Palatal Implants for Persistent Snoring and Mild Obstructive Sleep Apnea After Laser-Assisted Uvulopalatoplasty
A 56-year-old man visited our hospital with a 15-year history of persistent snoring and witnessed apnea after LAUP. His subjective snoring level was six on a seven-point Liker scale ranging from 0 (none of the time) to 6 (all of the time). He had no relevant medical history, including hypertension, diabetes mellitus, or stroke. Body mass index (BMI) was 24.8 kg/m2 (height was 162 cm and weight was 65 kg).\nOn direct examination of the oral cavity and oropharynx, the uvula was not observed because of the previous surgical procedure (). Palatine tonsils were small (hidden within the pillars), and the Friedman tongue position was presumed as grade 2 []. The soft palate length was longer than 2.5 cm, and nasopharyngeal stenosis was not found. Retropalatal obstruction was suspected based on physical examination and the Muller maneuver.\nHe was diagnosed with mild OSA based on diagnostic standard (overnight, attended, laboratory-based) polysomnographic results (AHI=7.6 events/hour [supine AHI=13.7 events/hour and non-supine AHI=0.6 events/hour], apnea index [AI]=0.8 events/hour, minimum SaO2=91%, arousal index=23.8 events/hour, and snoring=51.3%).\nContinuous positive airway pressure (CPAP) or oral appliance (OA) was recommended as a primary therapy. However, he was unwilling to accept CPAP or OA as a permanent solution and chose to undergo an alternative minimally invasive surgical treatment.\nA palatal stiffening procedure using the Pillar palatal implant procedure was performed under local anesthesia according to the following simple steps: (1) determine three palatal implant insertion sites and inject with local anesthetic agent on surgical fields; (2) insert the needle of the delivery system through the sub-mucosal tissue layer into the muscle and place the implants in the muscular layer of the palate (three implants were located at about 2 mm intervals); (3) withdraw the needle and inspect the palatal mucosal surface (oral and nasopharyngeal) to ensure the implants were properly placed. There were no specific perioperative complications except mild discomfort at the operative site.\nTwo months after the Pillar procedure, subjective snoring level decreased from 6 to 2 and follow-up standard polysomnographic results (AHI=1.3 events/hour [supine AHI=2.3 events/hour and non-supine AHI=0.3 events/hour], AI=0.0 events/hour, minimum SaO2=90%, arousal index=18.9 events/hour, and snoring=16.8%) were clearly improved compared to those of the preoperative sleep test (). BMI was 23.6 kg/m2 (body weight was 62 kg) at two months following the procedure. Mild discomfort at the operative site resolved without morbidity, and postoperative complications such as extrusion or infection were not observed.