HYPOPHARYNGEAL AIRWAY SURGERY FOR OBSTRUCTIVE SLEEP-APNEA SYNDROME

Sleep-related breathing disorders (SRBD) encompass a spectrum of disea se severity that includes simple snoring, upper airway resistance synd rome (UARS), obstructive sleep apnea (OSA), and obesity-hypoventilatio n syndrome. Treatment is instituted to avoid the cardiovascular sequel ae and behavioral derangements of sleep-related upper airway collapse, A number of medical and surgical options have been discovered only wi thin the last 25 years, Although effective for OSA, a tracheotomy is o ften not an option for most patients because of the lack of social acc eptance, The medical gold standard, nasal continuous positive airway p ressure (CPAP), has less than a 50% compliance rate, Oral appliances, which are designed to protrude the jaw or tongue, or both, have approx imately a 50% treatment success rate and compliance rates between 25 a nd 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 deficien ces have stimulated the implementation of multilevel pharyngeal surger y that has advanced the treatment of these SRBD to overall success rat es to as high as 95%, This success rate is seen with the Riley-Powell- Stanford Surgical Protocol and mandates a preoperative evaluation to i nclude a head and neck examination, flexible nasopharyngoscopy with th e Muller manuever and lateral cephalometric radiographs to determine t he location of upper airway obstruction, UPPP is directed to the palat al obstruction, and genioglossus advancement (GA) addresses the base o f tongue and hypopharyngeal collapse, When residual obstruction persis ts, either a hyoid suspension or maxillomandibular advancement culmina tes the reconstruction.