Multi Level Single Stage: Barbed Reposition Pharyngoplasty and Nasal Surgery in Treatment of OSA-Our Experience.

It has become increasingly clear in the past decade that surgical management of OSAHS is most successfully managed with multilevel surgery (Cahali in Laryngoscope 113(11):1961-1968, 2003; Friedman et al. in Otolaryngol Head Neck Surg 131:89-100, 2004; Laryngoscope 114:441-449, 2004; Pang and Woodson in Otolaryngol Head Neck Surg 137(1):110-114, 2007; Li and Lee in Laryngoscope 119:2472-2477, 2009; Vicini et al. in Head Neck 36:77-78, 2014; Mantovani et al. in Acta Otorhinolaryngol Ital 32:48-53, 2012; Morgenthaler et al. in Sleep 30:519-529, 2007). In particular, drug-induced sleep endoscopy (DISE) has shown that the nose and soft palate are important anatomic components of obstruction in OSAHS and therefore should be treated as far as possible as a single stage procedure. The nasal patency being pivotal in the outcome of the sleep apnoea surgery. To ascertain the effectiveness and ease of carrying out multilevel single stage procedure in patients of obstructive sleep apnoea, and to use BARB sutures for relocation palatoplasty as a new technique to address level 2 collapse without excising much of soft palatal tissue. We have carried out a prospective study of 50 OSA (mild to severe) patients with nasal and retropalatal obstruction specifically without BOT or hypopharyngeal component of obstruction. The nasal component being treated with various procedures depending on the deformity or nature of obstruction and retropalatal component addressed by barbed relocation pharyngoplasty (BRP) being a relatively new procedure. We observed that nasal surgeries along with BRP can provide as an effective and safe option with very promising results. Adding BRP in the same stage with nasal surgery has been proved to be a simple, easy to learn, safe procedure with promising results in the management of OSA. Key points to be, the level of obstruction noted on DISE and proper patient selection can help us give the patients a good surgical result in a single stage procedure.