Current upper airway and maxillofacial surgeries for obstructive sleep apnoea (OSA)
Intervention site | Main procedures | Main indications |
Nose | Septoplasty Turbinoplasty | For subjects with persistent nasal obstruction, mainly to improve feasibility of CPAP or MAD |
Nasopharynx | Adenoidectomy | Adenoid hypertrophy |
Oropharynx | Tonsillectomy Barbed reposition pharyngoplasty (BRP) Expansion sphincter pharyngoplasty (ESP) Soft palate RFITT | Tonsillar hypertrophy; in adults, mainly with other procedures Retropalatal obstruction Retropalatal obstruction Retropalatal obstruction in mild OSA |
Hyoid bone | Hyoidthyroidpexia | Hypopharyngeal obstruction |
Tongue | Tongue RFITT Transoral robotic surgery (TORS) Tongue suspension | Moderate macroglossia and retrolingual obstruction, mainly in mild-to-moderate OSA, or as part of multilevel surgery |
Maxilla/mandible | Maxillomandibular advancement Maxillary expansion | Mandibular deficiency, severe OSA with obstruction at multiple sites |
Larynx | Epiglottopexy | Obstruction at the epiglottic level |
Trachea | Tracheostomy | Only in emergency situations; rarely performed when other treatments are not feasible in severe OSA |
Multisite | Variable combined procedures | Obstruction at multiple sites in moderate-to-severe OSA |
CPAP: continuous positive airway pressure; MAD: mandibular advancement device; RFITT: radiofrequency interstitial thermotherapy.