Upper airway surgery for obstructive sleep apnea.

Upper airway surgical treatments for obstructive sleep apnea syndrome (OSAS) attempt to modify dysfunctional pharyngeal anatomy or by-pass the pharynx. Modifications of the pharynx diminish the bulk of soft tissue structures which abut the air column, place them under tension, others alter their spatial inter-relationships. Surgical procedures are designed to modify the retropalatal pharynx, the retrolingual pharynx, or both. There is no single surgical procedure, short of tracheostomy, which consistently results in complete elimination of OSAS. However, appropriate application of current surgical techniques (synchronously or sequentially) may achieve cure in most patients without resort to tracheostomy. Patient selection, versatility in varied surgical approaches, and willingness to utilize more than one procedure when necessary appear to be critical attributes of a successful surgical program. On the other hand, analysis of the efficacy of individual surgical interventions is thwarted by the frequent practice of reporting on the application of multiple procedures in combination with evaluation of the composite effect. Well designed, multi-center studies would help clarify the strengths and weaknesses of different treatment approaches.