DOI QR코드

DOI QR Code

The treatment of obstructive sleep apnea patient using extended uvulopalatal flap: a case report

폐쇄성 수면무호흡환자에서 확대 구개수구개피판을 이용한 치험례

  • Kim, Ji-Youn (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Kim, Soung-Min (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Myoung, Hoon (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Hwang, Soon-Jung (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Seo, Byoung-Moo (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Lee, Jong-Ho (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Choung, Pill-Hoon (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Kim, Myung-Jin (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Choi, Jin-Young (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University)
  • 김지연 (서울대학교 치과대학 구강악안면외과학교실) ;
  • 김성민 (서울대학교 치과대학 구강악안면외과학교실) ;
  • 명훈 (서울대학교 치과대학 구강악안면외과학교실) ;
  • 황순정 (서울대학교 치과대학 구강악안면외과학교실) ;
  • 서병무 (서울대학교 치과대학 구강악안면외과학교실) ;
  • 이종호 (서울대학교 치과대학 구강악안면외과학교실) ;
  • 정필훈 (서울대학교 치과대학 구강악안면외과학교실) ;
  • 김명진 (서울대학교 치과대학 구강악안면외과학교실) ;
  • 최진영 (서울대학교 치과대학 구강악안면외과학교실)
  • Received : 2010.09.28
  • Accepted : 2011.01.12
  • Published : 2011.02.28

Abstract

The uvulopalatal flap (UPF) technique is a modification of uvulopalatopharyngoplasty (UPPP) for the surgical treatment of obstructive sleep apnea. In the UPF technique, an uvulopalatal flap is fabricated and sutured to the residual mucosa of the soft palate to expand the antero-posterior dimensions of the oropharyngeal inlet. In the extended uvulopalatal flap (EUPF) technique, an incision at the tonsillar fossa is added to the classical UPF technique followed by the removal of mucosa and submucosal adipose tissue for additional expansion of the lateral dimension. The EUPF technique is more conservative and reversible than UPPP. Therefore, complications, such as velopharyngeal insufficiency, dysphagia, dryness, nasopharyngeal stenosis and postoperative pain, are reduced. In the following case report, the patient was diagnosed with obstructive sleep apnea and treated with the EUPF technique. The patient's total respiratory disturbance events per hour (RDI) was decreased to 15.4, the $O_2$ saturation during the sleep was increased, and the excessive daytime sleepiness had disappeared after the surgery without complications. The authors report this case with a review of the relevant literature.

Keywords

References

  1. Won CH, Li KK, Guilleminault C. Surgical treatment of obstructive sleep apnea: upper airway and maxillomandibular surgery. Proc Am Thorac Soc 2008;5:193-9. https://doi.org/10.1513/pats.200708-121MG
  2. Cho KS. Surgical management for obstructive sleep apnea. J Clin Otolaryngol 2008;19:168-76.
  3. Rhee CS, Han DH. Surgical management of sleep-disordered breathing. Tuberc Respir Dis 2009;66:417-30. https://doi.org/10.4046/trd.2009.66.6.417
  4. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230-5. https://doi.org/10.1056/NEJM199304293281704
  5. Huang SG, Li QY; Sleep Respiratory Disorder Study Group Respiratory Disease Branch Shanghai Medical Association. Prevalence of obstructive sleep apnea-hypopnea syndrome in Chinese adults aged over 30 yr in Shanghai. Zhonghua Jie He He Hu Xi Za Zhi 2003;26:268-72.
  6. Grote L, Hedner J, Grunstein R, Kraiczi H. Therapy with nCPAP: incomplete elimination of sleep related breathing disorder. Eur Respir J 2000;16:921-7. https://doi.org/10.1183/09031936.00.16592100
  7. Fujita S, Conway W, Zorick F, Roth T. Surgical correction of anatomic azbnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 1981; 89:923-34. https://doi.org/10.1177/019459988108900609
  8. Walker-Engstrom ML, Tegelberg A, Wilhelmsson B, Ringqvist I. 4-year follow-up of treatment with dental appliance or uvulopalatopharyngoplasty in patients with obstructive sleep apnea: a randomized study. Chest 2002;121:739-46. https://doi.org/10.1378/chest.121.3.739
  9. Lee YK, Myung H, Hwang SJ, Seo BM, Lee JH, Choung PH, et al. Clinical study of surgical treatments for snoring and obstructive sleep apnea. J Korean Assoc Oral Maxillofac Surg 2008;34:435-44.
  10. Fairbanks DN. Uvulopalatopharyngoplasty complications and avoidance strategies. Otolaryngol Head Neck Surg 1990;102:239-45. https://doi.org/10.1177/019459989010200306
  11. Haavisto L, Suonpaa J. Complications of uvulopalatopharyngoplasty. Clin Otolaryngol Allied Sci 1994;19:243-7. https://doi.org/10.1111/j.1365-2273.1994.tb01224.x
  12. HY, Chen NH, Shu YH, Wang PC. Changes in quality of life and respiratory disturbance after extended uvulopalatal flap surgery in patients with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 2004;130:195-200. https://doi.org/10.1001/archotol.130.2.195
  13. Powell N, Riley R, Guilleminault C, Troell R. A reversible uvulopalatal flap for snoring and sleep apnea syndrome. Sleep 1996;19:593-9. https://doi.org/10.1093/sleep/19.7.593
  14. Li HY, Li KK, Chen NH, Wang PC. Modified uvulopalatopharyngoplasty: the extended uvulopalatal flap. Am J Otolaryngol 2003;24:311-6. https://doi.org/10.1016/S0196-0709(03)00047-4
  15. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991;14:540-5. https://doi.org/10.1093/sleep/14.6.540
  16. Friedman M, Ibrahim H, Joseph NJ. Staging of obstructive sleep apnea/hypopnea syndrome: a guide to appropriate treatment. Laryngoscope 2004;114:454-9. https://doi.org/10.1097/00005537-200403000-00013
  17. Kim JH. Sleep apnea. In: Korean Society of Otorhinolayngology- Head and Neck Surgery, ed. Otorhinolaryngology-Head and Neck Surgery. 1st ed. Seoul: Ilchokak; 2002:1103-14.
  18. Li HY, Li KK, Chen NH, Wang CJ, Liao YF, Wang PC. Threedimensional computed tomography and polysomnography findings after extended uvulopalatal flap surgery for obstructive sleep apnea. Am J Otolaryngol 2005;26:7-11. https://doi.org/10.1016/j.amjoto.2004.06.006
  19. Kim SW. Eun YG. Surgical therapy for obstructive sleep apnea. J Clin Otolaryngol 2005;16:193-206.