ABSTRACT
There are potentially different phases of upper airway reconstruction. The initial phase of surgery directs treatment to the specific areas of obstruction. Persons with isolated obstruction at the level of the soft palate receive a palatal surgical procedure and patients with obstruction at the level of the hypopharyngx undergo a procedure designed to improve this region. If the patient has both palatal and hypopharyngeal obstruction, they receive procedures directed at both sites, either simultaneously or staged. The determination of the timing of surgery is dictated by the following: the patient’s ability to use nasal CPAP to protect the upper airway from collapse postoperatively, the severity of SDB, the safety and stability of the upper airway, and the
Figure 1 Hypopharyngeal view: (A) pre-Mu¨eller maneuver; (B) during Mu¨eller maneuver. (See color insert.)
Table 1 Factors Suggesting Hypopharyngeal Obstruction
Obesity (body mass index >31) Severe sleep apnea (apnea-hypopnea index >40) Small soft palate anatomy PAS <11mm noted on lateral cephalometric radiograph Lateral pharyngeal wall narrowing noted on fiberoptic examination Lateral pharyngeal wall collapse noted during the Mu¨ller maneuver
