Jul 10, 2018 - insufficient, Maxillomandibular advancement (Phase2) is suggested. Genioglossus Advancement (GA) enlarges the pharyngeal airway by.
B. Clinical Sleep Science
II. Sleep-Related Breathing Disorders
0587 WHERE DOES PHASE1 SLEEP SURGERY INCLUDING GENIOGLOSSUS ADVANCEMENT ENLARGE THE AIRWAY? Arisaka T1, Yagi T1, Chiba S1,2, Tonogi M3, Nakajima T4 1 Ota memorial sleep center, sleep surgery center, Kawasaki city, KANAGAWA, Japan, JAPAN, 2Department of Otorhinolaryngology, Jikei University School of Medicine,, Tokyo, JAPAN, 3Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry,, Tokyo, JAPAN, 4Department of Otorhinolaryngology, Ichikawa General Hosptal, Tokyo Dental College,, Ichikawa, Chiba, JAPAN Introduction: CPAP and OA are typical conservative treatments for Obstructive Sleep Apnea (OSA), but decreased adherence can be a problem for using each device. Therefore, we suggest Sleep Surgery (SS) as an alternative treatment for OSA. SS is performed in two phases according to the Stanford protocol. Phase1 is performed on the soft tissues (nasal cavity, pharynx, tongue). The effects of Phase1 are evaluated by Polysomnography (PSG) and CT imaging, and if insufficient, Maxillomandibular advancement (Phase2) is suggested. Genioglossus Advancement (GA) enlarges the pharyngeal airway by traction of the genioglossus and geniohyoid muscles. We investigated where the pharyngeal airway is enlarged by Phase1 including GA. Methods: We enrolled 22 OSA patients who were diagnosed by PSG and consented to CT imaging at the Ota Memorial Sleep Center before and after Phase1 including GA. Cases where AHI decreased by more than 50% after surgery and became 20/h or less were included in the effect group, and the other cases were included in the non-effect group. The pharyngeal airway measurement sites were the second cervical vertebra (SCV) area (Superior, Median and Inferior) and the Base of the Epiglottis. The anteroposterior and lateral diameters were measured and compared. Results: There were 6 cases in the effect group and 16 cases in the non-effect group, and the overall success rate was 27%. The anteroposterior diameters of both groups were not changed, but the lateral diameter was expanded significantly in all of the SCV area of the effect group. Conclusion: This study confirmed that expansion of the pharyngeal airway was not in the anteroposterior diameter, but the lateral diameter was increased by Phase1 including GA. However, the overall success rate was low, and the number of cases needs to be increased in the future to decide on indications and to devise improved techniques for surgery. Support (If Any): 0
0588 RELATIONSHIP BETWEEN PHARYNGEAL VOLUME AND APNEA HYPOPNEA INDEX AFTER MAXILLOMANDIBULAR ADVANCEMENT SURGERY IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA Faria AC1, Eckeli AL2, Garcia DM2, Mello-Filho FV3 1 University of Sao Paulo, Ribeirao Preto - SP, BRAZIL, 2University of Sao Paulo, Ribeirão Preto, BRAZIL, 3University of São Paulo, Ribeirão Preto, BRAZIL Introduction: The obstructive sleep apnea (OSA) is a progressive disease and that is gaining great attention of the health area due to the serious co-morbidities associated to it. Several works in the literature have pointed maxillomandibular advancement (MMA) as the most effective surgical treatment for OSA, with success rates of 96 to 100, but there are important aspects in the evaluation of this surgery that SLEEP, Volume 40, Abstract Supplement, 2017
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need to be further clarified. The objective of this study was to assess the volumetric anatomical changes of the pharynx after MMA surgery and its repercussions in Apnea Hypopnea Index (AHI). Methods: Thirty-two patients with a polysomnographic diagnosis of OSA participated in the study and where submitted to polysomnography (PSG) and image acquisition by Computed Tomography (CT). Polysomnography and CT were performed preoperatively (T0) and six months after MMA (T1). The pharyngeal air space of the region between the hard palate and he base of the epiglottis was divided into a retropalatal (RP) region and a retrolingual (RL) region. The comparison between preoperative and postoperative data was performed using Student’s t-test for paired samples (paired t-test). Results: Postoperative CT showed a mean volumetric increase of 37,6% in the RP region and of 38% in the RL region. The mean value of preoperative AHI was 34,5 events per hour of sleep, presenting a significant (p
