Airway Anatomy and Surgical Management in Obstructive Sleep Apnea

Area of Science:

• Otorhinolaryngology
• Sleep Medicine
• Anatomy

Background:

• Obstructive sleep apnea (OSA) stems from upper airway collapse during sleep.
• Upper airway anatomy, including the nasal cavity, palate, and tongue base, critically impacts airway stability.
• Surgical planning for OSA requires detailed anatomical knowledge.

Purpose of the Study:

• To review key anatomical features relevant to upper airway surgery for OSA.
• To guide surgical planning through an anatomy-based approach.
• To enhance patient selection and surgical outcomes in OSA.

Main Methods:

• Narrative review of anatomical structures influencing upper airway caliber and stability.
• Discussion of surgical strategies targeting specific anatomical regions.
• Exploration of multilevel and neuromodulatory treatment options.

Main Results:

• Nasal obstruction and internal nasal valve impact airway.
• Palatal muscles, parapharyngeal fat, and lateral palatal space are surgical targets.
• Genioglossus advancement, hyoid procedures, and tongue base reduction address lower airway collapse.
• Maxillomandibular advancement and hypoglossal nerve stimulation offer multilevel and neuromodulatory solutions.

Conclusions:

• Anatomically grounded, phenotype-based approaches are crucial for OSA surgery.
• Optimizing patient selection and minimizing complications improve long-term surgical outcomes.
• Detailed understanding of airway anatomy is essential for successful OSA surgical interventions.