Uvularis muscle strengthening advancement in palatopharyngeal collapse in selected cases of snoring and obstructive sleep apnea: a randomized trial.

BACKGROUND AND PURPOSE: The uvularis muscles shorten, elevate, and retract the uvula and assist the levator veli palatini muscle in velopharyngeal closure. This work was designed to present the uvularis muscle advancement technique in a selected group of obstructive sleep apnea (OSA) patients, assess the surgical applicability, and report the surgical outcomes.

METHODS

Thirty-four adult patients with single-level OSA who showed a predominant anteroposterior pattern of collapse at the retropalatal region were stratified into two groups: Group A underwent modified anterior palatoplasty (MAP) only, and Group B had modified anterior palatoplasty with uvularis muscle advancement (MAP-UMA).

RESULTS

At 6-8 months, a highly significant improvement was reported as regards the mean apnea hypopnea index (MAP group; from 12.9 to 5.7; MAP-UMA group: from 19.1 to 4.0) and the mean lowest oxygen saturation (MAP group; from 89.9 to 93.7; MAP-UMA group: from 88.7 to 94.3; P < 0.000) in both groups; but the comparison of both groups showed non-significant differences (p > 0.05). The visual analog scale of snoring and Epworth Sleepiness Scale showed a significant (p < 0.05) reduction in both groups; the comparison between groups was highly significant towards MAP-UMA. According to Sher's criteria, successful outcomes were reported in 27 patients (79.41%); MAP = 13 (76.47%), MAP-UMA = 14 (82.35%). The overall percentage of improvement (of the study group) was 78.65 ± 5.41%.

CONCLUSION

MAP-UMA is an effective procedure in patients with OSA who show a predominant retropalatal collapse. UMA results in a significant improvement in snoring. It could be incorporated into multi-level surgery in OSA.