The Efficacy Analyes And Its Related Anatomy Study Of Velopharyngoplasty For The Treatment Of Type Two Obstructive Sleep Apnea Hypopnea Syndrome

Obojective Based on the homologic anatomy study of soft palate, establishthe model of velopharyngoplasty(VPP), and collect OSAHS patientspreoperation and postoperation pharynx morphological changes, summing upits technical characteristics; explore the mechanism of VPP mechnism by themeasurement of velopharyngeal cavity during operation and that of system CTmeasurement.Methods 30 OSAHS patients diagnosed by PSG were included in this study,all cases had velopharyngoplasty(VPP).All had measured the velopharyngealcavity including: length of the soft palate, uvula length and width of the base,parapharyngeal space (distance between the tonsils).10 cases of patients hadthe measurement of velopharyngeal CT, with the time for patients beforeoperation, after the operation of three and six months; measurement methodas follows: patients were in awake quiet breathing, the scope of the upperairway CT scan from the orbital line to the glottis, further using CTworkstation to three-dimensional reconstruct and measure.During CT scan,patients were in supine position, and the teeth in the middle of the contactposition on the jaw; and maintain a static head and body during the scanningprocess, did not swallow; measurement parameters including: soft palatelength, maximum thickness of the soft palate, pharynx lateral spacing (distance between the tonsils), uvula length and base width of the free edge ofsoft palate to the throat wall spacing, velopharyngeal cross-sectional area,angina cross-sectional area,thickness of retropharyngeal wall.All the patientshad follow up for 6-11 months, filled out the ESS table, measuring the neckcircumference and BMI, oropharyngeal photographs, CT scans; for PSGreview, in accordance with the 2002 standards for efficacy assessment ofHangzhou, summarized VPP efficacy, its surgerical mechanism and theimpact of factors.Results 30 cases of OSAHS patients had successful VPP, all with short-termpostoperative velopharyngeal insufficiency, duration of 1 -5 weeks; allshort-term acute throat pain, duration of 1-4 weeks; 8 patients pharyngealforeign body sensation, considered 3 cases complicating with hypopharyngealreflux disease, five cases with unexplained reasons by specialist examination;2 patients had secondary hemorrhage, 1 case for the free edge of soft palate, 1case of tonsil pole cured by electrocoagulation, no pharyngeal scar narrow,open nasal, complications such as aspiration.30 cases had a significantdifference before and after surgery in the measurement ofvelopharyngeal,incluing: soft palate length, base of uvula length and width oflateral pharyngeal space (tonsil spacing); 10 cases had found that themorphological changes of oropharyngeal had a significant difference mainly in preoperative and postoperative 12 weeks, all the measurement ofvelopharyngeal, incluing: soft palate length, maximum thickness of the softpalate, pharynx lateral spacing (distance between the tonsils), uvula length andbase width of the free edge of soft palate to distance between the throat wall,velopharyngeal cross-sectional area,and angina cross-sectional area;however,there was no significant difference in retropharyngeal wall thickness.Apnea and hypopnea index(AHI)were decreased from 54.6±18.3preoperatively to 25.3±9.5 postoperatively, ESS score from 16.5±4.8preoperatively to 5.2±4.1 postoperatively.The recent rate of VPP was70.0%.Conclusion Velopharyngoplasty(VPP) remodeled palatopharyngeal districtand relieved the obstruction of palatal pharyngeal through the designing ofincision,the management of pharyngopalatine arch, tonsillectomy and thesuture of laterapharynx mucisae.This surgerical procedure could obviouslyupgrade the velum palatinum,enlarge the oropharynx airway effectively,andwas a parctical upper airway surgical technique.