Update on upper airway surgery for obstructive sleep apnea

Uvulopalatopharyngoplasty has limited efficacy in treating obstructive sleep apnea, with excellent results achieved in fewer than half of patients who undergo this procedure. Attempting to select patients who have only retropalatal collapse of the pharynx increases the likelihood of a successful outcome. Although this type of patient selection has been attempted with various techniques, the validity of these approaches is not documented. Objective studies of the airway of awake and asleep patients with obstructive sleep apnea using fiberoptic flexible pharnygoscopy and manometry points to the disparity between observations and complexity of adequate assessment of the mechanism and pattern of pharyngeal collapse. Various approaches to treating the patient with obstructive sleep apnea surgically include uvulopalatopharyngoplasty, genioglossal advancement and hyoid myotomy and suspension, and maxillomandibular advancement. Results of these procedures vary in different reports, possibly due to variation in patient populations or surgical technique. Optimal treatment requires careful consideration of many patient variables and involves the use of a protocol that includes several surgical procedures. Laser-assisted uvulopalatoplasty lacks documentation of efficacy for patients with obstructive sleep apnea. The efficacy of this procedure is likely to prove very limited. Until its proper place in the surgical armamentarium is known, caution is warranted.