0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Modified Expansion Sphincter Pharyngoplasty for Treatment of Children With Obstructive Sleep Apnea

Seckin O. Ulualp, MD1,2
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas
2Division of Pediatric Otolaryngology, Children’s Medical Center, Dallas, Texas
JAMA Otolaryngol Head Neck Surg. 2014;140(9):817-822. doi:10.1001/jamaoto.2014.1329.
Text Size: A A A
Published online

Importance  Lateral pharyngeal wall collapse has been implicated in the pathogenesis of obstructive sleep apnea (OSA). Modified expansion sphincter pharyngoplasty (ESP) is a simple procedure and can be considered in the surgical management of children with severe OSA.

Objective  To describe a modified ESP addressing lateral pharyngeal muscle wall collapse in the treatment of children with OSA.

Design, Setting, and Participants  Retrospective review of the medical records of children with OSA and lateral pharyngeal muscle wall collapse who underwent modified ESP and children who had tonsillectomy and adenoidectomy (TA) for OSA between 2008 and 2013 at a tertiary care children’s hospital.

Interventions  Modified ESP.

Main Outcomes and Measures  The primary outcome measure was the rate of cure, which was defined as an apnea-hypopnea index (AHI) lower than 1. Other outcomes were differences in preoperative and postoperative AHI, minimum saturation of peripheral oxygen, and percentage of total sleep study time with oxygen saturation less than 90%.

Results  Twenty-five children who had modified ESP and 25 AHI-matched children who had TA for severe OSA were identified. The postoperative AHI was lower than the preoperative AHI in both groups. Preoperative AHI was similar between modified ESP and TA groups. The mean (SD) postoperative AHI of the modified ESP group (2.4 [3.9]) was lower than that of the TA group (6.2 [6.0]) (P < .001). Cure rates for the modified ESP group (AHI <1, 64%; AHI <2, 72%; and AHI <5, 80%) were greater than those for the TA group (AHI <1, 8%; AHI <2, 44%; and AHI <5, 60%).

Conclusions and Relevance  Modified ESP provided objective clinical improvement of OSA in children with severe OSA and lateral pharyngeal wall collapse and might serve as an effective alternative to TA for treatment of OSA.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Figure 1.
The Main Steps of the Modified Expansion Sphincter Pharyngoplasty (ESP)

After completion of a tonsillectomy (A), a horizontal incision is made to divide the anterior fascicules of the palatopharyngeus muscle (B), and the superficial fibers of the palatopharyngeus muscle are isolated. C, A blunt palate tunneling extending superolaterally from the arching fibers of the palatoglossus muscle into soft palate is created. D, Then the isolated portion of palatopharyngeus muscle is attached to the arching fibers of the soft palate. Comparative views before modified ESP (A) and after modified ESP (E) show the created tension in lateral pharyngeal walls and the increased distance between the lateral pharyngeal walls.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Comparison of the Cure Rates of Modified Expansion Sphincter Pharyngoplasty (ESP) and Tonsillectomy and Adenoidectomy (TA) Groups

The cure rates, as defined by 4 of the 5 illustrated apnea-hypopnea index (AHI) criteria, were significantly greater in the modified ESP group than in the TA group. The cure rates as defined by 50% reduction in AHI and AHI lower than 20 were similar between the modified ESP and TA groups.

aP < .05 for comparison.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
Jobs
JAMAevidence.com

The Rational Clinical Examination
Make the Diagnosis: Sleep Apnea

The Rational Clinical Examination
Original Article: Does This Patient Have Obstructive Sleep Apnea?

brightcove.createExperiences();