Expansion Sphincter Pharyngoplasty

Expansion sphincter pharyngoplasty.

Clarification: Two suture methods are shown in a drawing in the video and either stitch can be used to secure the palatopharyngeal pedicle

o Symptomatic obstructive sleep apnea
o Obstruction located at the level of the velopharynx and accompanying lateral walls. This site determination is based on evaluations such as drug-induced sedated endoscopy and Friedman tongue position.
o Inability to tolerate or improve with positive airway pressure (PAP) therapy
o No improvement of symptoms with weight loss, oral appliance, or other non-surgical modalities

o No absolute contraindications
o Relative indications include high perioperative risk, anticoagulation and bleeding risk, poor nutritional status, pre-existing dysphagia or xerostomia, velopharyngeal insufficiency, or occupation dependent on pharyngeal function

Haney Needle Driver
On Tonsillectomy Forceps
Metzenbaum Scissors
Monopolar Needle-Tip Electrocautery
Right Angle Clamp
Tonsillectomy Set
Toothed Forceps

Tools necessary include tonsillectomy set, monopolar needle-tip cautery, toothed forceps, right angle clamp, kittners on tonsillectomy forceps, Metzenbaum scissors, Haney needle driver, 2-0 polysorb sutures for muscle suspension, and 4-0 chromic sutures for mucosal closure

Workup begins with a detailed history of sleeping difficulties. Gold standard for diagnosis is polysomnography with AHI > 5 or RDI > 5 and the patient has documented symptoms of obstructive sleep apnea. Sleep endoscopy is then utilized to determine anatomic location of obstruction to guide which treatment modality would be best effective.

o Insertion of palatopharyngeus into the soft palate
o Superior constrictors in lateral tonsillar fossa
o Pterygoid hamulus and buccopharyngeal raphe as anchors for muscle pedicle

o Standard operative risks: bleeding, infection, possible need for further surgery
o Velopharyngeal insufficiency
o Dysphagia

o Standard operative risks: bleeding, infection, possible need for further surgery
o Velopharyngeal insufficiency
o Dysphagia

1. o Dedhia RC, Soose RJ. Advanced Palatal Surgery. Myers & Snyderman (Eds) Operative Otolaryngology, 3rd edition.
2. Pang KP, Pang EB, Win MT, Pang KA, Woodson BT. Expansion sphincter pharyngoplasty for the treatment of OSA: a systemic review and meta-analysis. Eur Arch Otorhinolaryngol. 2016;273(9):2329-2333.