Surgical management of the hypopharyngeal airway in sleep disordered breathing

The etiology of sleep disordered breathing is collapse or obstruction of th e upper airway during sleep. This obstruction may be localized to one or tw o areas or may encompass the entire upper airway passages to include the na sal cavity, nasopharynx, oropharynx, hypopharynx, and larynx. The presurgic al evaluation, which includes polysomnography, a comprehensive head and nec k physical examination, fiberoptic nasopharyngoscopy, and lateral cephalome tric analysis is essential in directing surgical therapy in a site specific approach. The surgical procedures available to address hypopharyngeal and base of the tongue collapse include inferior sagittal mandibular osteotomy and gengioglossus advancement, hyoid myotomy and suspension, laser midline glossectomy, lingualplasty, partial glossectomy, and maxillomandibular adva ncement surgery. The Riley-Powell-Stanford Surgical Protocol has proven to be an effective and safe method for controlling upper airway collapse in sl eep disordered breathing.