New clinical staging for pharyngeal surgery in
                    obstructive sleep apnea patients

Vidigal, Tatiana Aguiar; Haddad, Fernanda Louise Martinho; Cabral, Rafael Ferreira Pacheco; Oliveira, Maria Claudia Soares; Cavalcante, Ricardo Rodrigues; Bittencourt, Lia Rita Azeredo; Tufik, Sergio; Gregório, Luis Carlos

doi:10.1016/j.bjorl.2014.09.003

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Brazilian Journal of Otorhinolaryngology

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Original Articles • Braz. j. otorhinolaryngol. 80 (6) • Nov-Dec 2014 • https://doi.org/10.1016/j.bjorl.2014.09.003 copy

New clinical staging for pharyngeal surgery in obstructive sleep apnea patients^☆ ☆ Please cite this article as: Vidigal TA, Haddad FL, Cabral RF, Oliveira MC, Cavalcante RR, Bittencourt LR, et al. New clinical staging for pharyngeal surgery in obstructive sleep apnea patients. Braz J Otorhinolaryngol. 2014;80:490-6. ,^☆☆ ☆☆ Institution: Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction:

The success of pharyngeal surgery in the treatment of obstructive sleep apnea syndrome depends on the appropriate selection of patients.

Objective:

To propose a new staging for indication of pharyngeal surgery in obstructive sleep apnea syndrome.

Methods:

A total of 54 patients undergoing extended tonsillectomy were retrospectively included, divided into six stages. Stage I: patients with palatine tonsils grade 3/4 and modified Mallampati index 1/2; stage II: palatine tonsils 3/4 and modified Mallampati index 3/4; stage III: palatine tonsils 1/2 and modified Mallampati index 1/2; stage IV: palatine tonsils 1/2 and modified Mallampati index 3/4; stage V: body mass index ≥40 kg/m² with palatine tonsils 3/4 and modified Mallampati index 1, 2, 3, or 4. Stage VI: body mass index ≥40 with palatine tonsils 1/2 and modified Mallampati index 1, 2, 3, or 4.

Results:

The surgical success rates were 88.9%, 75.0%, 35.7%, 38.5%, and 100.0% in stages I–V.

Conclusion:

The presence of hypertrophic palatine tonsils was the anatomical factor in common in the most successful stages (I, II, and V), regardless of body mass index. Although the modified Mallampati index classes 3 and 4 reduced the success rate of surgery in patients with hypertrophic tonsils (stage II), the presence of modified Mallampati index classes 1 and 2 did not favor surgical success in patients with normal tonsils (stage III).

Sleep apnea, obstructive; Tonsillectomy; Classification

Stage	MMI	PTC	BMI
Stage I	1 or 2	3 or 4	<40 kg/m²
Stage II	3 or 4	3 or 4	<40 kg/m²
Stage III	1 or 2	1 or 2	<40 kg/m²
Stage IV	3 or 4	1 or 2	<40 kg/m²
Stage V	1, 2, 3, or 4	3 or 4	>40 kg/m²
Stage VI	1, 2, 3, or 4	1 or 2	>40 kg/m²

	MMI	Size of palatine tonsils	BMI
Friedman I	1 or 2	3 or 4	<40 kg/m²
Friedman II	1 or 23 or 4	0, 1 or 2 3 or 4	<40 kg/m²
Friedman III	3 or 4	0, 1 or 2	<40 kg/m²
Friedman IV	1, 2, 3, or 4	0, 1, 2, 3, or 4 Evident craniofacial alteration	>40 kg/m²

	Success		Failure		Total	p
	n	%	n	%	n	p
Stage I	8	88.9	1	11.1	9	0.07
Stage II	6	75.0	2	25.0	8	0.44
Stage III	5	35.7	9	64.3	14	0.02
Stage IV	5	38.5	8	61.5	13	0.03
Stage V	10	100.0	0	0.0	10	<0.01
Stage VI	No surgical indication

	Success		Failure		Total	p
	n	%	n	%	Total	p
AHI 5–15	9	37.5	15	62.5	24	<0.01
AHI 15–30	16	80	4	20	20	0.08
AHI > 30	10	100	0	0	10	0.01

OSAS		Success		Failure		Total	p
OSAS		n	%	n	%	Total	p
Stage I
	Mild	0	0	1	100.0	1	0.11
	Moderate	6	100.0	0	0.0	6	0.33
	Marked	2	100.0	0	0.0	2	0.77
Stage II
	Mild	2	66.6	1	33.3	3	0.64
	Moderate	2	66.6	1	33.3	3	0.64
	Marked	2	100.0	0	0.0	2	0.53
Stage III
	Mild	4	40	6	60.0	10	0.54
	Moderate	1	25	3	75.0	4	0.54
	Marked	0	0	0	0.0	0	-
Stage IV
	Mild	2	22.2	7	77.8	9	0.11
	Moderate	2	66.6	1	33.3	3	0.31
	Marked	1	100	0	0.0	1	0.38
Stages V
	Mild	1	100	0	0.0	1	-
	Moderate	5	100	0	0.0	5	-
	Marked	4	100	0	0.0	4	-
Stages VI
No surgical indication

	Success		Failure		Total	p
	n	%	n	%	n	p
Stage I	8	89.9	1	11.1	9	0.13
Stage II	11	50.0	11	50.0	22	0.07
Stage III	5	38.5	8	61.5	13	0.03
Stage IV	10	100.0	0	0.0	10	<0.01

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] * Corresponding author. E-mail: femartinho@uol.com.br (F.L.M. Haddad).