Surgical Management of Obstructive Sleep Apnea
Surgical management should be considered an important component in the management of patients with obstructive sleep apnea (OSA). Surgery has multiple roles including primary therapy for patients having failed medical management (positive airway pressure, mandibular advancement devices) and as an adjunctive therapy to allow for improved compliance with such medical therapies. Please refer to the AAO-HNS Position Statement on Treatment of OSA for further information.
The following procedures are effective and not considered investigational when considered as part of a comprehensive approach in the medical and surgical management of adults with OSA. Some patients may require one or more of these procedures performed individually or sequentially on the following anatomic areas. These surgical procedures include, but are not solely limited to the following:
- Nose (please refer to AAO-HNS Nasal Surgery and OSA Position Statement)
- Hard palate
- Palatal advancement Woodson, 2005¹
- Soft palate
- Uvulopalatopharyngoplasty (please refer to AAO-HNS Uvulopalatopharyngoplasty Position Statement)
- Palatine tonsils
- Pharynx and associated musculature
- Expansion sphincter pharyngoplasty (Pang, 2000²)
- Base of Tongue
- Lingual tonsils
- Lingual tonsillectomy - electrocautery, coblation and robotic (Lin, 2009³; Lee, 2012⁴)
- Tongue and associated musculature
- Midline Glossectomy (please refer to AAO-HNS Midline Glossectomy Position Statement)
- Tongue Suspension (please refer to AAO-HNS Tongue Suspension Position Statement)
- Genioglossus advancement (please refer to AAO-HNS Genioglossus Advancement and Hyoid Myotomy / Suspension Position Statement)
- Supraglottis / Hypopharynx
- Supraglottoplasty (Digoy, 2012⁵)
- Hyoid myotomy / suspension (please refer to AAO-HNS Genioglossus Advancement and Hyoid Myotomy / Suspension Position Statement)
- Maxillary and Mandibular Advancement (Pirklbauer, 2011⁶)
- Woodson BT, Robinson S, Lim HJ. Transpalatal advancement pharyngoplasty outcomes compared with uvulopalatopharygoplasty. Otolaryngol Head Neck Surg. Aug 2005;133(2):211- 217.
- Pang KP, Woodson BT. Expansion sphincter pharyngoplasty: a new technique for the treatment of obstructive sleep apnea. Otolaryngol Head Neck Surg. Jul 2007;137(1):110-114.
- Lin AC, Koltai PJ. Persistent pediatric obstructive sleep apnea and lingual tonsillectomy. Otolaryngol Head Neck Surg. Jul 2009;141(1):81-85.
- Lee JM, Weinstein GS, O'Malley BW, Jr., Thaler ER. Transoral robot-assisted lingual tonsillectomy and uvulopalatopharyngoplasty for obstructive sleep apnea. Ann Otol Rhinol Laryngol. Oct 2012;121(10):635-639.
- Digoy GP, Shukry M, Stoner JA. Sleep apnea in children with laryngomalacia: diagnosis via sedated endoscopy and objective outcomes after supraglottoplasty. Otolaryngol Head Neck Surg. Sep 2012;147(3):544-550.
- Pirklbauer K, Russmueller G, Stiebellehner L, et al. Maxillomandibular advancement for treatment of obstructive sleep apnea syndrome: a systematic review. J Oral Maxillofac Surg. Jun 2011;69(6):e165-176.
Important Disclaimer Notice (updated 7/31/14)
Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery, Inc. or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library. In no sense do they represent a standard of care. The applicability of position statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this position statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. Position statements are not intended to and should not be treated as legal, medical, or business advice.