Surgery for Obstructive Sleep Apnea: One Size Doesn’t Fit All

Another related issue is the anesthesia. There are some noticeable advantages if patients are put under only a light sedation so they don’t require intubation, Dr. Woodson said. However, the preference by anesthesiologists for doing this can vary between centers.

Panelists addressed different approaches to surgery in patients with narrow or slit nostrils. Options for approaches include stabilizing the nasal valve with sutures via intraorbital or transconjunctival incisions, using a microdebrider to resect bone in the area, resecting the turbinates at the bone, or approaching the pyriform aperture sublabially.

Tailor UPPP to Patient’s Anatomy

When performing UPPP, the technique varies according to what’s appropriate for an individual patient’s anatomy, said Dr. Woodson. But panelists agreed that whatever the approach, a goal is to leave as much of the mucosal tissue as possible. Saving as much of the uvula as possible is desirable too. In some patients where UPPP is not viable, other, newer variations on the UPPP theme, such as the Z-palatoplasty, transpalatal advancement pharyngoplasty, or expansion pharyngoplasty, should be considered.

Surgeons should not limit themselves to one approach to the palate. When there are multiple such choices available, there is no one best choice for all patients, said Dr. Huntley. Panelists said their choice of palatal surgery varies from case to case, and that the patient’s presenting anatomy should be the guide.

In cases in which the uvula is not salvageable, a traditional UPPP with little or no resection of the soft palate might be the way to go. But stenosis can occur in this type of patient, presenting a whole other challenge.

Treatment of palatal and nasopharyngeal stenosis from tonsillectomy and UPPP surgery was also addressed. Panelists concurred that cases with stenosis are difficult, and reported varying success in using Z-plasty and other techniques. However, success is not always guaranteed and some degree of restenosis often is seen.

Again, saving as much mucosa as possible may help, Dr. Woodson said. On another note, Dr. Weaver cautioned against using lasers because it can make the problem worse.

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