(1358) Zeta-Palatopharyngoplasty with Sphincteroplasty in the Treatment of Snoring and Apnea: 20 Years Experience

Introduction: The aim of this study is to analyze our experience with zetapalatopharyngoplasty (ZPFP) focusing on indications, limitations, technical details, complications, and functional outcomes.

Methods: From 2001 to 2022, 236 patients underwent the procedure exclusively or in combination with other procedures. Of these, 184 were male and 52 female, with ages ranging from 15 to 73 years, with a mean of 47 and a median of 48 years. The technique begins with bilateral tonsillectomy. A zetaplasty is done bilaterally between the anterior and posterior tonsillar pillar associated with superior-lateral transposition of the palatopharyngeus (sphincteroplasty).

Results: Another airway procedure was done in 70% of cases (164). Septoplasty was the most frequently performed procedure in 56% (133). Other associated procedures included turbinectomy, sinus surgery, rhinoplasty, tongue base resection, laryngeal microsurgery and tracheostomy. We had one death secondary to anaphylactic shock from muscle relaxant during anesthetic induc tion. Pain and transient velopharyngeal insufficiency are expected in the immediate postoperative period and are most intense in the first week. Bleeding at the surgical site occurred in 3% of cases. We had no cases of nasopharyngeal stenosis. The evaluation of functional results is hampered by the long study period, during which changes in concepts, availability, and quality of available examinations occur. In a study with a smaller number of patients who underwent surgery more recently, we obtained a mean AHI decreased from 34.22 to 19.28 events/hour, a decreased in the desaturation time from 51.09 to 17.71 minutes (p < 0.001), a reduction in ESS score from 12.36 to 6.25. According to SAQLI, 97% of patients reported moderate to significant improvement in quality of life

Conclusions: We conclude that ZPFP is a low-complexity procedure, easy to learn, with a low complication rate and a high degree of patient and surgeon satisfaction due to good functional results. It should be considered in the surgical management of oropharynx for snoring and apnea treatment.