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Sleep Medicine

Palatoplasty: Modern Techniques, Historical Perspectives, and Its Use With Neurostimulation

Wednesday, October 4, 2023
8:00 AM - 9:00 AM East Coast USA Time
Location: 103A

    Panelist(s)

  • Colin T. Huntley, MD

    Associate Professor
    Thomas Jefferson University
    Philadelphia, Pennsylvania, United States

    • Moderator(s)

  • Maurits S. Boon, MD

    Professor
    Thomas Jefferson University
    Philadelphia, Pennsylvania, United States

    • Panelist(s)

  • Maurits S. Boon, MD

    Professor
    Thomas Jefferson University
    Philadelphia, Pennsylvania, United States

  • DK

    David T. Kent, MD

    Assistant Professor, Department of Otolaryngology - Head and Neck Surgery
    Vanderbilt University Medical Center
    Nashville, TN, United States

  • Clemens Heiser, MD, PhD

    Professor and ENT, Head and Neck Surgeon
    Technical University of Munich
    Munich, Bayern, Germany

Disclosure(s):
Maurits S. Boon, MD: No relevant relationships to disclose.
David T. Kent, MD: No relevant relationships to disclose.
Clemens Heiser, MD, PhD: No relevant relationships to disclose.
PROGRAM DESCRIPTION: Obstructive sleep apnea (OSA) is a disease impacting up to 20% of our population. It causes significant issues with a patient’s quality of life and confers increased risk of cardiovascular comorbidities. Positive airway pressure (PAP) is a typical initial treatment option for the management of OSA. However, many patients struggle with compliance with this intervention.

Motivated by the tremendous number of patients struggling with PAP therapy, alternative treatment options have been developed. The original derivation of the uvulopalatopharyngoplasty (UPPP) was described by Fujita in 1981. This was a huge advance in management of OSA as it offered an alternative to many patients and spurred the development of other management strategies. However, the traditional UPPP was plagued by limited effectiveness and unwanted surgical side effects.

Since the development of the UPPP, newer techniques have been created to address soft tissue collapse at the level of the velum and lateral oropharyngeal walls. These include expansion sphincter pharyngoplasty, lateral pharyngoplasty, barbed suture pharyngoplasty, among others. These techniques have shown improved efficacy over traditional UPPP and have been used in conjunction with upper airway stimulation (UAS) to optimize patient candidacy or improve outcomes in non-responders to stimulation therapy. UAS is a treatment option for select patients with OSA that selectively stimulates the medial branches of the hypoglossal nerve which innervate the genioglossus muscle, leading to tongue contraction and protrusion.

The goals of the session are to utilize brief lecture and case-based discussions to highlight advanced palatopharyngoplasty techniques. We will discuss the physical exam and diagnostic criterial used to select specific procedures and the steps involved in performing these procedures. We will also discuss the role of these techniques in converting patients with concentric collapse at the velum into candidates for UAS and their utility as a rescue procedure for those undergoing UAS with residual OSA.

OUTCOME OBJECTIVE 1: Understand the selection of various advanced palatopharyngoplasty techniques for management of obstructive sleep apnea and how they compare to traditional uvulopalatopharyngoplasty.

OUTCOME OBJECTIVE 2: Describe the steps involved in performing various advanced palatopharyngoplasty techniques for management of obstructive sleep apnea.

OUTCOME OBJECTIVE 3: Understand the use of various advanced palatopharyngoplasty techniques in converting patients to anatomic candidates for upper airway stimulation (UAS) and their role in optimizing UAS outcomes.

BACKGROUND STATEMENT: Obstructive sleep apnea plagues a large percentage of our population with many intolerant to positive airway pressure therapy. Newer surgical techniques have been developed since the advent of the UPPP that confer improved outcomes and lower rates of surgical side effect.