Contemporary Surgical Approaches to Upper Airway Reconstruction in Sleep-Disordered Breathing

Abstract

Objective: To assess the efficacy of surgical approaches for upper airway reconstruction in simple snoring and sleep-disordered breathing, using laser-assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP), genioglossus advancement, hyoid myotomy, and maxillomandibular osteotomy. Patients and Methods: A retrospective study of consecutively surgically treated patients with simple snoring or sleep-disordered breathing was performed. Twenty-two patients underwent treatment by LAUP, 23 by UPPP, and 12 by a phased surgical approach that included phase I surgery (UPP, genioglossus advancement, and hyoid myotomy) as the initial procedure and, if residual airway obstruction persisted, phase II surgery (maxillomandibular osteotomy). Results: The main outcome measures included improvement of excessive daytime sleepiness and improvement in objective sleep parameters: respiratory disturbance index (RDI) and lowest oxygen saturation (LSAT). For the patients undergoing phased airway reconstruction, the mean preoperative data included a RDI of 45.6, a LSAT of 80.9%, and an Epworth Sleepiness Scale score of 11.6. The responders of phase I surgery (7/11) revealed a change in the mean RDI from preoperatively to postoperatively of 32.0 to 3.6, LSAT of 82.6 to 91%, and Epworth Sleepiness Scale score of 9.3 to 6.8. The nonresponder group (4/11) revealed a change in the mean RDI of 69.3 to 55.6, LSAT of 78 to 77%, and Epworth Sleepiness Scale score of 14.0 to 7.7. Both patients undergoing phase II surgery were successfully treated. LAUP resolved snoring in 80.1% and UPPP in 90.9%. Conclusion: UPPP and LAUP are moderately effective procedures for resolving snoring. Phase I upper airway reconstruction using UPPP, genioglossus advancement, and hyoid suspension and phase II maxillomandibular advancement surgery offer a high surgical success rate in a disease that may need a stepwise approach to its management.