TABLE IX.D.4.c.

Evidence on lateral pharyngoplasty for OSA

Study	Year	LOE	Study design	Study groups	Clinical endpoint	Conclusion
Cahali1706	2003	2b	Prospective cohort	LP (n = 10) Oral findings and Müller maneuver: only retropalatal collapse, bulky lateral pharyngeal tissues	PSG ESS	LP significantly reduced median AHI (from 41.2 to 9.5, p = 0.009), snoring, ESS (from 13 to 5, p = 0.011) and increased slow wave sleep (from 5.3% to 16.3% of time, p = 0.037). Successa of LP was 60%.
Cahali et al.1707	2004	1b	Randomized parallel group trial	1 LP (n = 15) 2 UPPP (n = 12) Oral findings and Müller maneuver: only retropalatal collapse, bulky lateral pharyngeal tissues	PSG ESS CT scan	Only LP significantly reduced mean AHI (from 41.6 to 15.5, p = 0.002) and increased slow wave sleep (from 9.8% to 16.3% of time, p = 0.03). Significant decrease in AHI in LP vs. UPPP (p = 0.05). Both interventions significantly reduced ESS. No differences in postoperative upper airway CT measurements. Successa of LP was 53.3%.
Tunçel et al.1716	2012	4	Retrospective case series	1 LP (n = 9) 2 ZP (n = 13) 3 LP or ZP plus TBS (n = 13) Oral findings and Müller maneuver: only retropalatal collapse for LP	PSG	AHI significantly reduced in all groups (LP: 9–4, p = 0.007; ZP: 15–6, p < 0.001; combined surgery: 18–8, p = 0.002). Greater improvement with multilevel intervention. Success ratesa are not available.
De Paula Soares et al.1714	2014	2b	Prospective cohort	LP (n = 18) Oral findings: clearly identifiable posterior tonsillar pillars	PSG ABPM	LP significantly reduced AHI (from 33.5 to 20.9, p = 0.02), arousal index (31.6–16.7, p = 0.005) and T90% (10.6%–0.9%, p = 0.008). LP significantly reduced systolic (7.4 mmHg decrease, p = 0.006) and diastolic blood (4.2 mmHg decrease, p = 0.03) pressure during sleep and over a 24-h period. Successa of LP was 50%.
Chi et al.1711	2015	1b	Randomized parallel group trial	1 LP plus UPPP (n = 25) 2 UPPP (n = 29) Oral findings and Müller maneuver: retropalatal and retroglossal collapse	PSG	Significant decrease in AHI in LP with UPPP (30.7%) vs. UPPP (10.8%, p = 0.02) in moderate OSA. Similar but nonsignificant reduction in AHI in mild and severe OSA. Success ratesa non available.
Carrasco-Llatas et al.1713	2015	3b	Retrospective case series	1 LP (n = 10) 2 PPR (n = 22) 3 UPPP (n = 7) 4 ZP (n = 4) 5 ESP (n = 10) Oral findings and DISE: only retropalatal collapse	PSG	All interventions significantly reduced AHI. AHI decreased in LP group from 48.0 to 15.2 (p < 0.05) and successa of LP was 70%.
Dizdar et al.1712	2015	2b	Randomized parallel group trial	1 LP (n = 14) 2 UPPP (n = 9) Oral findings and Müller maneuver: only retropalatal collapse, bulky lateral pharyngeal tissues	PSG ESS	Both interventions significantly reduced AHI (LP: 23.4–11.3, p < 0.05) and ESS (LP: 15.3–6.8). Successa of both interventions were 100%.
Karacoc et al.1697	2018	2b	Prospective cohort	1 LP (n = 28) 2 ESP (n = 31) 3 AP (n = 20) Oral findings and Muller maneuver: only retropalatal collapse. For LP: bulky lateral pharyngeal tissues and primarily lateral wall collapse	PSG ESS Snoring	Only LP and ESP significantly reduced AHI, (LP: 17.69–12.05, p = 0.004). All interventions significantly decreased ESS (LP: 13.2–8.3) and snoring. Successa,b of LP was 64%.
Elzayat et al.1715	2020	2b	Prospective cohort	LP (n = 40) Non-selected (excluded previous palatal surgery)	PSG DISE	LP significantly reduced AHI (from 34.7 to 16.6, p < 0.001) and increased baseline and min O2 saturation during sleep. Successa was 70%. Complete postoperative hypopharyngeal collapse occurred in 83.3% of non-responders. By excluding cases with preoperative complete hypopharyngeal collapse (25% of cases), successa would be 90%.

Abbreviations: ABPM, ambulatory blood pressure monitoring; AP, anterior palatoplasty; CT, computed tomography; DISE, drug-induced sleep endoscopy; ESP, expansion sphincter pharyngoplasty; ESS, Epworth sleepiness scale; LP, lateral pharyngoplasty; PPR, partial palate resection; PSG, polysomnography; T90%, percentage of TST with oxyhemoglobin saturation <90%; TBS, tongue base suspension; UPPP, uvulopalatopharyngoplasty; ZP, Z-palatoplasty.

^aSuccess based on Sher’s criteria¹⁶³⁴ = reduction in AHI ≥ 50% with final AHI < 20/h (or

^b<15/h).