Practical tips for pharyngoplasty procedure

Uvulopalatopharyngoplasty (UPPP) is the most used procedure for treating obstructive sleep apnea (OSA). There are several technique modifications of the procedure to minimize the complications and expedite the recovery. Most of the failures of UPPP happen after surgery, and patients will return with a relapse of their OSA. Recently, the focus was redirected toward the lateral wall collapsibility of the airway at the level of the velum and oropharynx. All pharyngoplasty procedures now aim to minimize the procedure's invasiveness and expand the lateral pharyngeal wall. There is a change in the concept from UPPP to pharyngoplasty regarding the amount of normal tissues to be removed. For instance, the goal of UPPP was to remove the tonsils, part of the anterior tonsillar pillar, and the uvula and suture the anterior and posterior tonsillar pillars. A large amount of the soft palate is usually removed, and the risk of postoperative velopharyngeal insufficiency (VPI) after UPPP is about 2%. This "resective" concept has changed to a "reconstructive" concept with maintaining the normal tissues and instead suspending the pharyngeal muscles to expand the lateral pharyngeal wall. The purpose of this chapter is to review pearls and the pitfalls of using expansion pharyngoplasty (ESP) with barbed sutures.