Assessment of clinical and phoniatric outcomes of combined lateral expansion pharyngoplasty and anterior palatoplasty in obstructive sleep apnea patients

Background Surgical techniques for managing obstructive sleep apnea syndrome (OSAS) focus on remodeling the narrow pharynx by advancing the soft palate and reinforcing the lateral pharyngeal wall, thereby enlarging the airway lumen and mitigating collapse. While palatal surgery demonstrates efficacy when structural anomalies are present, outcomes can be less predictable in cases driven primarily by neuromuscular collapsibility. Consequently, the primary aim of contemporary surgical innovation is to reduce this pharyngeal collapsibility. To address both palatal and pharyngeal components of collapse simultaneously, the present study proposes a combined procedure of anterior palatoplasty with lateral expansion pharyngoplasty, with subsequent evaluation of its clinical and phoniatric outcomes. Results Significant reductions were observed in postoperative apnea hypopnea index (AHI), and snoring duration relative to sleep time with 84% of patients showing more than 50% in AHI. There was a significant improvement in minimum oxygen saturation (p < 0.001 for all). A significant improvement in retropalatal/oropharyngeal space collapse was observed in postoperative flexible nasopharyngoscopic examination (p < 0.001). No life-threatening postoperative complications were observed. Dehiscence of the sutures between anterior and posterior tonsillar pillar was detected in 15 patients without any problem. Only one patient suffered from secondary post tonsillectomy hemorrhage which was managed medically. Conclusion Lateral expansion pharyngoplasty and Anterior palatoplasty represent an effective surgical combination for the treatment of OSAS in patients with palatal and lateral collapse. These techniques, performed as a one-stage procedure, led to improvements in apnea hypopnea index, snoring, and respiratory parameters in patients with OSAS by acting on lateral and retropalatal collapse.