Lugo-Saldaña R, Moreno-Sales R, Hidalgo-Venegas M, González-Lara CT, Alcas-Arce O, Osorio-Anaya S

Language: Spanish
References: 0
Page: 20-27
PDF size: 129.34 Kb.

ABSTRACT

Background: Uvulopalatopharyngoplasty (UPPP) is the most common sleep surgery performed in Otorhinolaryngology, despite being the first technique proposed more than 50 years ago by Ikematsu and popularized by Fujita in the early 1980’s decade. This technique is only ideal in patients with a pattern of pure antero-posterior obstruction. With new preoperative assessment techniques, such as upper airway endoscopy under drug-induced sleep (DISE), it is possible to determine obstructive sites to select the appropriate surgical technique.
Objetive: To describe the obstructive patterns in patients not tolerant to CPAP and to identify the current techniques in sleep surgery according to this one.
Material and Method: A prospective study was done including patients with obstructive sleep apnea-hypopnea syndrome with sleep study type I, II or III, adaptation and titration of respiratory therapy at nocturnal positive pressure attended from 2009 to 2016. Patients were staged and scheduled endoscopy under induced sleep, observing the patterns and levels of obstruction in the upper airway, VOTE classification was used as a method of data collection and a method of classification modified by the authors.
Results: Four types of palatopharyngeal obstruction were identified, two at the base of the tongue and two at the epiglottic level, according to the current literature that mentions the role of the lateral pharyngeal wall in obstruction and collapse of the upper airway, dropping of the tongue base, lingual tonsils and epiglottis in the multifactorial collapse of patients with sleep and snoring respiratory disorders.
Conclusion: Identifying the level and characteristics of the obstruction supports the selection of the surgical technique, a fundamental aspect for the postoperative success of patients with obstruction and collapse of the upper airway. The role of the uvula and soft palate is minimal, causal of the high recurrence of obstructive symptoms in UPP techniques and uvulectomy.