Hypopharyngeal Surgery in Obstructive Sleep Apnea:A Differential Pattern-Based Surgical DecisionOA

Background:This study aimed to discuss the outcomes after surgical interventions for OSA in patients with hypopharyngeal collapse;the selection of the individual procedure was primarily based on the preoperative endoscopic examination(positional awake endoscopy and DISE)data.Surgeries were planned to combat the direction of collapse.Methods:The study included adult patients with OSA who had apnea-hypopnea index(AHI)>15.Patients were diagnosed by polysomnography and had upper airway mapping using positional awake endoscopy and DISE.The anteroposterior pattern of the collapse was managed by tongue base coblation reduction,the transverse collapse was managed by hyoidthyroidpexy,and the concentric type of collapse was managed by both techniques.Results:No early or late major complications were reported.Within the groups,highly significant improvements were recorded as regards all objective and subjective data(p=0.0001).As regards the postoperative AHI,the comparison showed significant results between Group Ⅰ and Group Ⅱ,and Group Ⅱ and Group Ⅲ,while nonsignificant data were obtained between Ⅰ and Ⅲ with a statistical tendency toward Ⅲ.Conclusion:The pattern-based surgical protocol reported subjective and objective favorable outcomes without significant morbidity.The protocol may aid in selecting appropriate surgical decisions and tailoring individual surgical maneuvers for OSA patients with HC,for whom the optimal surgical plan remains to be determined.Summary This prospective study aimed to discuss the surgical outcomes after tailored surgical interventions for OSA in patients with hypopharyngeal collapse;the selection of the individual procedure was based on the preoperative DISE and awake endoscopy data.What this study addsThe study emphasizes that the provided pattern-based protocol for managing hypopharyngeal collapse was reliable,applicable,and effective.The differential therapeutic management would optimize surgical tasks,minimize the morbidity of the intervention,and decrease the need for theater re-entry.