ABSTRACT
VSE in our establishment is reserved for research protocols, selected snorers, and
the OSAS surgical candidates as selected by our multidisciplinary team. Our multi-
disciplinary team consists of respiratory physicians, psychiatrists, neurologists, oto-
laryngologists, pediatricians for the pediatric cases, and physiotherapists for our
weight control program for the obese. VSE is not used for the diagnosis of OSAS
and is interpreted in the light of a full night’s polysomnographic sleep study
(PSG). Our criteria for surgical intervention in adult patients are the PSG proven
snorers, upper airway resistance syndrome, OSAS patients with a body mass index
(BMI) of < 30, and patients with correctable craniofacial deficits, e.g., ‘‘South China
chin,’’ retrognathia, which is common in our locality in the Cantonese population.
Surgical candidates in our institution should be under 60 years of age. All our surgi-
cal candidates are required to have tried CPAP with the present-day selection of
masks for at least 6 months. The procedures performed at our institution for the different VSE established
sites of obstruction in OSAS patients are summarized in Table 1. VSE is only useful if there is a surgical procedure to treat effectively the diag-
nosed sites of obstruction. We have adopted a reserved approach of no surgical
intervention unless our repertoire of procedures is appropriate for the observed
obstructive sites. The surgical patients are informed that they may experience an
improvement but not necessarily a cure. Many medium and long-term failures of
surgical treatment are related to the fundamental design of the surgical procedure.
The stiffness or extra room achieved by scarring, tightening, or widening procedures
is unable to counter the natural laxity of pharyngeal tissue, which yields to the upper
airway negative pressure with time, resulting in re-obstruction. In obese patients with
multiple medical problems and invariably multilevel obstruction, our experience with
surgery has been disappointing. These patients are not subjected to VSE. They are
patiently counseled and recommended for CPAP. Bilevel Positive Airway Pressure
(BIPAP) ventilation is recommended for the obese hypoventilation patients under
the supervision of our respiratory physicians, or a tracheostomy can be offered if
they should select this option.
