HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Palatal Procedures for Obstructive Sleep Apnea

The procedure was performed under general anesthesia. A tonsillectomy was per- formed, and the palatopharyngeus muscle was identified and the inferior end trans- ected and rotated superolaterally. The muscle was left with its posterior surface partially attached to the horizontal superior pharyngeal constrictor muscles. Enough muscle had to be isolated to allow suturing. An incision was made on the anterior pillar identifying the palatoglossus muscles. The palatopharyngeus muscle was then attached to the arching fibers of the soft palate. A partial uvulectomy was then per- formed and the incisions closed ( Fig. 6 ). Fig. 5. ( A ) Operative view after left tonsillectomy with (a) palatopharyngeus muscle, (b) pal- atoglossus muscle, (c) superior pharyngeal constrictormuscle, and (d) right tonsil. ( B ) Elevation and section of the left superior pharyngeal constrictor muscle. ( C ) Anterior suture of the supe- rior pharyngeal constrictor muscle (lateral flap) to the palatoglossus muscle. ( D ) Z-plasty covering the superior part of the tonsillar fossa: (a) palatine flap, (b) upper part of the palato- pharyngeus muscle. Incision to remove part of the uvula ( dashed line ). ( E ) Final aspect of the lateral pharyngoplasty. ( From Cahali M. Lateral pharyngoplasty: a new treatment for obstruc- tive sleep apnea hypopnea syndrome. Laryngoscope 2003;113:1962–64; with permission.)

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