Surgical indications and treatment methods for obstructive sleep apnea syndrome

Surgical Treatment:

Surgical treatment primarily addresses upper airway narrowing and obstruction in patients with obstructive sleep apnea syndrome. It is suitable for moderate to severe obstructive sleep apnea syndrome patients with confirmed pharyngeal-palatine stenosis who are unsuitable for nasal continuous positive airway pressure (CPAP).

(I) Uvula-palatopharyngoplasty (UPPP)
UPPP is mainly used for patients whose upper airway closure site is above the soft palate level. It is one of the more commonly used methods. The surgery includes removal of enlarged tonsils, excision of the uvula-palatine margin and excess soft tissue of the lateral pharyngeal wall, and widening of the pharyngeal and nasopharyngeal inlets. This surgery can widen the upper airway, reduce closure pressure, and achieve satisfactory results in most patients, reducing the number of sleep apnea episodes by 50% and improving symptoms.

(II) Tongue Reconstruction Surgery
Tongue reconstruction surgery is suitable for patients with macroglossia, posterior displacement of the tongue base, or excessively long or thickened epiglottis. The surgery involves midline resection of the tongue base, partial resection of the epiglottis, and partial resection of the epiglottic arborvitae mucosa to open the central hypopharyngeal passage, reduce airway resistance, and eliminate apnea.

(III) Tracheostomy
Tracheostomy is suitable for patients with obstructive sleep apnea syndrome accompanied by severe hypoxemia leading to coma, pulmonary heart disease (cor pulmonale), heart failure, and arrhythmias. It is the most timely and effective measure to relieve life-threatening asphyxia caused by upper airway obstruction, as it can bypass the site of obstruction and establish a respiratory bypass. Clinically, it is not as widely used as nCPAP.

(iv) Other anatomical abnormalities of the respiratory tract associated with the onset of obstructive sleep apnea syndrome, such as deviated nasal septum, nasal polyps, micrognathia, malocclusion, and tonsillar hypertrophy, can be treated with septoplasty, jaw reduction, mandibular repositioning, hyoid bone suspension, and tonsillectomy. These procedures can increase the diameter of the nasal and pharyngeal airways, reduce ventilation resistance, and relieve the clinical symptoms of patients with obstructive sleep apnea syndrome.