Evolution of soft palate surgery techniques for obstructive
sleep apnea patients: A comparative study for single-level
Mohamed S. Rashwan
Mohamed Badr el Deen
Diaa El Hennawi
Mohammed El Tabbakh
Faculty of Medicine, Department of
Otorhinolaryngology, Suez Canal University
Teaching Hospitals, Ismailia, Egypt
Head and Neck Department – ENT & Oral
Surgery Unit, G.B. Morgagni - L. Pierantoni
ı - ASL of Romagna, Italy
Department of Otorhinolaryngology,
University of Messina, Messina, Italy
ENT & Audiology Department, University
of Ferrara, Ferrara, Italy
Mohamed S. Rashwan, Department of
Otolaryngology, Faculty of Medicine, Suez
Canal University Teaching Hospitals, Ismailia,
Objectives: To compare the results of tissue preservation techniques of soft palate
surgeries including expansion sphincter pharyngoplasty (ESP) and barbed reposition
pharyngoplasty (BRP) for patients suffering from obstructive sleep apnoea (OSA)
with the traditional uvulopalatopharyngoplasty (UPPP).
Design: Interventional comparative study.
Setting: Morgagni-Pierantoni Hospital.
Participants: Seventy-five patients were included in the study, divided into three
groups with 25 patients per group: UPPP, ESP or BRP.
Main outcomes measures: Polysomnography was carried out for all patients pre-
and postoperatively; the postoperative results were recorded at least 6 months after
surgery. All patients were assessed preoperatively using drug-induced sleep endo-
scopy. Epworth Sleepiness Scale and body mass index (BMI) were registered for all
patients before and after surgery.
Results: The mean of pre- and postoperative differences of apnoea-hypopnoea
index values was higher in BRP group than ESP: 15.76 Æ 14.5 Vs 10.13 Æ 5.3;
P<.05 and UPPP groups: 15.76 Æ 14.5 vs 6.08 Æ 5.5; P<.0005. The mean of dif-
ferences of oxygen desaturation index values was higher in BRP group than UPPP
group: 15.09 Æ 17.6 vs 7.13 Æ 6.8; P<.0005, but not significantly higher than ESP
group: 15.09 Æ 17.6 vs 6.48 Æ 7.9; P>.05. The mean of differences of ESS values
was higher in BRP group than ESP group: 5.52 Æ 4.1 vs 4.84 Æ 3.3; P<.005 and
UPPP groups: 5.52 Æ 4.1 vs 1.36 Æ 1.9; P<.005. Finally, the pre- and postopera-
tive means of differences of lowest oxygen saturation values were not statistically
significant among the three groups (P > .05).
Conclusion: Barbed reposition pharyngoplasty (BRP) can be considered an effective
procedure on the basis of the postoperative outcomes. ESP still proves to be a good
technique especially when performed by experienced surgeons. Both techniques
proved to be superior to UPPP.
Accepted: 29 October 2017
© 2017 John Wiley & Sons Ltd wileyonlinelibrary.com/journal/coa Clinical Otolaryngology. 2018;43:584–590.