Various combinations of velopharyngeal and hypopharyngeal surgical procedures for treatment of obstructive sleep apnea: Single-stage, multilevel surgery

Abstract Objective The aim of this study was to investigate the safety and outcomes of velopharyngeal surgeries combined with hypopharyngeal surgeries as single-stage interventions for treatment of obstructive sleep apnea (OSA). Methods Retrospective analysis of operated patients. The velopharyngeal surgical interventions were uvulopalatal flap, anterior palatoplasty, expansion sphincter pharyngoplasty, transpalatal advancement pharyngoplasty, Cahali lateral pharyngoplasty, Z-palatoplasty, and modified uvulopalatopharyngoplasty. The hypopharyngeal surgical interventions were tongue base suspension, mucosal sparing partial glossectomy, genioglossus advancement, mandibulohyoid suspension, thyrohyoid suspension, and epiglottoplasty. Results Forty-one patients were enrolled after inclusion and exclusion criteria. The evaluation of symptoms and polysomnographic findings were performed preoperatively and at a minimum of 3 months postoperatively. The mean age was 42.17 ± 9.50 years and the mean follow-up time was 6.8 ± 6.0 months. After single-stage multilevel surgery, the mean apnea hypopnea index (AHI) improved from 29.13 ± 15.87 events/h to 14.28 ± 16.14 events/h (p   50% reduction in AHI and postoperative AHI  Conclusion According to outcomes of this study, OSA patients with multilevel obstructions can benefit from combined surgeries for velopharyngeal and hypopharyngeal regions at the same operation stage, without experiencing persistent complaints. It is promising that, despite multiple levels of obstruction was operated at single-stage, airway safety was preserved in all patients.