Acta Scientific Otolaryngology (ASOL) (ISSN: 2582-5550)

Case Report Volume 4 Issue 5

Recurrence of OSAHS in a Patient Previously Treated with MAD and Multilevel Surgery: The Role of Epiglottis

Giulia Anna Marciante*, Federico Leone, Alessandro Bianchi, Chiara Re and Fabrizio Salamanca

Unit of Otorhinolaryngology, Head and Neck Surgery, Humanitas San Pio X, Milan, Italy

*Corresponding Author: Giulia Anna Marciante, Unit of Otorhinolaryngology, Head and Neck Surgery, Humanitas San Pio X, Milan, Italy.

Received: April 04, 2022; Published: April 19, 2022


The introduction of sleep endoscopy in the diagnosis of sleep apnea-hypopnea syndrome (OSAHS) has led to the development of a customization in the surgical approach of patients refusing nocturnal ventilation. Sometimes follow up polysomnography can show a recurrence of OSAHS, even in patients with no changes in weight or head and neck anatomy. We report a case of a patient undergone uvulopalatopharyngoplasty and epiglottoplasty showing a worsening of OSAHS years after surgery.

A 69-year-old man with moderate OSAHS refusing overnight ventilation underwent sleep endoscopy showing collpase of palate, tongue base and epiglottis. Uvulopalatopharyngoplasty and epiglottoplasty were then perfomed in addiction to application of mandibular advancement device (MAD), with normalization of parameters, as shown by the following polysomnographies. Over time, symptomes started to recur, and the patient underwent a new polysomnpography showing increase of apnea-hypopnoea index (AHI). A second sleep endoscopy was therefore performed, pointing out the role of the collapse of the residual epiglottis in developing apneas. Epiglottis stiffening operation was consequently perfomed with resolution of symptoms and reduction of AHI.

Patients treated with surgery and MAD should always be monitored with follow up polysomnography. Worsening of symptoms should be evaluated by means of sleep endoscopy in order to identify and treat the new causes of obstruction.

Keywords: OSAHS; Mandibular Advancement Device; Epiglottoplasty; Sleep Endoscopy


  1. Weaver TE and Grunstein RR. “Adherence to continuous positive airway pressure therapy: the challenge to effective treatment”. Proceedings of the American Thoracic Society 5 (2008): 173-178.
  2. Chong KB., et al. “Drug-Induced Sleep Endoscopy in Treatment Options Selection”. Sleep Medicine Clinics 14 (2019): 33-40.
  3. Heiser C and Eckert D. “Pathophysiology of obstructive sleep apnea”. HNO 67 (2019): 654-662.
  4. Salamanca F., et al. “Surgical treatment of epiglottis collapse in obstructive sleep apnoea syndrome: epiglottis stiffening operation”. Acta Otorhinolaryngology Italy 39 (2019): 404-408.
  5. Young T., et al. “The occurrence of sleep-disordered breathing among middle-aged adults”. The New England Journal of Medicine 328 (1993): 1230-1235.
  6. Rotenberg BW., et al. “Trends in CPAP adherence over twenty years of data collection: a flattened curve”. Journal of Otolaryngology - Head and Neck Surgery 45 (2016): 43.
  7. Lin HC., et al. “Multilevel Obstructive Sleep Apnea Surgery”. Advances in Otorhinolaryngology 80 (2017): 109-115.
  8. Meccariello G., et al. “Transoral robotic surgery for the management of obstructive sleep apnea: a systematic review and meta-analysis”. European Archives of Otorhinolaryngology 274 (2017): 647-653.
  9. Barrera JE. “Skeletal Surgery for Obstructive Sleep Apnea”. Otolaryngologic Clinics of North America 49 (2016): 1433-1447.
  10. Ramar K., et al. “Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015”. Journal of Clinical Sleep Medicine 11 (2015): 773-827.
  11. De Vito A., et al. “European position paper on drug-induced sleep endoscopy: 2017 Update”. Clinical Otolaryngology 43 (2018): 1541-1552.
  12. Dieltjens M and Vanderveken O. “Oral Appliances in Obstructive Sleep Apnea”. Healthcare (Basel) 7 (2019): 141.
  13. Mozota Núñez JR., et al. “Effectiveness of Uvulopalatopharyngoplasty in Snoring Disorders and Obstructive Sleep Apnea”. Acta Otorrinolaringology Esp 49 (1998): 629-632.
  14. Torre C., et al. “Epiglottis collapse in adult obstructive sleep apnea: A systematic review”. Laryngoscope 126 (2016): 515-523.
  15. Golz A., et al. “Laser partial epiglottidectomy as a treatment for obstructive sleep apnea and laryngomalacia”. Annals of Otology, Rhinology and Laryngology 109 (2000): 1140-1145.


Citation: Giulia Anna Marciante., et al. “Recurrence of OSAHS in a Patient Previously Treated with MAD and Multilevel Surgery: The Role of Epiglottis".Acta Scientific Otolaryngology 4.5 (2022): 26-29.


Copyright: © 2022 Giulia Anna Marciante., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Acceptance rate34%
Acceptance to publication20-30 days
Impact Factor0.871

Indexed In

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is May 30, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US