Surgery in the treatment of snoring and sleep apnea

Abstract

Simple snoring and obstructive sleep apnea are part of a complex disease process with a high prevalence. Surgical treatment options have been developed by otolaryngologists over the last decades. Knowledge of different surgical procedures is required to address the various findings during preoperative assessment. Patients with nasal airway blockage due to septal deviation, large turbinates or polyps may benefit from endonasal surgery. Obstructive tonsils, palatal webbing, and an enlarged uvula require surgical approaches including the soft palate and tonsils. The controversy on indications and contraindications for the standard uvulopalatopharyngoplasty, laser-assisted uvulopalatoplasty and the use of radiofrequency is still ongoing. Dysgnathia may require maxillofacial surgery and macroglossia may be treated with reductive surgery of the tongue. Narrowing of the posterior airway space at the level of the tongue base may be addressed by advancement of the bony insertion of the genioglossus muscle and suspension of the hyoid. A new procedure is the suspension of the tongue with a non-resorbable suture fixed to a mandible anchored screw. Our first promising results need to be re-evaluated over time.