Abstract
Purpose
The purpose of this study is to evaluate the effect of the different surgical techniques of expansion sphincter pharyngoplasty (ESP) on the dimensions of the oropharyngeal airway.
Methods
The techniques that were evaluated included the preservation and transection of the palatopharyngeus (PP) and superior pharyngeal constrictor (SPC) muscle attachment and transposition of the PP muscle to the hamulus of the medial pterygoid plate and the palatal musculature. Surgical techniques were applied in twenty half heads.
Results
The preservation of the PP–SPC attachment inhibited the transposition of the PP muscle to the hamulus and resulted in comparable enlargement in the medial–lateral dimension in the oropharyngeal airway when the PP muscle was transposed to the palatal musculature. After transection of the PP–SPC attachment, significant enlargement was observed in anterior–posterior and medial–lateral directions in the oropharyngeal airway when the PP muscle was transposed both to the hamulus and the palatal musculature. The distances measured after both the transposition techniques were similar.
Conclusion
The present study is a basic study demonstrating how different techniques of ESP affect the position of the soft palate. The PP–SPC attachment can be transected in the patients with anterior–posterior palatal and lateral wall collapse to pull the soft palate anteriorly in addition to prevent the lateral wall collapse. The PP–SPC attachment can be preserved in the patients with only lateral wall collapse. Nevertheless, the clinical consequences of these static changes need to be evaluated in clinical studies.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Pang KP, Woodson BT (2007) Expansion sphincter pharyngoplasty: a new technique for the treatment of obstructive sleep apnea. Otolaryngol Head Neck Surg 137(1):110–114. https://doi.org/10.1016/j.otohns.2007.03.014
Ulualp SO (2014) Modified expansion sphincter pharyngoplasty for treatment of children with obstructive sleep apnea. JAMA Otolaryngol Head Neck Surg 140(9):817–822. https://doi.org/10.1001/jamaoto.2014.1329
Pang KP, Pang EB, Win MT, Pang KA, Woodson BT (2016) Expansion sphincter pharyngoplasty for the treatment of OSA: a systemic review and meta-analysis. Eur Arch Otorhinolaryngol 273(9):2329–2333. https://doi.org/10.1007/s00405-015-3831-2
Steinbichler TB, Bender B, Giotakis AI, Dejaco D, Url C, Riechelmann H (2018) Comparison of two surgical suture techniques in uvulopalatopharyngoplasty and expansion sphincter pharyngoplasty. Eur Arch Otorhinolaryngol 275(2):623–628. https://doi.org/10.1007/s00405-017-4852-9
Despeghel AS, Mus L, Dick C, Vlaminck S, Kuhweide R, Lerut B, Speleman K, Vinck AS, Vauterin T (2017) Long-term results of a modified expansion sphincter pharyngoplasty for sleep-disordered breathing. Eur Arch Otorhinolaryngol 274(3):1665–1670. https://doi.org/10.1007/s00405-016-4395-5
Sorrenti G, Pelligra I, Albertini R, Caccamo G, Piccin O (2018) Functional expansion pharyngoplasty: technical update by unidirectional barbed sutures. Clin Otolaryngol 43(5):1419–1421. https://doi.org/10.1111/coa.13105
Bosco G, Pérez-Martín N, Racionero MA, Plaza G (2019) Expansion sphincter pharyngoplasty: usefulness of DISE. Acta Otorrinolaringol Esp 70(4):215–221. https://doi.org/10.1016/j.otorri.2018.04.006
Rashwan MS, Montevecchi F, Cammaroto G, Badr El Deen M, Iskander N, El Hennawi D, El Tabbakh M, Meccariello G, Gobbi R, Stomeo F, Vicini C (2018) Evolution of soft palate surgery techniques for obstructive sleep apnea patients: a comparative study for single-level palatal surgeries. Clin Otolaryngol 43(2):584–590. https://doi.org/10.1111/coa.13027
Vicini C, Montevecchi F, Pang K, Bahgat A, Dallan I, Frassineti S, Campanini A (2014) Combined transoral robotic tongue base surgery and palate surgery in obstructive sleep apnea-hypopnea syndrome: expansion sphincter pharyngoplasty versus uvulopalatopharyngoplasty. Head Neck 36(1):77–83. https://doi.org/10.1002/hed.23271
Huang MH, Lee ST, Rajendran K (1997) A fresh cadaveric study of the paratubal muscles: implications for eustachian tube function in cleft palate. Plast Reconstr Surg 100(4):833–842. https://doi.org/10.1097/00006534-199709001-00003
Jackson IT, Silverton JS (1977) The sphincter pharyngoplasty as a secondary procedure in cleft palates. Plast Reconstr Surg 59(4):518–524
Marrinan EM, LaBrie RA, Mulliken JB (1998) Velopharyngeal function in nonsyndromic cleft palate: relevance of surgical technique, age at repair, and cleft type. Cleft Palate Craniofac J 35(2):95–100. https://doi.org/10.1597/1545-1569_1998_035_0095_vfincp_2.3.co_2
Ysunza A, Pamplona MC, Molina F, Chacón E, Collado M (1999) Velopharyngeal motion after sphincter pharyngoplasty: a videonasopharyngoscopic and electromyographic study. Plast Reconstr Surg 104(4):905–910. https://doi.org/10.1097/00006534-199909040-00002
Orticochea M (1983) A review of 236 cleft palate patients treated with dynamic muscle sphincter. Plast Reconstr Surg 71(2):180–188. https://doi.org/10.1097/00006534-198302000-00005
Ysunza A, Pamplona MC (2006) Velopharyngeal function after two different types of pharyngoplasty. Int J Pediatr Otorhinolaryngol 70(6):1031–1037. https://doi.org/10.1016/j.ijporl.2005.10.015
Maue-Dickson W, Dickson DR (1980) Anatomy and physiology related to cleft palate: current research and clinical implications. Plast Reconstr Surg 65(1):83–90. https://doi.org/10.1097/00006534-198001000-00019
Chauvet D, Missistrano A, Hivelin M, Carpentier A, Cornu P, Hans S (2014) Transoral robotic-assisted skull base surgery to approach the sella turcica: cadaveric study. Neurosurg Rev 37(4):609–617. https://doi.org/10.1007/s10143-014-0553-7
Cho JH, Kim JK, Lee HY, Yoon JH (2013) Surgical anatomy of human soft palate. Laryngoscope 123(11):2900–2904. https://doi.org/10.1002/lary.24067
Shires C, Smith A, Lee J, Boughter J, Sebelik M (2017) Classification system for lateral pharyngotomy: systematic study of anatomic exposure in a human cadaver model. Surg Radiol Anat 39(9):975–979. https://doi.org/10.1007/s00276-017-1827-x
Acknowledgements
The authors thank all donors of the cadavers used in this study and to their families.
Funding
The study has no funding.
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by EC, AC and ZŞ. The first draft of the manuscript was written by EC and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethics approval
The study is an anatomic cadaveric research. Ankara University Faculty of Medicine Institutional Review Board has confirmed that the study is an exemption and does not require approval.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on sleep apnea syndrome. Guest Editors: Manuele Casale and Rinaldi Vittorio.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Online Resource 1 Video presenting relations of the palatopharyngeus (PP) muscle with levator veli palatine muscle and superior pharyngeal constrictor (SPC) muscle and the effect of the transpositions of the PP muscle to the hamulus and the palatal musculature after transection of the PP–SPC attachment on the soft palate (in MOV format) (MOV 7451 kb)
Rights and permissions
About this article
Cite this article
Cömert, E., Cömert, A. & Şencan, Z. Expansion sphincter pharyngoplasty: analyzing the technique based on anatomy. Eur Arch Otorhinolaryngol 278, 857–863 (2021). https://doi.org/10.1007/s00405-020-05940-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-020-05940-w