OSAS Tedavisinde Palatal Cerrahinin Yeri

Murat ENÖZ

2005, Cilt 10, Sayı 4, Sayfa(lar) 147-150

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OSAS Tedavisinde Palatal Cerrahinin Yeri

Murat ENÖZ

İstanbul Üniversitesi İstanbul Tıp Fakültesi Kulak Burun Boğaz Hastalıkları Anabilim Dalı, İSTANBUL

Anahtar Kelimeler: Uvulopalatofarengoplasti, uvulopalatal flep, obstrüktif sleep apne, palatal cerrahi, komplikasyonlar, Uvulopalatopharyngoplasty, uvulopalatal flap, obstructive sleep apnea, palatal surgery, complications

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Uvulopalatofarengoplasti (UPPP) ilk olarak 1981 yılında Fujita ve arkadaşları¹ tarafından tanımlanmış ve obstrüktif sleep apne sendromu (OSAS) cerrahi tedavisinde başlıca temel teknik olarak kabul edilmiştir. Bu tekniğin ilk tanımlanmasından itibaren yöntemin sleep apne tedavisindeki etkinliği araştırılmıştır. Maalesef bu çalışmaların sonucunda tek başına UPPP nin tedavideki etkinliğinin sınırlı olduğu görülmüştür. Tek başına UPPP, sleep apneli hastaların tedavisinde sınırlı başarı oranına sahiptir. Buna karşılık, özenle seçilmiş hastalarda, palatal prosedürler üst hava yolundaki obstrüksiyon yerlerine yönelik diğer cerrahi yöntemlerle kombine edildiğinde başarı oranı artmaktadır. ©2005, Fırat Üniversitesi, Tıp Fakültesi

The uvulopalatopharyngoplasty (UPPP) first described in 1981 by Fujita et al ¹, continues to be the mainstay for surgical treatment of OSA patient. . Since its introduction, there has been considerable effort expended studying the efficacy of this procedure and the role that it should play in the management of OSA. Unfortunately, the results of these studies have shown that UPPP as an isolated intervention for the treatment of OSA has met with mediocre results. Isolated UPPP has been shown to have limited success for treatment of OSA patients. In comparison, palatal procedures combined with other surgical approaches that address the multiple sites of obstruction in the upper aerodigestive tract seem to have improved success in the carefully selected patient. ©2005, Fırat Üniversitesi, Tıp Fakültesi

Giriş

OSAS, uyku sırasında periyodik olarak aralıklı solunumun durmasına (apne) yol açan tam veya parsiyel havayolu obstrüksiyonu veya solunum eforuna rağmen airflowda azalma (hipopne) ile karakterizedir (Şekil I ²).

Obstrüktif sleep apne fizyopatolojisi

Trakeotomi haricinde kesin olarak OSAS tedavisini sağlayan başka bir cerrahi yöntem olmamakla birlikte uvulopalatofarengoplasti (UPPP) en sık kulanılan yöntemdir ².

OSAS tedavisindeki amaç, en az yan etki ile mortalite ve morbiditeyi azaltarak semptomları hafifletmektir. Son 20 yıl içerisinde OSAS tedavisi için birçok cerrahi prosedür tanımlanmıştır (Tablo I ³).

Tablo 1: Cerrahi prosedürlerin primer etki yerleri ve mekanizmaları

Kaynaklar

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