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Volumetric MRI analysis pre‐ and post‐Transoral robotic surgery for obstructive sleep apnea
Author(s) -
Chiffer Rebecca C.,
Schwab Richard J.,
Keenan Brendan T.,
Borek Ryan C.,
Thaler Erica R.
Publication year - 2015
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.25270
Subject(s) - medicine , uvulopalatopharyngoplasty , soft palate , obstructive sleep apnea , airway , tongue , magnetic resonance imaging , hypopnea , soft tissue , transoral robotic surgery , apnea , radiology , nuclear medicine , anesthesia , surgery , polysomnography , pathology
Objectives/Hypothesis To quantitatively measure volumetric changes in upper airway soft tissue structures using magnetic resonance imaging (MRI) pre‐ and post transoral robotic surgery for obstructive sleep apnea (OSA‐TORS). Study Design Prospective, nonrandomized, institutional board‐approved study. Methods Apneics undergoing OSA‐TORS, which included bilateral posterior hemiglossectomy with limited pharyngectomy and uvulopalatopharyngoplasty, had upper airway MRIs pre‐ and postoperatively. Changes (percent and absolute values) in upper airway and surrounding soft tissue volumes were calculated. We assessed whether there were significant volumetric changes and if changes correlated with apnea‐hypopnea index (AHI) changes. Results Nineteen MRIs and 18 polysomnograms were analyzed pre‐ and postoperation. Total airway volume increased by 19.4% ( P = 0.030). Soft palate and tongue volumes decreased by 18.3% ( P = 0.002) and 5.8% ( P = 0.013), respectively. Retropalatal and total lateral wall volumes decreased by 49.8% ( P = 0.0001) and 17.9% ( P = 0.008), respectively. Changes in other structures were not significant. Eleven patients had surgical success, with a mean AHI decrease of 52.9; six were nonsuccesses with a mean AHI decrease of 4.5 ( P =0.006). Decreased retropalatal lateral wall volume correlated with decreased AHI. Conclusion Airway, tongue, soft palate, and lateral wall volumes change significantly after OSA‐TORS. Changes in the volume of the lateral walls correlated with changes in AHI. Volumetric upper airway MRI may be a helpful tool to better understand reasons for surgical success. Level of Evidence 4. Laryngoscope , 125:1988–1995, 2015