Structural effectiveness of pharyngeal sleep apnea surgery.
Obstructive sleep apnea results from the combination of a structurally small upper airway combined with the loss of muscle tone during sleep. Most therapies aim to reduce apnea severity by increasing airway size and stability. Conceptually, upper airway surgery should be a highly effective method to treat obstructive sleep apnea and other forms of sleep disordered breathing. Although major reconstructive surgeries such as maxillomandibular advancement demonstrate high success rates, more limited forms of surgery often demonstrate significantly lower success rates. Reviews of such surgical procedures have uniformly ignored contributions of the structural effectiveness of surgery. The purpose of the review is to evaluate current knowledge of how surgery for OSA alters structure. The majority of data available on surgical outcomes involve uvulopalatopharyngoplasty. Data demonstrate that pre-morbid surgical anatomy and techniques have significant effects on ultimate outcomes. Further research on structural outcomes for palatopharyngoplasty, as well as other surgical procedures, is needed to improve clinical outcomes.
Tucker Woodson
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Division of Sleep Medicine, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA. bwoodson@mcw.edu
D000402:Airway Obstruction / Q000503:physiopathology / Q000601:surgery; D000403:Airway Resistance / Q000502:physiology; D005927:Glossectomy; D006801:Humans; D019248:Jaw Fixation Techniques; D019186:Mandibular Advancement; D010160:Palate, Soft / Q000503:physiopathology / Q000601:surgery; D010614:Pharynx / Q000503:physiopathology / Q000601:surgery*; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000601:surgery*; D014068:Tonsillectomy; D014609:Uvula / Q000503:physiopathology / Q000601:surgery