Hong Liang Yi

Genioglossus advancement and hyoid suspension plus uvulopalatopharyngoplasty for severe OSAHS

Objective To evaluate the outcome of a comprehensive surgical approach on the treatment of severe obstructive sleep apnea hypopnea syndrome (OSAHS) and find out possible predictors to the effectivenss of this approach. Study Design And Setting Eighteen patients received genioglossus advancement with hyoid suspension (GAHM) and uvulopalatopharyngoplasty (UPPP). The multiple logistic regression was used to analyze predictors for the outcome of treatment. Results Apnea hypopnea index (AHI) showed a reduction in the preoperative vs postoperative polysomnography (63.83 ± 16.34 vs 21.43 ± 20.34). With success defined as a final postoperative AHI of less than 20 events per hour, the success rate was 67%. The main differences between responders and nonresponders include age, posterior airway space (PAS), time of oxyhemoglobin saturation below 90% (CT90), and body mass index (BMI). Age and BMI were key predictors for therapeutic effect. Conclusion GAHM plus UPPP may benefit severe OSAHS patients with oropharyngeal and hypopharyngeal obstruction. The success was best predicted by low BMI and younger age. Significance This paper provides reference for patient selection of UPPP plus GAHM, and considers that older or morbidly obese patients with OSAHS should be excluded from this operation.

Anatomic and spiral computed tomographic study of the genial tubercles for genioglossus advancement.

Objective To measure and compare Chinese mandibulaö genial tubercles measured anatomically and with computed tomography (CT). Study Design And Setting Spiral CT scans were taken of 40 adult human skulls; the superior genial spines were measured using anatomic and CT methods. Results The height and width of the superior genial spines, mandible thickness, and distance from the menton to the inferior and superior margins of the superior genial spines were 5.82 ± 0.71, 6.98 ± 1.35, 11.95 ± 1.59, 11.08 ± 2.05, and 16.91 ± 2.30 mm from anatomic measurements and 6.17 ± 0.71, 7.01 ± 1.13, 12.19 ± 1.64, 10.41 ± 1.55, and 15.73 ± 2.12 mm using spiral CT, respectively. The anatomic and CT measurements were correlated. Conclusion Spiral CT of the genial tubercles can help locate the osteotomy in genioglossus advancement. Significance This study acquired reference data on Chinese genial tubercles demonstrating that CT measurements of the genial tubercles reflect their anatomy, which should allow accurately locate the osteotomy.

The Application of CT to Localize the Upper Airway Obstruction Plane in Patients with OSAHS

Objective To identify a correlation in terms of airway obstruction between awake and sleep apnea using spiral computed tomography (CT). Study Design Case series with planned data collection. Setting College medical center. Methods Sixty-one patients diagnosed with obstructive sleep apnea/hypopnea syndrome (OSAHS) underwent CT scans under 3 conditions: quiet breathing while awake, the end of deep inspiration during wakefulness, and apnea while asleep. The upper airway morphology under the 3 conditions was compared, and the accuracy of the obstructive planes as determined by CT scans under the 2 awake conditions was analyzed while considering the obstructive planes that occurred during apnea as a reference. Results The differences in the anteroposterior diameter, lateral dimension, and cross-sectional area of the retropalatal and retroglossal regions among the 3 states were statistically significant. Obstruction of the retropalatal region occurred in 100%, whereas retroglossal obstruction occurred in 44.3% of the 61 cases during sleep apnea. The coincidence rate between the awake quiet breathing and the sleep apnea was 85.2% in the retropalatal obstruction and 52.5% in the retroglossal obstruction. The coincidence rate between the awake deep inspiration and the sleep apnea was 82.0% in the retropalatal obstruction and 54.1% in the retroglossal obstruction. Conclusion The main obstructive plane in patients with OSAHS was the retropalatal region. An awake upper airway CT scan can properly diagnose palatopharyngeal obstruction; however, it is not suitable for detecting retroglossal obstruction.

Changes in facial appearance after maxillomandibular advancement for severe obstructive sleep apnoea hypopnoea syndrome in Chinese patients: a subjective and objective evaluation

This study evaluates the outcome and change in facial appearance after maxillomandibular advancement (MMA) in Chinese adults with severe obstructive sleep apnoea hypopnoea syndrome (OSAHS). Twelve patients underwent MMA with adjunctive procedures for severe OSAHS. All underwent physical examination, Epworth Sleepiness Scale evaluation, cephalometry, polysomnography, and facial photographic assessment before and 6 months after MMA. The aesthetic plane (relationship of nose, lips, and chin) was used to judge soft tissue facial profile change after MMA. Postoperative cephalometric data were compared with normal occlusive standards and aesthetic norms. Pre- and postoperative aesthetic appearance was evaluated by 100 lay people using a 10-point visual analogue scale. The maxillomandibular complex (MMC) was advanced 5-10 mm (mean 7.4 mm). The success rate was 83%. All patients were satisfied with the functional and aesthetic results. Postoperative SNA, SNB, and posterior airway space increased and mandibular plane-to-hyoid distance decreased significantly in all patients. The lower lip was closer to EP than the preoperative and normal occlusive standard. In 11 of 12 patients, the lay aesthetic scores were significantly higher postoperatively. MMA is effective for Chinese adults with severe OSAHS. In most patients, facial appearance was more attractive after MMC advancement of 5-10 mm.

Predictors of Surgical Outcomes of Uvulopalatopharyngoplasty for Obstructive Sleep Apnea Hypopnea Syndrome

Objectives. To investigate predictors of surgical outcomes of uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea hypopnea syndrome (OSAHS). Study Design. Case series with planned data collection. Setting. A university medical center. Subjects and Methods. Thirty-nine patients with OSAHS received Z-palatopharyngoplasty (ZPPP) or Han-uvulopalatopharyngoplasty (H-UPPP). All patients were evaluated within 3 months before surgery and at 6 to 12 months after surgery. Statistical analyses were conducted on preoperative parameters that could have affected surgical efficacy and outcome. Success was defined as an apnea–hypopnea index (AHI) fewer than 20 times per hour and a decrease of more than 50%. Results. The success rate was 56.4% (22/39 patients). There were statistically significant differences in AHI, lowest oxygen saturation (L-Sao2), time with oxygen saturation less than 90% (CT90), percentage of time with oxygen saturation less than 90% (CT90%), microarousal index (MI), apolipoprotein E (ApoE), high-density lipoprotein (HDL), fasting blood glucose (FBG), and Friedman OSA stage between the treatment success and failure groups. Higher success rate was predicted by lower severity, as indicated by lower AHI, CT90, CT90%, and MI; higher L-Sao2; and fewer glucose and lipid metabolism abnormalities, shown by lower ApoE and FBG and higher HDL. Conclusions. Disease severity, glucose and lipid metabolism, and Friedman OSA stage may be important predictors of surgical outcome of UPPP for OSAHS.

Z-Palatopharyngoplasty Plus Genioglossus Advancement and Hyoid Suspension for Obstructive Sleep Apnea Hypopnea Syndrome

Objective. To explore the feasibility and efficiency of Z-palato-pharyngoplasty (ZPPP) plus genioglossus advancement and hyoid suspension (GAHM) for severe obstructive sleep apnea hypopnea syndrome (OSAHS). Study Design. Case series with planned data collection. Setting. A university medical center. Subjects and Methods. Twenty-six patients who had OSAHS with Friedman obstructive sleep apnea stage II/III and posterior airway space <11 mm received GAHM and ZPPP. All patients were reevaluated 6 months after surgery using the preoperative methods. Results. Based on success criteria, defined as an apnea-hypopnea index (AHI) of <20 and a decrease >50%, the success rate was 46.2% at 6 months postoperatively. The AHI showed a significant reduction from 65.6 ± 17.6 preoperatively to 30.1 ± 23.1 postoperatively. The percentage of time with oxyhemoglobin saturation below 90% (CT90) decreased from 30.9% ± 28.1% preoperatively to 15.5% ± 25.6% postoperatively (P < .01). Sleep architecture was effectively changed. The S3 + S4 percentage of total sleep time increased from 3.6% ± 4.4% to 8.7% ± 5.0% (P < .05). The success rates were 100% (8/8) and 22.2% (4/18) in patients with Friedman obstructive sleep apnea stage II and III, respectively. Conclusion. The success rate of ZPPP plus GAHM for patients with severe OSAHS who suffer from oropharyngeal and hypopharyngeal obstruction was limited. Friedman stage was a predictor of ZPPP plus GAHM surgical success.

Primary maxillomandibular advancement with concomitant revised uvulopalatopharyngoplasty with uvula preservation for severe obstructive sleep apnea-hypopnea syndrome.

Background This study aimed to evaluate the efficacy and safety of primary maxillomandibular advancement (MMA) with concomitant adjunctive revised uvulopalatopharyngoplasty with uvula preservation (H-UPPP) in selected patients with severe obstructive sleep apnea-hypopnea syndrome (OSASH). Methods Eleven consecutive male patients with velo-orohypopharyngeal and hypopharyngeal narrowing underwent MMA with concomitant H-UPPP for severe OSAHS. All patients underwent a physical examination, Epworth Sleepiness Scale evaluation, cephalometry, nocturnal polysomnogram, and velopharyngeal insufficiency questionnaire survey before and at 6 to 12 months after surgery. Results On the basis of the success criteria, defined as an apnea-hypopnea index less than 20 and a decrease greater than 50%, the success rate was 91%. The apnea-hypopnea index decreased from 67.44 (13.30) to 9.41 (7.20) events per hour (P < 0.001) and the lowest oxygen saturation increased from 63.0% (10.70%) to 88.55% (4.59%) (P < 0.001) after surgery. All patients showed a significant decrease in mandibular plane to hyoid bone and increase in PAS after surgery. One patient reported regurgitation of liquids when drinking hastily after surgery. Two patients reported regurgitation as occasional occurrences. Half a year later, 2 patients reported complete resolution of the symptoms. One patient still complained of rare regurgitation of liquids when drinking quickly. Five patients had paresthesia of the lower lip; in 4 patients, the paresthesia had resolved by 12 months after surgery. One patient still complained of paresthesia of the lower lip after 2 years of follow-up. No major complication (eg, upper airway obstruction) occurred. Conclusions Primary MMA with concomitant adjunctive H-UPPP is effective in selected patients with severe OSAHS without major complications.

Anatomic and Computed Tomographic Study of Genial Tubercles for Genioglossus Advancement

Problem: To acquire anatomic and computed tomographic measurements of Chinese mandibular genial tubercles and to evaluate the correlations between them. Methods: The horizontal computed tomographic images were taken by CT scanning with a 1 mm thick section from infraorbital margin to menton in 40 adult human skulls. Sagittal plane reconstruction was produced through the mandibular central line in the horizontal images. Then the height and width of genial tubercles, the distance between menton and inferior margin of genial tubercles, the distance between the mandibular incisor apex and superior margin of genial tubercles, and the thickness of the mandible were measured respectively. Thereafter anatomic measurements corresponding to the computed tomographic images were taken. Finally, a paired-samples t test was made via SPSS 12.0. Results: The height and width of genial tubercles, the distance between menton and inferior margin of genial tubercles, the distance between the mandibular incisor apex and the superior margin of the genial tubercles, the thickness of mandibles in the anatomic measurements were 6.28 ± 0.90 mm, 7.08 ± 1.40 mm, 10.34 ± 1.49 mm, 14.22 ± 3.45 mm, and 11.79 ± 1.81 mm, respectively, while they were 6.24 ± 0.79 mm, 7.10 ± 1.22 mm, 8.35 ± 1.45 mm, 12.24 ± 3.88 mm, and 12.14 ± 1.87 mm in the computed tomographic measurements. The correlation coefficients between anatomic measurements and computed tomographic measurements of the above-mentioned measuring parameters were 0.68 (P 0.05), 0.48 (P < 0.05), and 0.55 (P < 0.05), respectively. Conclusion: The anatomic and computed tomographic measurements of genial tubercles appear to have significant correlations. Preoperative computed tomographic measurements of genial tubercles can offer a beneficial reference for the intraoperative exact location of osteotomy in genioglossus advancement. Significance: This study can help otolaryngologists avoid complications such as mandibular incisor apex injury, muscle injury, and mandibular fractures in genioglossus advancement. Support: None reported.