SLEEP-DISORDERED BREATHING DIAGNOSIS AND TREATMENTkapak

PALATAL AND OROPHARYNGEAL SURGERIES IN OBSTRUCTIVE SLEEP APNEA SYNDROME

Ömer Faruk Çufalı

Ankara Bilkent City Hospital, Department of Otorhinolaryngology, Ankara, Türkiye

Çufalı ÖF. Palatal and Oropharyngeal Surgeries in Obstructive Sleep Apnea Syndrome. In: Özcan KM, editor. Sleep-Disordered Breathing: Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.145-155.

ABSTRACT

Obstructive Sleep Apnea Syndrome (OSAS) is a prevalent disorder characterized by repetitive upper airway collapse during sleep, leading to intermittent hypoxia and disrupted sleep architecture. Surgical management of OSAS has evolved significantly, transitioning from traditional morbid procedures like tracheotomy to more targeted and minimally invasive palatal surgeries. This review summarizes the current surgical techniques addressing the soft palate and oropharynx in the treatment of OSAS, highlighting their indications, mechanisms, and outcomes. Among minimally invasive options, radiofrequency volumetric tissue reduction, palatal injection sclerotherapy, and palatal implants aim to stiffen the soft palate through fibrosis or implant mediated structural support, primarily benefiting patients with simple snoring or mild OSAS. Although radiofrequency application to the soft palate has declined in recent years, it remains a good alternative, particularly for patients with a low apnea/hypopnea index and simple snoring. 350-500 joules are applied to three separate areas of the soft palate. A reduction in snoring has been demonstrated in patients. Generally, 2-3 applications, spaced 3-6 months apart, are required. More invasive approaches, including uvulopalatopharyngoplasty, z-palatopharyngoplasty, relocation pharyngoplasty, and transpalatal advancement pharyngoplasty offer treatment for moderate to severe OSAS by enlarging the retropalatal airway and reducing collapsibility. Recent innovations like expansion sphincter pharyngoplasty have improved outcomes while minimizing complications. Expansion sphincter pharyngoplasty is a suitable option for patients experiencing narrowing of the lateral pharyngeal bands in the retropalatal region. It involves dissecting the palatopharyngus muscle from the posterior tonsillar fold and suturing it superolaterally after tonsillectomy. Palatal surgery is often performed in conjunction with other surgeries. Patients with OSAS often experience obstruction in multiple areas of the upper airway. Therefore, multilevel surgery is often necessary to achieve a successful outcome. Multilevel surgery can be performed in a single session or multiple sessions. Palatal surgery is often performed as part of a multilevel surgery. Although several palatal procedures show promising results in selected OSAS patients, most evidence comes from retrospective studies. High quality prospective research is needed to clarify long-term efficacy, guide patient selection, and define the role of these techniques in comprehensive OSAS management.

Keywords: Sleep apnea; Obstructive; Palate, soft; Velopharyngeal sphincter; Surgical procedures, operative; Postoperative complications

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