Hypopharyngeal Surgery in Obstructive Sleep Apnea

Abstract

To perform an evidence-based medicine review of the literature describing outcomes of hypopharyngeal surgery in obstructive sleep apnea. Design: We performed a MEDLINE search of Englishlanguage articles or abstracts using the keywords sleep and surgery in combination with any of the following terms: hypopharynx, tongue, tongue base, epiglottis, genioglossus, advancement, mortised, genioplasty, glossectomy, tongue radiofrequency, hyoepiglottoplasty, hyoid, suspension, and stabilization. Additional studies were identified from their reference lists. We reviewed abstracts to select publications reporting outcomes of hypopharyngeal surgery in obstructive sleep apnea. Articles were included only if patients underwent treatment of the palate for suspected retropalatal obstruction. Data Extraction: Evidence-based medicine review for level of evidence, preoperative patient characteristics, surgical outcomes, and patient-specific factors associated with outcomes. Results: We identified 36 articles. These were primarily case series studies (level 4 evidence), although some studies provided levels 1 and 2 evidence. Hypopharyngeal surgery demonstrates improvements in respiratory physiology during sleep, daytime somnolence, and quality of life. Severalfactorssuchasthebodymassindex,apnea-hypopnea index, Friedman stage, and SNB angle on lateral cephalogram have been associated with surgical outcomes. Considering the improvement in respiratory physiology alone, successful outcomes are achieved in 35% to 62% of patients; certain subgroups achieve higher success rates. Conclusions: Hypopharyngeal surgery in obstructive sleep apnea is associated with improved outcomes, although this benefit is supported largely by level 4 evidence. Future research should include larger, higherlevel studies that consider the variety of treatment effects, compare surgical treatments, and identify factors associated with outcomes.

Contribution of Hyoid and Tonsillar Procedures to Outcome in Multilevel Surgery for Obstructive Sleep Apnea Syndrome

“…An evidence-based medicine review included 36 articles, mainly case series with level 4 evidence [1]. The review showed success rates between 17 and 83% of the various procedures.…”

Optimal treatment of obstructive sleep apnea and excessive sleepiness

“…Furthermore, the efficacy of these procedures was found to be poor when assessed using clinically important endpoints. The success of surgery has historically been reported in terms of ≥50% reduction in AHI score from baseline or to a score of ≤20 102. It appears questionable to declare surgery as successful if moderate OSA (an AHI score of 16-30) 1 persists in postoperative patients.…”

A case of severe mandibular retrognathism with bilateral condylar deformities treated with Le Fort I osteotomy and two advancement genioplasty procedures

“…Severe mandibular retrognathism is often accompanied by pharyngeal airway obstruction,3 probably because of downward displacement of the tongue. Therefore, advancement genioplasty can achieve extensive anterior retraction of the suprahyoid musculature and decrease the signs and symptoms of obstructive sleep apnea syndrome, including the apnea–hypopnea index 1617. Moreover, the posterior airway space significantly increases after advancement genioplasty 1819.…”