Current upper airway and maxillofacial surgeries for obstructive sleep apnoea (OSA)

Intervention siteMain proceduresMain indications
For subjects with persistent nasal obstruction, mainly to improve feasibility of CPAP or MAD
NasopharynxAdenoidectomyAdenoid hypertrophy
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 boneHyoidthyroidpexiaHypopharyngeal obstruction
TongueTongue 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/mandibleMaxillomandibular advancement
Maxillary expansion
Mandibular deficiency, severe OSA with obstruction at multiple sites
LarynxEpiglottopexyObstruction at the epiglottic level
TracheaTracheostomyOnly in emergency situations; rarely performed when other treatments are not feasible in severe OSA
MultisiteVariable combined proceduresObstruction at multiple sites in moderate-to-severe OSA

CPAP: continuous positive airway pressure; MAD: mandibular advancement device; RFITT: radiofrequency interstitial thermotherapy.