Palatal Implantation Using Platelet Rich Plasma and Radio Frequency Palatal Surgery for Management of Obstructive Sleep Apnea

Research Article

Int J Nutr Sci. 2022; 7(1): 1064.

Palatal Implantation Using Platelet Rich Plasma and Radio Frequency Palatal Surgery for Management of Obstructive Sleep Apnea

Elsayad OA*, Bioumy OE and El Sayed MD

Department of Otolaryngology, Benha University, Egypt

*Corresponding author: Osama A Elsayad, Department of Otolaryngology, Benha University, Benha 13111, Egypt

Received: June 09, 2022; Accepted: July 07, 2022; Published: July 14, 2022


Background: Obstructive Sleep Apnea (OSA) is a common health problem affecting large number of people all over the world with great psychological and physiological burdens. The aim of this study is to investigate the effect of radio frequency palatal Surgery and platelet rich plasma in the soft palate as a new technique in treatment of obstructive sleep apnea OSA.

Patients and Methods: This study included 30 patients with mild to moderate OSA Group A: n=15 (Tonsillectomy and palatal radio frequency surgery) and Group B n=15 (Tonsillectomy and Platelet Rich Plasma (PRP) palatal injection, this study investigate the effect of body mass index, retropalatal anteroposterior diameter, Epworth Steepness Scale Apnea Hypopnia Index in treatment of OSA in both groups.

This study found that both techniques improved day time sleepiness with reduction of Apnea-Hypopnea Index (AHI), also there was marked improvement in radiological parameters in the form of increase of the anteroposterior diameter and retro-palatal cross section area, there was reduction of Body Mass Index BMI in postoperative in both groups but there was superiority of group A over group B in improvement of this parameters, group A success rate was 86.6% and Group B was 80%.

Conclusion: Radio frequency palatal surgery and platelet rich plasma, both are effective as a treatment of obstructive sleep apnea due to retro-palatal collapse.

Keywords: Radiofrequency Ablation; Platelet Rich Plasma; Snoring; Obstructive Sleep Apnea; Body Mass Index; Apnea Hypopnea Index; Palatal; Retropharyngeal Diameter


Obstructive Sleep Apnea (OSA) is a serious health problem affecting a large number of people all over the world. The prevalence ranged from 9% to 37%, the Apnea-Hypopnea Index (AHI) =5, being higher in men. It increases with age. OSA prevalence is directly proportional to the Body Mass Index (BMI), so the disease is more common among obese people [1].

Obstructive Sleep Apnea (OSA) is presented by pharyngeal collapse during sleep, Pharyngeal collapse can occur at the retropalatal level (soft palate), retroglossal level (tongue base), oropharyngeal lateral walls, and/or hypopharynx. [1].

Radiofrequency Ablation (RFA) is effective in treatment of OSA, The mechanism of action for RFA is due to a low temperature, high frequency current leads to local inflammation, fibrosis and stiffening of the tissue. RFA of the soft palate is minimally invasive, with few complications, and aims to stiffen the soft palate [2].

The treatment of patients with obstructive sleep apnea using palatal implantation in the of multi- level or stepwise surgery has been relatively little research on using palatal implants alone for the treatment of OSA [3].

Platelets are unique blood elements initiating homeostasis and healing processes. Platelet Rich Plasma (PRP) is plasma contains a high concentration of platelets. Data from human and animal studies provide both direct and indirect evidence that platelet rich plasma plays a considerable role in tissue regenerative processes [4].

The recent development of platelet concentrate for surgical use is an evolution of the fibrin glue technologies [5], these different technologies were tested in many clinical fields, particularly oral and maxillofacial surgery, Ear-Nose-Throat surgery, plastic surgery, orthopedic surgery, sports medicine, gynecologic and cardiovascular surgery and ophthalmology [6].

This study aimed to investigate the effect of palatal Radiofrequency technique and platelet rich plasma injection in the soft palate as a new technique in treatment of mild and moderate obstructive sleep apnea.

Patients and Methods

This study is a prospective randomized case series clinical study. The study was conducted on Otorhinolaryngology clinics of Benha University Hospitals, during the period from June 2019 June 2021. This study included 30 patients with mild to moderate OSA were divided into two groups

The study was approved by the local ethics committee of faculty of medicine, Benha University in accordance with the declaration of Helsinki. Oral and written consent were taken from all patients who participated in this study

Inclusion Criteria

• Both sexes

• Patients> 18 years old, and < 60 years.

• Body Mass Index (BMI) of patients less than 35 kg/m2.

• Patients diagnosed with OSAS with palatal flutter and collapse.

• Documented failure/refusal of attempts of conservative treatment measures (not limited to continuous positive airway pressure CPAP).

• Class 1 occlusion.

• Pharyngeal tonsillar size grade I–II- III

Exclusion Criteria

• Patient age<18 or >60 years old.

• Marked deviated septum or marked hypertrophy of inferior turbinate

• Modified Mallampati classification: class IV tongue position

• Retrognathia, craniofacial abnormalities, chronic rhino sinusitis, trismus, anesthetic allergies.

• Patient with central type apnea.

• Body mass index (BMI)>35Kg/m2.

• Failure to attend postoperative follow-up polysomnography

• Previous surgery to the palate or other surgical treatment of OSAHS.

• A history of malignancy of the head and neck region, laryngeal trauma, or other previous oropharyngeal/laryngeal surgery.

• Class 2 occlusion.

• Patients with severe medical illness.

Study Population

Thirty patients complaining of OSA (mild to moderate) degree, due to retropalatal collapse. After getting informed consent, patients were randomly allocated to two groups:

Group A: tonsillectomy with palatal radiofrequency technique

Group B: tonsillectomy with palatal PRP injection.

Preoperative Evaluation

• Full detailed history (personal, present and past history)

• Complete clinical and physical examination:

• Otorhinolaryngological examination.

• Endoscopic examination by Awake Fiberoptic

Nasopharyngoscopy with Müller’s maneuver:

• Epworth Sleepiness Scale

• Polysomnography (PSG):

• Radiological examination, by Volumetric CT for the upper airway to evaluate the retropalatal space:

• Other preoperative investigation

• Bleeding profile

• Liver functions

• Kidney functions

• Blood sugar

• Viral markers


• Chest X-Ray

Operative Procedures

• Patients were operated upon through the period from June 2019 to June 2021

• All the operative procedures were done by same E.N.T. surgeon.

• Patients were randomly allocated to two groups each included fifteen patients.

• Group A: n=15 palatal radiofrequency technique

• Group B: n=15 Tonsillectomy and PRP injection

• All patients underwent transoral endotracheal intubation under general anesthesia.

Group A: As shown in (Figure 1,2)