Introduction: Surgery for obstructive sleep apnea (OSA) has evolved significantly over the last few decades owing to lessons learned from prior failures and increased understanding of this condition. Analysis of single-level palatal surgery failures and the advent of sleep endoscopy showed the presence of a concomitant hypopharyngeal obstruction, highlighting the importance of hypopharyngeal obstruction in the treatment of OSA.
Objective: This article aims to delineate the concepts behind optimal patient selection for hypopharyngeal OSA surgery.
Results: Understanding the various factors contributing to hypopharyngeal obstruction allows the treating surgeon to build a framework in the thought process. This allows customization in selecting proper surgical techniques for individual patients in the setting of treating this multifactorial condition. These concepts include understanding the significance of hypopharyngeal obstruction, the concept of volume reduction versus tension enhancement in upper airway surgery, synchronization of major airway dilator with respiration during sleep, the notion of multilevel surgery and significance of holistic management in OSA. It is also important to understand multiple surgeries or different types of surgery may be applicable at the different timeline, for the same patients.
Optimal treatment outcome relies on accurate assessment. Assessment methods of particular relevance to hypopharyngeal surgery for OSA include drug-induced sleep endoscopy, Friedman Tongue Position and tongue base lymphoid tissue grading. Types of hypopharyngeal surgery, their indication and efficacy are also discussed in this article.
Conclusion: Hypopharyngeal obstruction is prevalent, and its presence is associated with increased OSA severity. In the context of hypopharyngeal surgery for OSA, the key achieving optimal outcome is integration of targeted treatment, clinical expertise, patient preference, and understanding potential positive and negative predictive clinical findings.
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