The Pillar Implant Procedure
The Pillar Implant procedure is a Palatal Stiffening operation. As with radiofrequency ablation of the soft palate (alias RPM, Somnoplasty), the principle is that reduction of soft palate flutter during sleep reduces snoring. Polyester implants are inserted using a disposable hand-held advancing device under local anesthetic in the office setting. Subsequent fibrosis further improves the stiffening effect. The patient is able to return to normal activities at once. Complications include inadvertent placement of the implant through the posterior palatal wall into the nasopharynx, and spontaneous extrusion of the implant at a later date.
The procedure was approved by Health Canada in the fall of 2006, but has been in use extensively in the USA and elsewhere since about 2004.
Friedman (33) has studied retrospectively 125 consecutive patients who had the implant, following them for an average of 7.5 months. He treated primary snorers and those with mild to moderate OSA. He found subjective improvement in snoring in 88%, and objective “cure” of OSA in 34% (“cure” was defined as AHI reduction by 50% or more and a resultant AHI less than 20). There was an approximately 4% extrusion rate. Morbidity was minimal. The majority of patients rated their pain level as a 3-5 on a 10 point scale for the first 24 hours.
In a more recent prospective study (34), not yet peer-reviewed but reportedly presented at the Sept. 2006 AAO meeting in Toronto; Friedman looked at 55 consecutive patients and used a sham procedure, double blind, to form a control group. At least 50% improvement in snoring occurred in 62%, and daytime somnolence was also statistically improved. OSA was “cured” (definition as above) in 38%.
The maximum follow up period studied so far is 15 months. Results have been sustained for that period.
At this point therefore, for snoring, the PIP has the advantage over LAUP in that the pain and morbidity is significantly less. It may have an advantage over RPM, particularly in relapse rate, but this really remains to be proved. In terms of effectiveness for snoring, the success rate is comparable to other procedures. For OSA, the results are not impressive, but nor are the overall results of the much more invasive UPPP. The key for UPPP lies in patient selection on the basis of level-of-obstruction at upper airway endoscopy, which provides much better results (depending on indication criteria). It remains to be seen whether the same will be true for PIP.