Surgical approaches to the management of obstructive sleep apnea (OSA) include uvulopalatopharyngoplasty (UPPP) and similar procedures.
Surgical approaches to the management of obstructive sleep apnea (OSA) include uvulopalatopharyngoplasty (UPPP) and similar procedures. For example, Pang and Woodson1 assessed the efficacy of expansion sphincter pharyngoplasty (ESP) in the treatment of OSA. They reported that the apnea-hypopnea index (AHI) decreased from 44 to 12 events/hour following ESP and from 38 to 19 events/hour in a similar group that had UPPP. But, it appears that these surgical techniques were unable to eradicate OSA entirely. Similarly, Bertoletti et al found a significant reduction in continuous positive airway pressure (CPAP) levels 3 months after minimally invasive pillar placements, but the underlying OSA remained unresolved. On the other hand, Conley and Legan3 demonstrated the importance of surgical transverse expansion of the maxillary and mandibular arches in patients with severe OSA. They found a marked improvement in the degree of OSA, but the severity of the surgical procedure, which included distraction osteogenesis, cannot be overlooked. Similarly, Bonetti et al4 reported a case of severe OSA in which an increase in the transverse dimensions by surgically-assisted rapid maxillary expansion and mandibular symphyseal distraction osteogenesis dramatically decreased the AHI to 9 events/ hour. Therefore, it appears that surgical techniques are able to moderate but not eliminate OSA entirely.
A possible alternative to surgical intervention might be nonsurgical manipulation of the upper airway. In a recent study,5 the upper airway was evaluated following midfacial treatment in adults who had never had been tested for OSA. Pre- and post-treatment lateral cephalographs of 99 patients (mean age 42.9 ± 1.5 years: treatment time 21.3 ± 6.2 months) were analyzed using appropriate software. Using 2-dimensional finite-element analysis, a relative 22% increase in nasopharyngeal airway area was found above and behind the soft palate.6 It was concluded that upper airway changes in nongrowing adults are similar to those of actively growing children undergoing functional orthodontic corrections,7 and these findings suggested that genetically-encoded developmental mechanisms might be modulated by maxillary appliances to enhance the upper airway in adults.
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