Single-Stage Drug-Induced Sleep Endoscopy, Nasal Surgery and Modified Barbed Soft Palatal Posterior Pillar Flap Palatopharyngoplasty for Treatment of Obstructive Sleep Apnea

Abstract

This article reports a case of isolated left sphenoid sinusitis with the presentation of cavernous sinus thrombosis as a complication in a 60 years old diabetic female, we present the case history, significant physical findings, radiological investigations and discuss relevant anatomy, pathogenesis, diagnostic evaluation and treatment. Abstract Objective: To investigate the overall efficacy of a single-stage surgical procedure based on localizing the site of anatomic obstruction with simultaneous combined nasal-palatopharyngeal surgery for the treatment of OSA. Methods: A total of 35 consecutive OSA patients were enrolled in the study. All patients had OSA, were type I Fujita classification, stage 1 or 2 Friedman classification and had nasal septal deviation and inferior turbinate hypertrophy. Intraoperative drug-induced sleep endoscopy (DISE) was performed in all patients. Modified barbed palatopharyngoplasty with septoplasty and reduction of the size of inferior turbinate were used to correct the upper airway abnormalities. Baseline and 6 months postoperative overnight portable polysomnography was performed. Surgical results (Subjective symptoms improvement, reduction of OSA), patient satisfaction, complications were recorded. Surgical success was defined as a reduction of at least 50% in the preoperative apnea-hypopnea index (AHI) and a final AHI of less than 20 per hour. Results: The Surgical success was 89% (31/35) of patients, 26 males, and 9 females. Snoring was improved with a snoring scale reduced from 9.4±2.8 to 1.07±0.3 (p<0.0001). The nasal blockage was improved with the nasal Obstruction Visual Analog Scale from 8.6±1.3 to 0.57±0.2 (p<0.0001). The Epworth Sleepiness score (ESS) was decreased from 8.9±1.3 to 1.11±0.2(p< 0.0001). The pre-operative to post-operative AHI statistically improved from 38.4±23.3 to 12.3±21.1 (p <0.0001) and lowest O2 saturation from 73.9±12.6% to 87.8±9.4%(p<0.001). There were no significant complications. All patients were satisfied with the single-stage treatment. Conclusion: Our data indicate that Single-staged modified barbed soft palatal posterior pillar flap palatopharyngoplasty with nasal surgery is a safe, effective. It has the potential to serve as an effective alternative for the staged surgery without adding to the cost-effectiveness in terms of total hospitalization.