Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P149

Oral Presentations

Optimizing Functional and Esthetic
Outcomes of the Nasomaxillary Complex
for Maxillomandibular Advancement
Mohamed A. Abdelwahab, MD, MS (Presenter);
Stanley Yung-Chuan Liu, MD, DDS
Objectives: Maxillomandibular advancement (MMA) is one
of the most effective surgical options for obstructive sleep
apnea (OSA); however, nasal function and form can be jeopardized, which may require corrective nasal surgery during
follow-up. The objective of this study was to describe the preoperative and surgical modifications applied for MMA candidates with OSA and investigate its effect on postoperative
outcome measures.
Methods: In this retrospective cohort study, the patients
reviewed were undergoing MMA for OSA in a tertiary referral
center with the described perioperative modifications in our
new protocol between January 2014 and February 2019.
Outcomes were the apnea-hypopnea index (AHI), Nasal
Obstruction Symptom Evaluation (NOSE) scores, SpO2 nadir,
and rate of corrective nasal surgery needed as compared to
the rate reported before applying these modifications.
Results: In this cohort, nasal surgery performed after MMA
was reported in 6.5% (8 of 122) of subjects at a mean of
7.5 months; range, 3 to 22 months. Among 122 patients
included, 6 subjects had functional nasal procedures either septoplasty and/or valve stenosis repair, whereas 2 had a combined
functional and cosmetic rhinoplasty, with an average follow-up
of 7.5 months. There was a significant reduction in AHI (−34.65,
P < .001) and NOSE scores (−5.96, P < .001); meanwhile, the
SpO2 nadir increased significantly (+6.08, P < .001).
Conclusions: The perioperative modifications described in
our new algorithm have been shown to minimize the incidence of corrective nasal surgery with relative risk reduction
of 65% compared with our previous reported incidence, with
significant improvement in NOSE scores and AHI.
Optimizing Intraoperative Identification of
Mixed Activation During Hypoglossal Nerve
Stimulation
Joshua J. Sturm, MD (Presenter); Clara H. Lee, MD;
Oleg Modik, PhD, CNIM; Ioannis Koutsourelakis;
Maria V. Suurna, MD
Objectives: Hypoglossal nerve stimulation (HGNS) reduces
upper airway obstruction by selectively stimulating nerve fibers

that innervate muscles that produce tongue protrusion (genioglossus [GG]) and stiffening (transverse/vertical [T/V]),
whereas avoiding nerve fibers that innervate muscles that produce tongue retraction (styloglossus/hyoglossus [SG/HG]).
Patients who exhibit mixed activation profiles (combination of
protrusion and retraction) have inferior therapeutic outcomes
compared with patients with protrusion only. This study illustrates how using an expanded intraoperative stimulation protocol can be used to intraoperatively identify and avoid
difficult-to-detect retractor nerve fibers.
Methods: This is a case series of 4 patients undergoing unilateral (right) HGNS for moderate to severe obstructive sleep apnea.
Data included electromyography responses in GG, T/V, and SG/
HG muscle groups to intraoperative unipolar and bipolar stimulation at various intensities via an implantable pulse generator.
Results: The expanded intraoperative stimulation protocol
identified significant mixed activation that was undetectable
by standard settings. Specifically, using low-stimulation
voltages and unipolar settings was crucial for identifying patterns of mixed activation that were otherwise hidden.
Identification of mixed activation enabled successful electrode cuff repositioning.
Conclusions: Mixed activation of tongue muscles that produce tongue protrusion and retraction during HGNS can lead
to inferior clinical responses compared with protrusion only.
Using a novel, expanded intraoperative stimulation protocol
can optimize identification of retractor nerve branches contributing to mixed activation, which can be addressed with
electrode cuff repositioning.
The Predictive Value of TCM Scoring
System for Velopharyngeal Surgical
Outcomes in Adult Obstructive Sleep Apnea
Jingying Ye, MD (Presenter); Junbo Zhang, MD;
Guoping Yin, MD; Xin Cao; Jingying Ye, MD
Objectives: Our research group had built what we call a TCM
scoring system, based on tonsil size, hyoid position, and the percentage of time with oxygen saturation below 90% during sleep,
and had further proved the high efficacy of this system in predicting the treatment outcomes of velopharyngeal surgery for
adult obstructive sleep apnea (OSA). The present study was performed to prospectively test the clinical value of this system.
Methods: A total of 145 OSA patients who underwent velopharyngeal surgery were prospectively studied. The Friedman
stage and TCM score were calculated for all patients. A ≥50%
reduction in apnea-hypopnea index (AHI) to a final AHI of
<20 at least 3 months after surgery was defined as surgical
success. A final AHI of <5 was defined as surgical cure.
Results: The overall AHI decreased significantly from 46.6 ±
22.0 to 15.7 ± 15.2 events/h after surgery (P < .001). There
were 95 responders (65.5%), including 35 who were totally
cured (24.1%). The percentage of patients with Friedman stage
I was 9.0% (13/145), which was significantly lower than the
percentage of patients with TCM scores of <14, 35.2% (51/145;
P < .001). The success rate and cure rate in Friedman stage I

Sleep Medicine

(P = .17). At final follow-up, more of the R group showed
subjective improvement (316/329; 96%) as measured by the
Clinical Global Impression index compared with the NR
group (108/139; 78%; P = .0001).
Conclusions: Patients classified as NR to upper airway stimulation continued to use therapy with improvement in percentage time of sleep with O2 <90%, reduction in daytime
sleepiness, and improvement in quality of life. Therefore,
ongoing use of the device should be encouraged in patients
initially determined to be nonresponders.

P149

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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