Dados do Trabalho

Título

Are Barbed Pharyngoplasty always good? The experience of the technique in Brazil alone and with multilevel procedures

Introdução

Pharyngoplasties remains the most common surgical procedure for OSAS alone or in combination with adjunctive multilevel procedures. New procedures involve reconstruction of the upper pharyngeal airway tissues, modifying structural abnormalities and improving form and function. With the advent of polypropylene barbed sutures, the capacity of sutures to withstand loads has greatly increased and becomes one of the possibilities of surgery. To obtain better palatal expansion in patients with retropalatal and laterolateral collapse, were proposed the combined use of two techniques, lateral and expansion pharyngoplasty. Until now, we don’t have a study that shows the long-term effect of sutures in pharyngoplasties.

Objetivo

The aim is to describe the experience of barbed procedures in a private service.

Métodos

Observational, cross-sectional and analytical study, with quantitative approach, based on the analysis of clinical records. The inclusion criteria was who had an anterior-posterior palate collapse or circular collapse confirmed by DISE or primary snore, mild and moderate OSAS. All patients were followed up from the procedure until this date, with a mandatory polysomnography after 6 months and every year after surgery.

Resultados

35 cases selected from July 2018 to June 2024. The mean age was 43 years, the mean AHI before was 31. 82% performed septoplasty and turbinectomy plus barbed pharyngoplasty, 14% glossectomy with coblation, and 2,8% rhinoplasty. Almost had a significant reduction in excessive daytime sleepiness and snoring, confirmed by decreased AHI. Three patients (8,5%) had an increased AHI after surgery. One of them, from 17 to 59.3 (248% more), the other from 8.4 to 38.2 (354% more) and other from 13 to 17.2 (32% more). Those patients had glossectomy, septoplasty and turbinectomy and rhynoplasty, respectively. The first patient had a decrease AHI right after the surgery, but six years after, an increase. That patient had thread exposure. Complications were observed: thread exposure (5,7%), needle inserted in the wrong way (2,8%) and heart attack (2,8%).

Conclusões

Barbed suture is an extremely promising technology in the field of pharyngoplasty. The use of barbed reinforces stability, distributes tension, avoids damage of velopharyngeal tissues, and prevents collapse, with an important effect on long-term outcomes, but more studies must be done to conclude the real benefits of these approache alone or with multilevel procedures and after long time.

Palavras -chave

Barbed; OSA; multilevel procedures.