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n this study, 39 patients from Turkey with obstructive sleep apnoea (of varying severity) underwent an expansion sphincter pharyngoplasty. This operation was devised by Prof Kenny Pang in Singapore and involves using the palatopharyngeus muscle and partly relocating it laterally towards the hamulus. Polysomnography, Epworth sleepiness score and a visual analogue score of snoring was conducted before and after this operation. At six months postoperatively, the AHI dropped from an average of 25.2 (+/-8.3) down to 11.6 (+/-6.9) with a significant P value of 0.012. From what I can tell, everyone improved postoperatively with respect AHI at six months. The upper score reduced from 10.4 on average prior to the operation, down to 4.4 even three years afterwards. The visual analogue score changed from 8.6 snoring level down to 1.9 three years later (p>0.05). There were no serious complications reported in the short or long term. What is interesting is that they did not use drug-induced sleep endoscopy and, rather annoyingly, they did not do a polysomnography three years later. It does seem, however, that the Epworth score and snoring outcome measures remained low after three years, but it would have been nice to see the AHI at this point. This data only augments the growing evidence for oropharyngeal surgery for obstructive sleep apnoea. With the changes in the NICE guidelines in August 2021 which recommend tonsillectomy for grade 3-4 tonsils prior to CPAP and consideration of oropharyngeal surgery in those patients who are unable to tolerate CPAP or a mandibular advancement device, hopefully the UK will be able to catch up with the rest of the world with respect to pursuing this type of surgery.

Long-term efficacy of expansion sphincter pharyngoplasty in obstructive sleep apnea syndrome.
Serkan C, Kerim Y, Serkan K.
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Vik Veer

Royal National Throat, Nose & Ear Hospital and Queens Hospital, Romford, UK.

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