Uvulopalatal Flap Research Articles

Therapeutic Effect of Extended Uvulopalatal Flap Surgery in Patients With Obstructive Sleep Apnea

Background and Objective Although numerous studies have reported surgical results of uvulopalatopharyngoplasty, efficacies of extended uvulopalatal flap (EUPF) surgery have only been reported in a few studies. Thus, the aim of this study was to evaluate the success rate of EUPF and investigate the advantage and practicality of this surgery.Methods Medical records of patients who underwent EUPF surgery were retrospectively analyzed. Through medical record analysis, demographic information was confirmed. Postoperative polysomnography (PSG) results were divided into a surgical ‘success’ group and a ‘failure’ group. Patients’ PSG results, questionnaires, and cephalometry were comparatively analyzed.Results All sleep parameters of PSG except rapid eye movement latency and hypopnea index were significantly improved after surgery. Ten patients were in the success group (success rate, 33.3%) and 20 patients were in the failure group. Among preoperative PSG parameters, apnea-hypopnea index, apnea index, and number of awakenings showed significant differences between the two groups. However, there were no significant differences in results of cephalometry or Friedman stage between the two groups.Conclusions The EUPF surgery can change sleep factors and improve subjective symptoms in obstructive sleep apnea patients. It could be considered as one of the treatment options for patients with surgical indications, although its success rate was only 33.3%.

Optimal application of soft-palate webbing flap pharyngoplasty combined with nasal surgery for surgical treatment of primary snoring and obstructive sleep apnea

BackgroundExcessive collapse of the soft palate and lateral pharyngeal wall narrowing are established causes of loud snoring and sleep apnea in subjects with obstructive sleep apnea (OSA). Therefore, delicate surgical techniques are needed to reshape the soft palate and create sufficient tension in the lateral pharyngeal wall. This study aimed to determine the therapeutic outcome and favorable indications of soft-palate webbing flap pharyngoplasty in subjects with OSA and primary snoring.MethodsA total of 174 subjects who underwent soft-palate webbing flap pharyngoplasty combined with uvulopalatal flap and septoturbinoplasty from August 2015 to February 2020 were included in this study. Medical records, including pre- and postoperative sleep parameters, were retrospectively reviewed. The primary outcome measure was the degree of improvement in AHI after surgery. Other outcomes were differences in surgical response rates, subjective visual analog score (VAS) for snoring, sleep quality, and complications.ResultsPolysomnographic results showed that apnea–hypopnea index (AHI) scores were significantly reduced from 39.6 ± 6.1 to 22.9 ± 3.6 following soft-palate webbing flap pharyngoplasty in 59 subjects, and overall success and response rates of this technique were analyzed with 71%. We found that the successful outcomes were observed in 50% of mild (n = 12) and 56% of moderate (n = 16) subjects with OSA subjects due to lateral pharyngeal wall collapse. The success rate of soft-palate webbing flap pharyngoplasty was relatively higher in subjects with mild and moderate OSA than those with severe OSA. Additionally, the mean VAS snoring scale was 4.7 and subjects’ primary snoring intensity significantly improved to 2.9 after soft-palate webbing flap pharyngoplasty. Subjective symptoms such as daytime sleepiness and sleep quality also showed improvement. Most complications were found to be minimal and improved by 1 month after the operation.ConclusionOur data demonstrate that soft-palate webbing flap pharyngoplasty is an effective treatment for OSA and primary snoring and may be a promising technique to reduce lateral pharyngeal wall collapse.

Machine learning-based model for prediction of outcomes in palatal surgery for obstructive sleep apnoea.

● Our retrospective cohort study aimed to elucidate which factors (nasal surgery: septoplasty or functional endoscopic sinus surgery (FESS), palate surgery: uvulopalatal flap (UPF) or palatal muscle resection (PMR)), demography, polysomnography, Friedman stage, drug-induced sleep endoscopy (DISE) results) influence the success of surgery in patients who had been operated to treat obstructive sleep apnea (OSA). ● We used seven machine learning (ML) models (logistic regression-based models (lasso, elastic net (EN), ridge), tree-based models (bagging, random forest (RF), support vector machine (SVM), and neural networks (NN)). ● Among the seven models, their performances were first ranked by the area under the receiver operating characteristic curve (AUC): lasso (0.8317), EN (0.7500), SVM (0.7163), bagging (0.7115), random forest (0.7115), NN (0.6923) and ridge (0.6538), which shows that lasso had the best performance. ● Tonsil grade and Nasopharynx Oropharynx Hypopharynx and Larynx (NOHL) classification of the epiglottis in DISE were selected as the most important variables in all models including lasso. ● Through the novel ML technique, the surgical success rate of OSA is ultimately dependent on tonsil grade and NOHL classification of the epiglottis in DISE regardless of the type of nasal or palate surgery.

Comparison of postoperative pain scores and dysphagia between anterior palatoplasty and uvulopalatal flap surgeries

Background: Dysphagia and pain are most common problems after soft palate surgery in obstructive sleep apnea (OSA) patients.Objective: The aim of this study was to compare the postoperative pain scores and presence of dysphagia in patients who underwent anterior palatoplasty (AP) or uvulopalatal flap (UPF) surgeries.Materials and methods: In this prospective study, AP or UPF was performed on the patients with mild or moderate OSA. Daytime sleepiness of all patients was evaluated with Epworth sleepiness scale (ESS). Snoring, pain and dysphagia complaint of the patients was evaluated with visual analog scale (VAS).Results: In both AP and UPF groups, VAS snoring and ESS scores decreased significantly after operation. VAS pain and dysphagia scores were determined to be significantly higher in UPF compared with the AP.Conclusion and significance: Since the success rates of surgical interventions to the soft palate are similar, preferring surgical approaches with a less damage to the life quality of patients after operations is more rational. In this regard, AP, which is technically quite simple with a short operation time and fewer postoperative complaints affecting life quality such as pain or dysphagia may be preferred in selected patients with OSA.

Comparison of Anterior Palatoplasty and Uvulopalatal Flap Placement for Treating Mild and Moderate Obstructive Sleep Apnea

Nasal septal perforations cause a subset of patients to suffer with significant impairments in quality of life. While smaller perforations can often be surgically repaired, perforations exceeding 2 cm are challenging to close. These repairs are highly technical, and there is a lack of consensus regarding the most effective means to do so. The authors performed a retrospective chart review of patients with perforation enlargements and have found that, in select patients, enlarging the septal perforation's edge posterior to the head of the middle turbinates has proven effective in relieving symptoms.

Comparison of anterior palatoplasty and uvulopalatal flap placement for treating mild and moderate obstructive sleep apnea.

We prospectively compared the efficacy of anterior palatoplasty and the uvulopalatal flap procedure for the treatment of patients with mild and moderate obstructive sleep apnea syndrome (OSAS). Our study group was made up of 45 patients who had been randomly assigned to undergo one of the two procedures. Palatoplasty was performed on 22 patients-12 men and 10 women, aged 28 to 49 years (mean: 39.2)-and the flap procedure was performed on 23 patients-14 men and 9 women, aged 28 to 56 years (mean: 41.3). Our primary outcomes measure was the difference in pre- and postoperative apnea-hypopnea index (AHI) as determined by polysomnography at 6 months after surgery. Surgical success was observed in 18 of the 22 palatoplasty patients (81.8%) and in 19 of the 23 flap patients (82.6%). Compared with the preoperative values, mean AHIs declined from 17.5 to 8.1 in the former group and from 18.5 to 8.6 in the latter; the improvement in both groups was statistically significant (p < 0.001). In addition, significant postoperative improvements in both groups were seen in mean visual analog scale (VAS) scores for snoring, in Pittsburgh Sleep Quality Index values, and in Epworth Sleepiness Scale scores (p < 0.001 for all). VAS scores for pain at rest were significantly lower in the palatoplasty group than in the flap group at 2, 4, and 8 hours postoperatively and on postoperative days 4 through 7 (p < 0.002). Likewise, VAS scores for pain during swallowing were significantly lower in the palatoplasty group at 2, 4, 8, and 16 hours and on days 4 through 7 (p < 0.009). We conclude that both anterior palatoplasty and uvulopalatal flap procedures are effective for the treatment of mild and moderate OSAS in patients with retropalatal obstruction. However, our comparison of postoperative pain scores revealed that anterior palatoplasty was associated with significantly less morbidity.

The effects of uvulopalatal flap operation on speech nasalance and the acoustic parameters of the final nasal consonants

ObjectiveThe acoustic characteristics of voice are determined by the source of the sound and shape of the vocal tract. Various anatomical changes after uvulopalatal flap (UPF) operation can change nasalance and/or other voice characteristics. Our aim was to explore the possible effects of UPF creation on speech nasalance and the resonatory features of the final nasal consonants, and thus voice characteristics. MethodsA total of 30 patients (26 males, 4 females) with obstructive sleep apnea who underwent UPF operation were recruited. A Nasometer II 3.4 instrument was used to assess nasalance pre- and post-operatively; the patients read standard Korean passages and the readings were recorded in Computer Speech Laboratory for later spectral analysis. Praat software was used to identify frequency bands affecting perioperative nasalance scores. Minima, maxima, and slopes were analyzed. ResultsWe found no significant correlation between nasalance scores (any passage) and the respiratory distress index or body mass index. No significant perioperative change in any nasalance score. The moment variations in the final consonants /m/ and /n/ did not change significantly postoperatively. However, the postoperative moment variation of the final consonant /ng/ differed significantly in the third formant (F3) and second bandwidth (BW2). ConclusionFew significant changes in nasal resonance speech quality were apparent after UPF operation. However, a postoperative acoustic change in the final sound /ng/ may be sustained. Patients may be preoperatively advised that the risk of voice change is very low, but not absent.

Various combinations of velopharyngeal and hypopharyngeal surgical procedures for treatment of obstructive sleep apnea: Single-stage, multilevel surgery

ObjectiveThe aim of this study was to investigate the safety and outcomes of velopharyngeal surgeries combined with hypopharyngeal surgeries as single-stage interventions for treatment of obstructive sleep apnea (OSA). MethodsRetrospective analysis of operated patients. The velopharyngeal surgical interventions were uvulopalatal flap, anterior palatoplasty, expansion sphincter pharyngoplasty, transpalatal advancement pharyngoplasty, Cahali lateral pharyngoplasty, Z-palatoplasty, and modified uvulopalatopharyngoplasty. The hypopharyngeal surgical interventions were tongue base suspension, mucosal sparing partial glossectomy, genioglossus advancement, mandibulohyoid suspension, thyrohyoid suspension, and epiglottoplasty. ResultsForty-one patients were enrolled after inclusion and exclusion criteria. The evaluation of symptoms and polysomnographic findings were performed preoperatively and at a minimum of 3months postoperatively. The mean age was 42.17±9.50years and the mean follow-up time was 6.8±6.0months. After single-stage multilevel surgery, the mean apnea hypopnea index (AHI) improved from 29.13±15.87events/h to 14.28±16.14events/h (p<0.001). According to the classical definition of success criteria (>50% reduction in AHI and postoperative AHI<20events/h), the surgical success rate was 56%, with cure of OSA (AHI<5events/h) in 41% of study population. The combined surgeries also improved Epworth scores, snoring scores, and respiratory parameters significantly (in all p<0.05). The major complications were bleeding requiring re-admission in surgery room and severe tongue base edema which regressed by steroid administration. The minor complications were pain, difficulty in swallowing, velopharyngeal insufficiency, regurgitation, minor bleeding, and occlusion disorder. The mean postoperative period to beginning of normal feeding was 1.81±1.01days. The percentage of pain, the number of patients with major bleeding, and the need for patient-controlled analgesia were higher in patients undergoing tissue resection/ablative hypopharyngeal procedures. The mean postoperative period to beginning of normal feeding was shorter in patients undergoing suture/repositioning hypopharyngeal procedures. ConclusionAccording to outcomes of this study, OSA patients with multilevel obstructions can benefit from combined surgeries for velopharyngeal and hypopharyngeal regions at the same operation stage, without experiencing persistent complaints. It is promising that, despite multiple levels of obstruction was operated at single-stage, airway safety was preserved in all patients.

Tonsillectomy as prevention and treatment of sleep-disordered breathing: a report of 23 cases.

BackgroundThe paradigm of tonsillectomy has shifted from a treatment of recurrent throat infection to one of multi-discipline management modalities of sleep-disordered breathing (SDB). While tonsillectomy as a treatment for throat problems has been performed almost exclusively by otorhinolaryngologists, tonsillectomy as a part of the armamentarium for the multifactorial, multidisciplinary therapy of sleep-disordered breathing needs a new introduction to those involved in treating SDB patients. This study has its purpose in sharing a series of tonsillectomies performed at the Seoul National University Dental Hospital for the treatment and prevention of SDB in adult patients.MethodsTotal of 78 patients underwent tonsillectomy at the Seoul National University Dental Hospital from 1996 to 2015, and 23 of them who were operated by a single surgeon (Prof. Jin-Young Choi) were included in the study. Through retrospective chart review, the purpose of tonsillectomy, concomitant procedures, grade of tonsillar hypertrophy, surgical outcome, and complications were evaluated.ResultsTwenty-one patients diagnosed with SDB received multiple surgical procedures (uvulopalatal flap, uvulopalatopharyngoplasty, genioglossus advancement genioplasty, tongue base reduction, etc.) along with tonsillectomy. Two patients received mandibular setback orthognathic surgery with concomitant tonsillectomy in anticipation of postoperative airway compromise. All patients showed improvement in symptoms such as snoring and apneic events during sleep.ConclusionsWhen only throat infections were considered, tonsillectomy was a procedure rather unfamiliar to oral and maxillofacial surgeons. With a shift of primary indication from recurrent throat infections to SDB and emerging technological and procedural breakthroughs, simpler and safer tonsillectomy has become a major tool in the multidisciplinary treatment modality for SDB.

The uvulopalatal flap

The uvulopalatal flap was initially described by Powell and Riley in 1996 and has become a popular surgical option for treating obstructive sleep apnea (OSA). A number of advantages exist over the uvulopalatopharyngoplasty, and these include reduced risk of velopharyngeal insufficiency and nasopharyngeal stenosis, potential to be reversible, improved velopalatal opening from preserved uvular muscle, low risk of bleeding, and reduced pain. An extensive preoperative workup should be performed to evaluate the patient, and the procedure is indicated in patients who demonstrate velopharyngeal obstruction, and who are refractory to conservative medical management. Studies have confirmed that the uvulopalatal flap results in both objective and subjective improvements in OSA. Complications are rare and typically minor. As a result, the uvulopalatal flap has become a popular option and the palatal procedure of choice for OSA for many otolaryngologists.

Geniotubercle advancement with a uvulopalatal flap and its effect on swallow function in obstructive sleep apnea.

Evaluate swallowing characteristics before and after geniotubercle advancement (GTA) with a uvulopalatal flap (UPF). Prospective case control series in an academic military practice. Fourteen patients with apnea-hypopnea index (AHI) >10 scheduled for GTA were enrolled consecutively, eight of whom completed all aspects of the study for evaluation. Video fluoroscopic swallow study was performed preoperatively and 4 months postoperatively. National Institute of Health freeware ImageJ64 software was used to measure hyolaryngeal elevation and displacement. Video recordings assessed vallecular pooling, aspiration, and bolus movement. Studies were reviewed by a speech pathologist and an otolaryngologist. Preoperatively, the mean AHI was 48.3 ± 48.45 events per hour, with a median of 48.5 (range, 12.4-76). Postoperatively the mean AHI was 11.6 ± 10.7 events per hour, with a median of 10.75 (range, 3.8-29) (P = .003). There was no reported pre- or postoperative dysphagia or aspiration. No radiographic evidence of silent aspiration was seen. Hyolaryngeal movements were measured as a percentage of C2-C4 reference distance. The superior elevations were pre- and postoperatively 40% and 37% (P = .85), anterior displacement changes 18.9% and 18.8% (P = .23), and total motion 49% and 42% (P = .26), respectively. GTA with UPF surgery did not significantly affect the hyolaryngeal function of patients.

Comparison of Two Techniques in Simple Snoring and Obstructive Sleep Apnea Syndrome Patients: Palatal Implant or Uvulopalatal Flap

Obstruktif uyku apneli ve basit horlam hastalarinda uygulanan pillar palatal implant ve uvulopalatal flep uygulamalari basarilarinin polisomnografik ve subjektif metodlarla karsilastirilmasi. 117 hastanin retrospektif analizine dayanan calismamizda hastalar; Epworth skalasina, preoperatif ve postoperative polisomnografi sonuclarina ve gun icindeki uykululuk, gece horlama ve apne derecelerine gore degerlendirildiler. Calismaya dahil edilen hastalarin 59 tanesine palatal implant uygulamasi, 58 tanesine ise uvulopalatal flep cerrahisi yapildi. Ameliyat oncesi ve sonrasi datalar ve hasta memnuniyetleri karsilastirildi. Palatal implant grubunda ameliyat oncesi apne hipopne indeksi seviyelerinde anlamli bir degisiklik saptanmamasina ragmen uvulopalatal flep grubunda degisiklikler anlamli sekilde azalmisti. Hem palatal implant hem de uvulopalatal flep gruplarindaki Epworth skorlarinda anlamli dusmeler saptandi. Hafif ve orta obstruktif apne sendromlu grupta uygulanan uvulopalatal flep apne ve gunduz uykululuk halinde tercih edilebilir. Basit horlama hastalari icin ise palatal implant metodu tercih edilebilecek bir yontemdir

Changes in serum levels of MDA and MMP-9 after UPF in patients with OSAS

The aim of the study was to assess the markers of oxidant-antioxidant status in patients with obstructive sleep apnea syndrome (OSAS) who underwent uvulopalatal flap (UPF) surgery. Twenty-five patients who underwent UPF surgery participated in this study. Polysomnographic examinations were performed before and after the surgery to assess sleep apnea in all patients and to determine the success of the UPF surgery regarding the improvement in the apnea-hypopnea index (AHI). Descriptive factors (BMI, age, gender and neck thickness, etc.) of patients were recorded before operation. Blood samples were taken preoperatively, and repeated postoperatively at 6-month intervals to determine the changes in serum malondialdehyde (MDA) and matrix metalloproteinase-9 (MMP-9) levels. The mean age at surgery was 45.6±9.9years (range 25-63years). There was a significant difference between preoperative and postoperative AHI, MDA and MMP-9 values (p<0.05). There was no significant correlation between categorical variables. There was no correlation between postoperative ODI, MMP-9 and MDA. These results indicate that OSAS is associated with abnormal lipid peroxidation, which can be improved by UPF surgery. OSAS may increase risks of cardiovascular morbidity; however, UPF might be useful for decreasing these risks in patients with OSAS who are suitable candidates for UPF surgery.

A modified uvulopalatal flap with lateral pharyngoplasty for treatment in 92 adults with obstructive sleep apnoea syndrome

A modified uvulopalatal flap with lateral pharyngoplasty for treatment in 92 adults with obstructive sleep apnoea syndrome

Prognostic Factors for Improved Daytime Sleepiness after Uvulopalatal Flap for Obstructive Sleep Apnea

Background and ObjectivesZZWe aimed to evaluate pre-operative factors for patients with obstructive sleep apnea (OSA) and determine the correlation these factors have with the improvement of daytime sleepiness based on the change of Epworth Sleepiness Scale (ESS) score before and after uvulopalatal flap (UPF). Subjects and MethodZZTwenty-two patients with OSA who had received UPF surgery were enrolled in the study. We checked age, body mass index (BMI), size of tonsils, and position of palate. Using the Muller maneuver, we quantified the degree of obstruction at the velopharynx and the tongue base level. The cephalometric variables were checked by X-ray. Apnea-hypopnea index, respiratory distress index, and lowest oxygen saturation were obtained by portable monitoring. Finally, we obtained ESS score before and after UPF. The correlation between the aforementioned pre-operative factors and changes in ESS score was evaluated. ResultsZZA significant correlation was observed between the change in ESS score and patients’ age (R=0.168, p=0.031), BMI (R=0.642, p=0.004), and posterior airway space (PAS)(R=0.378, p=0.029). Patients who were older than 40 years old (p=0.030), obese patients with BMI≥25.0 (p=0.001), and those who had reported severe daytime sleepiness before surgery (pre-operative ESS score ＞10, p＜0.01) reported greater improvement of daytime sleepiness after UPF. ConclusionZZWe propose age, BMI, and wider PAS as predictors for greater improvement of daytime sleepiness after UPF in patients with OSA. � Korean J Otorhinolaryngol-Head Neck Surg 2013;56:495-500 Key WordsZZObstructive sleep apnea ㆍPrognosis ㆍTreatment outcome.

Preliminary Findings from Our Experience in Anterior Palatoplasty for the Treatment of Obstructive Sleep Apnea

ObjectivesObstructive sleep apnea (OSA) is a common disorder affecting at least 2% to 4% of adult population characterized by the collapse of the pharyngeal airway. It is well established that retropalatal region is the most common site of obstruction. Consequently, many surgical techniques have been introduced. The purpose of this study is to present our preliminary results in the anterior palatoplasty (AP) compared with results of uvulopalatal flap (UPF).MethodsThirty-eight consecutive patients with mild-moderate OSA were prospectively enrolled into a randomised surgical protocol. Surgical success was measured primarily by satisfactory reduction in snoring, as reported by snoring assessment questionnaire (SQ) of sleep partners. Secondary outcomes measures included improvement in the Epworth Sleepiness Scale (ESS) scores, changes in the magnitude of pharyngeal collapse, and postoperative pain intensity.ResultsThe ESS after AP improved from a preoperative value 8.5±3.7 to a postoperative mean of 4.9±3.2 (P<0.001) after UPF improved from a preoperative value of 8.1±3.5 to 5.2±3.2 postoperatively (P<0.001). The results of satisfactory reduction in the volume of snoring and response at polysomnographic data were also similar in both procedures. We reported a statistically significant difference of the collapse noted at Müller manoeuvre that improved from 2.7±1.0 on average, to 1.1±0.9 (P<0.001) after AP and with a lesser extent, (from 2.8±1.1 on average to 1.8±1.1; P<0.05), after UPF. The mean duration of pain was 10.8 days for UPF patients and 7.1 days for AP patients. The mean pain score in the first 3 days, was 6.8 in UPF patients and 5.1 in AP patients.ConclusionThe subjective and objective improvements evidenced may suggest how AP is far superior to other techniques aimed at creating a palatal fibrotic scar. In the light of these results we can suggest AP procedure as more practical and comfortable when compared to UPF.

Computer‐assisted quantitative upper airway analysis following modified uvulopalatal flap and lateral pharyngoplasty for obstructive sleep apnoea: a prospective case‐controlled study

The study aims to perform static and dynamic quantitative assessment of the anatomical changes of the upper airway before and after modified uvulopalatal flap and lateral pharyngoplasty and comparison of the improvement in airway dimensions, collapsibility and extent of normalisation to that of control patients. Prospective case-controlled study. Computer-assisted quantitative measurement is used to compare upper airway parameters before and after modified uvulopalatal flap and lateral pharyngoplasty in patients with obstructive sleep apnoea (OSA). Patients with obstructive sleep apnoea diagnosed on sleep study and failed positive airway pressure therapy. Sleep study results, upper airway parameters and symptom score following surgery and its comparison to normal patients to assess the degree and extent of normalisation. Thirty-five study and 32 control subjects were recruited and completed the study. All the retropalatal airway dimensions like area, transverse diameter, longitudinal diameter and collapsibility showed statistically significant improvement following surgery. The success rate of this surgery is 43% (15 of 35) overall, 58% (14 of 24) for patients with isolated palatal obstruction and only 9% (1 of 11) for patients with multi-level obstruction. Comparing obstructive sleep apnoea to the control subjects, there are obvious and logical differences in their biostatistics, sleep study parameters and airway dimensions. The postoperative obstructive sleep apnoea retropalatal longitudinal diameter has a higher tendency of normalising to be comparable to those of control patients. Modified uvulopalatal flap and lateral pharyngoplasty is an effective surgical technique for the treatment of obstructive sleep apnoea. The surgery increases the resting retropalatal dimensions and reduces the retropalatal collapsibility.

Analysis of genetic expression in the soft palate of patients with obstructive sleep apnea

Conclusion: Genetic dysregulation may be associated with development of obstructive sleep apnea (OSA). Objectives: Genetic expression was investigated in the soft palate of patients with OSA to evaluate the biomolecular characteristics of the tissue where airway obstruction actually occurs. Methods: Soft palate mucosa was obtained during uvulopalatal flap surgery. Three patients with apnea/hypopnea index (AHI) >30/h and three simple snoring patients with AHI < 5/h were enrolled. After total RNA was extracted and amplified, gene expression levels were determined by microarray analysis, and relative signal intensities for each gene were evaluated. Results: Of the 45,034 genes analyzed, 137 were up-regulated in OSA patients compared with simple snorers and 95 were down-regulated. Gene network analysis showed that genes related to RNA interference and transcription were most commonly involved in the functional pathophysiology of OSA. In particular, genes encoding proliferating cell nuclear antigen and proteasome 26S subunit ATPase 6 were functionally connected with other genes.

Hyoid advancement to the mandible (hyo-mandibular advancement)

Hyoid advancement to the mandible was first described in 1984, but was later abandoned by most surgeons for the easier to perform advancement to the laryngeal cartilage. New modifications of the hyo-mandibular advancement technique has made this approach easier to perform and are described in this paper. The hyo-mandibular advancement technique has a higher success rate for the treatment of sleep apnea, especially in women.

Relocation pharyngoplasty

Relocation pharyngoplasty