Advances in the Role of Pharyngeal Surgery in the Treatment of OSAS

Abstract

The American Academy of Sleep Medicine and the American Academy of Otolaryngology–Head and Neck Surgery recommend surgery as an option for the treatment of OSAS, when noninvasive treatments such as CPAP or oral appliances have not been successful or are not tolerated. A gradual and logical approach must be taken into account when a patient seeks a surgical solution, and it is a fundamental requirement that the patient find a surgeon who understands both the pathophysiology of sleep apnea and anatomy of the upper airways (UA) to guarantee the best chances of success. The surgical options aim to solve the obstructive problem according to two ways, the first is the reduction of the content, and then acts through the volumetric reduction of soft tissues at the level of UA, most often at the level of palate, uvula, tonsils, adenoids and tongue. The second option aims at enlarging the container, and therefore on more complex interventions to adapt the bony structures of the skull. The soft palate in the snore-surgery is the anatomical site on which most of the attention has always been concentrated since it is responsible for most of the phenomena of snoring and most of the obstructive ones and has undergone the greatest innovations. The rationale for palatal surgery is to reduce volume and stiffen a structure that vibrating with the passage of air causes snoring and collapsing causes an obstruction of the UA. In general, interventions on the palate can be broadly divided into two groups, the first is represented by interventions that have the aim of reduce snoring, and in this case are less invasive surgeries, as the goal is that of stiffening the palate and reducing the excess mucosa that vibrating causes snoring. The second group consists of interventions that have the aim of reducing above the snoring especially the apnoic episodes, so they are interventions that have a greater invasiveness, since they must stiffen and reconstitute the functionality of a segment of the UA.