Ethan I Huang1, Chia-Ling Kuo2, Yu-Ting Chou3, Yu-Ching Lin4, Shu-Yi Huang5. 1. Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Sleep Center of Chang Gung Memorial Hospital, Chiayi, Taiwan. Electronic address: ehuang@alumni.pitt.edu. 2. Connecticut Institute for Clinical and Translational Science and Department of Community Medicine & Health Care, University of Connecticut Health Center, Farmington, United States. 3. Sleep Center of Chang Gung Memorial Hospital, Chiayi, Taiwan; Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan. 4. School of Medicine, Chang Gung University, Taoyuan, Taiwan; Sleep Center of Chang Gung Memorial Hospital, Chiayi, Taiwan; Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan. 5. Sleep Center of Chang Gung Memorial Hospital, Chiayi, Taiwan; Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Nursing, Chang-Gung University of Science and technology, Chiayi, Taiwan.
Abstract
OBJECTIVE: The meticulous two-layer closure is a step to complete the modified Z-palatoplasty, which has been reported to serve as an effective element in multilevel sleep surgery for patients with severe obstructive sleep apnea, especially with Friedman anatomical stages II and III diseases. A single layer closure-the suture closure as originally described in uvulopalatopharyngoplasty by Fujita et al., is an alternative of the two-layer closure, featured by simplicity while its efficacy has not been completely proved in patients with severe obstructive sleep apnea. METHODS: By apnea-hypopnea index (AHI), we investigated 7 patients with severe obstructive sleep apnea undergoing the modified Z-palatoplasty with one-layer closure in a multilevel surgery. RESULTS: The mean apnea-hypopnea index is reduced from 52.9±17.1 (preoperative) to 18.4±9.7 events/h (postoperative) without any wound dehiscence or bleeding that results in an unplanned return to the operating room. In comparison, the percentage of reduction in mean apnea-hypopnea index is 65%. The improvement of apnea-hypopnea index is statistically significant with the p-value 0.004. CONCLUSION: Our results support that one-layer closure remains the efficacy of modified Z-palatoplasty (with two-layer closure) in one-stage multilevel surgery for severe obstructive sleep apnea with an unfavorable anatomical stage.
OBJECTIVE: The meticulous two-layer closure is a step to complete the modified Z-palatoplasty, which has been reported to serve as an effective element in multilevel sleep surgery for patients with severe obstructive sleep apnea, especially with Friedman anatomical stages II and III diseases. A single layer closure-the suture closure as originally described in uvulopalatopharyngoplasty by Fujita et al., is an alternative of the two-layer closure, featured by simplicity while its efficacy has not been completely proved in patients with severe obstructive sleep apnea. METHODS: By apnea-hypopnea index (AHI), we investigated 7 patients with severe obstructive sleep apnea undergoing the modified Z-palatoplasty with one-layer closure in a multilevel surgery. RESULTS: The mean apnea-hypopnea index is reduced from 52.9±17.1 (preoperative) to 18.4±9.7 events/h (postoperative) without any wound dehiscence or bleeding that results in an unplanned return to the operating room. In comparison, the percentage of reduction in mean apnea-hypopnea index is 65%. The improvement of apnea-hypopnea index is statistically significant with the p-value 0.004. CONCLUSION: Our results support that one-layer closure remains the efficacy of modified Z-palatoplasty (with two-layer closure) in one-stage multilevel surgery for severe obstructive sleep apnea with an unfavorable anatomical stage.