Soft-Tissue Surgery for Obstructive Sleep Apnea Syndrome

Abstract

The great majority of adult patients with obstructive sleep apnea (OSA) have no specific space-occupying lesions, and apnea results from disproportionate anatomy of the upper airway and its supporting structures. Skeletal and soft-tissue components of the anatomy of the head and neck contribute to this disproportionate anatomy. The pharyngeal airway, the site of obstruction, is functionally divided into two portions: retropalatal and retrolingual. This functional classification has served as the basis for the development of contemporary surgical protocols. Each surgical technique is designed to alter primarily the retropalatal or retrolingual portion of the pharyngeal anatomy. Each surgical procedure alters the soft-tissue components, the skeletal components, or both. Procedures that alter primarily the soft tissue components are the subject of this review: uvulopalatopharyngoplasty (UPPP), uvulopalatopharyngoglossoplasty (UPPGP), laserassisted uvulopalatoplasty (LAUP), laser midline glossectomy (LMG), and linguoplasty. Techniques, and limitations of techniques, for identifying retropalatal and retrolingual collapse in assigning patients to surgical approach are discussed. Surgical outcomes for each procedure are reviewed.

Key Words:

obstructive sleep apnea - sleep apnea syndrome - surgery - soft-tissue surgery - palate surgery - tongue surgery