nasal and mandibular surgeries as treatment options for OSA


  • surgical option for OSA is a phased approach
  • phase 1 involves soft tissue surgery
  • phase 2 involves bone surgery

phase 1

  • phase 1 involves tonsillectomy, septoplasty, turbinate reduction, uvulopalatal flap, hyoid suspension, genioglossus advancement
  • drug induced sedation/sleep endoscopy (DISE) is examination of pharyngeal wall in office to see if there is collapse during negative pressure maneuver
  • Septoplasty, nasal valve reconstruction/stabilization, turbinate reduction aim at expanding nasal floor for OSA from nasal obstruction
  • Distraction osteogenesis with maxillary expansion (DOME) is used for expanding both nasal and intraoral airway
  • Uvulopalatopharyngoplasty is most common surgery for OSA
  • Genioglossus advancement: tongue moves forward more
  • Lingual tonsillectomy: tongue volume reduction

phase 2

  • maxillomandibular advancement: osteotomies of maxilla and mandible and move them forward with counterclockwise rotation1

Footnotes

  1. Murray and Nadel Ch 122 Sleep Disordered Breathing Treatment