Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
Department of Head and Neck Surgery, Kaiser Permanente, Vallejo, California, USA.
Otolaryngol Head Neck Surg. 2024 Sep;171(3):902-909. doi: 10.1002/ohn.849. Epub 2024 Jun 11.
Pharyngeal surgery is a treatment option for patients with obstructive sleep apnea (OSA) unable to tolerate positive pressure therapy. This study aims to determine the association between palate shape as described by Woodson and pharyngeal surgical outcomes.
Exploratory analysis of retrospective cohort.
Multicenter.
Three blinded reviewers assessed palate shape using drug-induced sleep endoscopy (DISE) videos from a previously-assembled cohort of adults undergoing pharyngeal surgery. Palate shape scores were examined for association with surgical outcomes with univariate and multivariate analyses. Multivariate analyses included adjustment for consensus DISE findings determined previously.
Two hundred nine study subjects were included from 13 centers. Age was 53.7 ± 11.5 years, body mass index (BMI) was 30.3 ± 5.0 kg/m, and 21% were female. In isolated soft palate surgery, greater GenuAP narrowing was associated with lesser odds of surgical response, whereas greater GenuLW narrowing was associated with greater odds of surgical response. These findings largely persisted after adjustment for key DISE findings, age, gender, OSA severity, BMI, and tonsil size. Other palate-shape findings were not clearly associated with surgical outcomes, although some palate-shape findings demonstrated trends toward an association with outcomes (P < .10).
Greater GenuAP narrowing and GenuLW narrowing were associated with lesser and greater, respectively, odds of surgical response after isolated soft palate surgery. Palate shape and other palate shape level scores were not clearly associated with surgical outcomes. Larger studies may determine more precisely the association between palate shape and pharyngeal surgery outcomes.
对于不能耐受正压治疗的阻塞性睡眠呼吸暂停（OSA）患者，咽手术是一种治疗选择。本研究旨在确定 Woodson 描述的腭形状与咽手术结果之间的关系。
回顾性队列的探索性分析。
多中心。
三位盲审员使用先前汇总的接受咽手术的成人药物诱导睡眠内窥镜（DISE）视频评估腭形状。使用单变量和多变量分析检查腭形状评分与手术结果的关联。多变量分析包括先前确定的共识 DISE 结果的调整。
从 13 个中心纳入了 209 名研究对象。年龄为 53.7±11.5 岁，体重指数（BMI）为 30.3±5.0kg/m2，女性占 21%。在单纯软腭手术中，GenuAP 变窄程度越大，手术反应的可能性越小，而 GenuLW 变窄程度越大，手术反应的可能性越大。这些发现在调整关键 DISE 发现、年龄、性别、OSA 严重程度、BMI 和扁桃体大小后基本保持不变。其他腭形状发现与手术结果没有明确相关，尽管一些腭形状发现与结果呈趋势相关（P<.10）。
在单纯软腭手术后，GenuAP 变窄和 GenuLW 变窄与手术反应的可能性分别降低和增加相关。腭形状和其他腭形状水平评分与手术结果没有明确相关。更大的研究可能更准确地确定腭形状与咽手术结果之间的关系。
