What types of surgical interventions are used in the treatment of obstructive sleep apnea (OSA)?

Answer

When surgical therapy is indicated, conservative procedures are attempted first. These procedures include uvulectomy, nasal reconstruction, adenotonsillectomy, and palatal implants. More aggressive operations include uvulopalatopharyngoplasty (UPPP, or UP3; demonstrated in the image below) and genioglossal advancement with hyoid myotomy. Second-line treatments for OSA are more complex and include maxillary-mandibular advancement, bimaxillary advancement, palatal advancement and tongue-base surgery (midline glossectomy), and tracheostomy.

Uvulopalatopharyngoplasty. Reprinted with permission from Elsevier [Hester JE, Powell NB, Riley RW, and Li KK. Maxillary-mandibular advancement in obstructive sleep apnea. Operative Techniques in Otolaryngology-Head and Neck Surgery. 2002;13(2):135-7].

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Media Gallery

Uvulopalatopharyngoplasty. Reprinted with permission from Elsevier [Hester JE, Powell NB, Riley RW, and Li KK. Maxillary-mandibular advancement in obstructive sleep apnea. Operative Techniques in Otolaryngology-Head and Neck Surgery. 2002;13(2):135-7].
Hyoid suspension for obstructive sleep apnea. The infrahyoid muscles are detached from the body of the hyoid bone using electrocautery. Reprinted with permission from Elsevier [Krespi YP and Kacker A. Hyoid suspension for obstructive sleep apnea. Operative Techniques in Otolaryngology-Head and Neck Surgery. 2002;13(2):144-9].
Hyoid suspension for obstructive sleep apnea. The hyoid is divided in the midline, and the loop suture is passed around the hyoid. The loop suture is suspended to the mandible, thereby suspending the tongue base anterosuperiorly. This enhances the posterior air space. A variation of this procedure is the hyoid advancement, whereby the hyoid is advanced, with several sutures (ie, 2-0 Ethibond) anteriorly and inferiorly over the thyroid lamina. Reprinted with permission from Elsevier [Krespi YP and Kacker A. Hyoid suspension for obstructive sleep apnea. Operative Techniques in Otolaryngology-Head and Neck Surgery. 2002;13(2):144-9].
Maxillary-mandibular advancement in obstructive sleep apnea. Final appearance of the advancement with rigid fixation. Reprinted with permission from Elsevier [Hester JE, Powell NB, Riley RW, and Li KK. Maxillary-mandibular advancement in obstructive sleep apnea. Operative Techniques in Otolaryngology-Head and Neck Surgery. 2002;13(2):135-7].
Bipolar radiofrequency cold ablation turbinate reduction for obstructive inferior turbinate hypertrophy. Depiction of linear passage of the coblation wand. Reprinted with permission from Elsevier [Bhattacharyya N and Kepnes LJ. Bipolar radiofrequency cold ablation turbinate reduction for obstructive inferior turbinate hypertrophy. Operative Techniques in Otolaryngology-Head and Neck Surgery. 2002;13(2):170-4].
Bipolar radiofrequency cold ablation turbinate reduction for obstructive inferior turbinate hypertrophy. Anterior rhinoscopic view of the coblation wand as it enters the anterior head of the right inferior turbinate. Reprinted with permission from Elsevier [Bhattacharyya N and Kepnes LJ. Bipolar radiofrequency cold ablation turbinate reduction for obstructive inferior turbinate hypertrophy. Operative Techniques in Otolaryngology-Head and Neck Surgery. 2002;13(2):170-4].
Preoperative findings: The larynx is exposed with a Parson's laryngoscope; the laryngeal inlet and supraglottic structures are visualized along with an appropriate sized laser-safe endotracheal tube. Short, tethered aryepiglottic folds are noted bilaterally.
Postoperative result: Successful decrease in prolapse of supraglottic structures after release of the aryepiglottic fold with evidence of excellent hemostasis.
Preoperative findings: The prominent lingual tonsil and underlying epiglottis are exposed with an operating laryngoscope.
Postoperative result: Successful interval reduction of lingual tonsillar hypertrophy using electrocautery with evidence of excellent hemostasis.

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Author

Charles E Morgan, DMD, MD Assistant Professor, Department of Surgery, Division of Otolaryngology, University of Alabama at Birmingham School of Medicine

Charles E Morgan, DMD, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Jonathan P Lindman, MD Otolaryngology-Head and Neck Surgeon, Piedmont Ear, Nose, Throat and Related Allergy

Jonathan P Lindman, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, Phi Beta Kappa, American Academy of Sleep Medicine, Triological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Robert M Kellman, MD Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York Upstate Medical University

Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Head and Neck Society, American Rhinologic Society, Triological Society, American Neurotology Society, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;Cliexa, eMedevents, Neosoma, MI10<br/>Received income in an amount equal to or greater than $250 from: , Cliexa;;Neosoma<br/> Received stock from RxRevu; Received ownership interest from Cerescan for consulting; for: Neosoma, eMedevents, MI10.

Additional Contributors

Hassan H Ramadan, MD, MSc, FACS, FARS Professor and Chairman, Director of Rhinology and Allergy Center, Department of Otolaryngology-Head and Neck Surgery, Professor, Department of Pediatrics, West Virginia University School of Medicine

Hassan H Ramadan, MD, MSc, FACS, FARS is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Rhinologic Society

Disclosure: Nothing to disclose.

Michele M Carr, MD, DDS, PhD, MEd Professor, Department of Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo

Michele M Carr, MD, DDS, PhD, MEd is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Vijay A Patel, MD Clinical Instructor, Fellow in Rhinology and Cranial Base Surgery, Department of Otolaryngology, UPMC Centers for Cranial Base Surgery and Sinonasal Disorders and Allergy, University of Pittsburgh School of Medicine

Vijay A Patel, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Rhinologic Society, American Society for Laser Medicine and Surgery, North American Skull Base Society, Pennsylvania Academy of Otolaryngology-Head and Neck Surgery, Pennsylvania Medical Society, The Triological Society

Disclosure: Nothing to disclose.

Steven W Coutras, MD, FACS, FAAOA Assistant Professor, Department of Otolaryngology-Head and Neck Surgery and Department of Medicine, Section of Pulmonary Critical Care and Sleep Medicine, West Virginia University School of Medicine

Steven W Coutras, MD, FACS, FAAOA is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Sleep Medicine, American College of Surgeons

Disclosure: Nothing to disclose.

What types of surgical interventions are used in the treatment of obstructive sleep apnea (OSA)?

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