .05). 26 Both studies were performed with 3 implants, but the manufacturer currently recommends the use of 5 implants for treatment. The implants were done in the outpatient clinic setting. After rinsing the mouth with antiseptic oral rinse, local anesthetic was injected into the soft palate in the midline and adjacent left and right areas. Three pillar palate implants were injected, using the supplied handpiece, in the midline at the junction of the hard palate and soft palate and the paramedian left and right positions in a parallel manner. Fig. 8. ( A ) Radiofrequency treatment shows placement of the handpiece after local anes- thetic is injected. ( B ) Lateral view of treatment procedure depicting placement of the elec- trode tip into the submucosal soft palate. The palate creates a lesion that is within the submucosal rather than mucosal tissue. ( From Coleman, S, Smith T. Midline radiofrequency tissue reduction of the palate for bothersome snoring and sleep-disordered breathing; a clinical trial. Otolaryngol Head Neck Surg 2000;122:388; with permission.) In reviewing the literature for this article, some articles on modified uvulopalatophar- yngoplasty can best be described as variations on a theme; there were more than could be included in this article. Terms such as EUPF , lateral inversion flap , snare uvu- lopalatoplasty , and resection of the musculus uvulae , to name just a few, were proced- ures that were published for the treatment of obstructive sleep apnea. On behalf of the American Academy of Sleep Medicine Standards of Practice, Caples and colleagues 27 conducted a systematic review and meta-analysis of the literature reporting outcomes for surgical treatment of obstructive sleep apnea. This review led to the conclusion that “most of the data are drawn from small case series of selected patients, in whom there were varied preoperative and surgical ap- proaches. There were few controlled trials and varying approaches to pre-operative and post-operative follow up with inconsistent decreases in AHI.” 27 VARIATION ON A THEME

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