SLEEP-DISORDERED BREATHING DIAGNOSIS AND TREATMENTkapak

EPIGLOTTOPLASTY IN OBSTRUCTIVE SLEEP APNEA SYNDROME

Şeyda Akbal Çufalı

University of Health Sciences, Ankara Bilkent City Hospital, Department of Otorhinolaryngology, Ankara, Türkiye

Akbal Çufalı Ş. Epiglottoplasty in Obstructive Sleep Apnea Syndrome. In: Özcan KM, editor. Sleep-Disordered Breathing: Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.175-183.

ABSTRACT

Obstructive Sleep Apnea Syndrome (OSAS) is characterized by repetitive upper airway obstructions during sleep. Although international guidelines recommend Continuous Positive Airway Pressure (CPAP) as the first-line therapy, the presence of various phenotypes and patient groups with poor adherence to CPAP therapy have increasingly positioned sleep surgery as a significant alternative. The widespread adoption of drug-induced sleep endoscopy (DISE) has enabled better identification of obstructions at the epiglottic level, thereby increasing interest in epiglottoplasty techniques. This chapter discusses the types of epiglottic collapse, patient selection, and surgical indications. Various surgical

techniques-including CO2 laser, monopolar cautery, coblation, suture-based methods, and transoral robotic surgery-are reviewed and evaluated. Epiglottis stiffening is a frequently performed epiglottic surgery. It can be performed in patients who are diagnosed with epiglottic collapse, an anteroposte-

rior obstructing the airway, during drug-induced sleep endoscopy. These patients typically fail CPAP titration or begin using CPAP but develop pressure intolerance. Coblation is performed by peeling the mucosa of the lingual surface of the epiglottis and the glossoepiglottic fold. Postoperative scar tissue reduces epiglottis laxity. Epiglottis stiffening can also be performed with monopolar cautery or laser. Transoral robotic surgery can also be performed with precise dissection, removing the mucosa of the epiglottis and the base of the tongue for better visibility. In glossoepiglottopexy, the epiglottis is sutured to the base of the tongue or the hyoid bone. After peeling the epiglottis with cautery or laser, it is fixed with nonabsorbable sutures. Partial epiglottectomy can be performed with various instruments. Epiglottis resection can be performed using a carbon dioxide laser, monopolar cautery, or a coblator. In patients with megaepiglottis, an resection can be made at the epiglottis tip, or in patients with lateral epiglottic collapse, an incision can be made at the aryepiglottic fold and a resection can be made lateral to the epiglottis. Epiglottis surgeries can be performed alone or often in conjunction with tongue base surgeries. Multilevel surgery can be performed in conjunction with palate surgeries, either in the same session or in separate sessions. Pain and difficulty swallowing are common after epiglottis surgeries. Hoarseness and voice changes are common after epiglottis interventions but are temporary. Permanent difficulty swallowing or hoarseness has not been reported. Temporary aspiration is a common complication, but permanent outcomes are uncommon. The need for a tracheotomy due to severe bleeding or edema is rarely seen in cases undergoing multilevel surgery.

Keywords: Sleep apnea, obstructive; Surgical procedures, operative; Epiglottis; Laryngoplasty; Postoperative complications

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