Hypopharyngeal Airway Surgery For Obstructive Sleep Apnea Syndrome

Abstract

Sleep-related breathing disorders (SRBD) encompass a spectrum of disease severity that includes simple snoring, upper airway resistance syndrome (UARS), obstructive sleep apnea (OSA), and obesity-hypoventilation syndrome. Treatment is instituted to avoid the cardiovascular sequelae and behavioral derangements of sleep-related upper airway collapse. A number of medical and surgical options have been discovered only within the last 25 years. Although effective for OSA, a tracheotomy is often not an option for most patients because of the lack of social acceptance. The medical gold standard, nasal continuous positive airway pressure (CPAP), has less than a 50% compliance rate. Oral appliances, which are designed to protrude the jaw or tongue, or both, have approximately a 50% treatment success rate and compliance rates between 25 and 75%. Uvulopalatopharyngoplasty (UPPP) alone has been shown to have only a 40% success rate. Oral appliances and UPPP surgery offer lower success rates in those with moderate to severe disease. These deficiences have stimulated the implementation of multilevel pharyngeal surgery that has advanced the treatment of these SRBD to overall success rates to as high as 95%. This success rate is seen with the Riley-Powell-Stanford Surgical Protocol and mandates a preoperative evaluation to include a head and neck examination, flexible nasopharyngoscopy with the Midler manuever and lateral cephalometric radiographs to determine the location of upper airway obstruction. UPPP is directed to the palatal obstruction, and genioglossus advancement (GA) addresses the base of tongue and hypopharyngeal collapse. When residual obstruction persists, either a hyoid suspension or maxillomandibular advancement culminates the reconstruction.

Key Words:

genioglossus advancement (GA) - hyoid myotomy and suspension (HM) - maxillomandibular osteotomy advancement (MMO)