Revision uvulopalatoplasty by Z-palatoplasty.

Objective: To study the effectiveness of Z-palatoplasty (ZPP) for patients with persistent obstructive sleep apnea/hypopnea syndrome (OSAHS) after previous uvulopharyngopalatoplasty (UP3).

Setting: Prospective study of 31 subjects who sought revision surgery in university-affiliated medical center.

Study Design: In accord with Institutional Review Board approval, 40 consenting adult patients with persistent, progressive, or recurrent OSAHS of moderate/severe severity despite previous UP3 surgeries were enrolled. All patients had preoperative subjective assessment of daytime sleepiness, quality of life, and snoring level. All patients underwent revision ZPP, radiofrequency tongue-base reduction, and often repair of nasopharyngeal stenosis. Follow-up continued for 6 months.

Results: Thirty-one patients completed the study. No patient demonstrated clinically significant postoperative velopharyngeal incompetence after 14 weeks. No major perioperative complications occurred. Subjective improvement was achieved in all patients, and objective cure was achieved in 21 patients (67.7%).

Conclusions: Z-palatoplasty is safe and effective for selected patients who have failed UP3.