Talks：

Intrapharyngeal surgery with integrated treatment for Obstructive Sleep Apnea

Name：

李學禹(Hsueh-Yu Li)

Position：

1.Professor of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung University 2.Chairperson, Taiwan Voice Society

Affiliation：

Department of Otolaryngology, Chang Gung Memorial Hospital,

Email：

hyli38@adm.cgmh.org.tw

Photo：

Research Interests：

Snoring, Sleep surgery, Obstructive sleep apnea, Integrated treatment

Selected Publications：

◆ Li HY, Lo YL, Wang CJ, Hsin LJ, Lin WN, Fang TJ & Lee LA. (2016, Oct).Dynamic drug- induced sleep computed tomography in adults with obstructive sleep apnea.. Sci Rep., 2016 Oct 20;6:35849. doi: 10.1038/srep35849. (SCI, multidisciplinary sciences 7/63). MOST 103-2314-B-182A-062. ◆ Hsueh-Yu Li (2015, Dec). Efficacy of Coblation Endoscopic Lingual Lightening in Multi-level Surgery for Obstructive Sleep Apnea . JAMA Otolaryngology- Head & Neck Surgery. (Accepted). (SCI, Otorhinolaryngology 4/43). MOST 102-2314-B-182A-082. ◆ Li HY, Lee LA, Kezirian EJ. (2015, Jan). Coblation endoscopic lingual lightening (CELL) for obstructive sleep apnea.. Eur Arch Otorhinolaryngol., DOI 10.1007/s00405-014-3475-7. ◆ Li HY.. Updated Palate Surgery for Obstructive Sleep Apnea. Adv Otorhinolaryngol. 2017;80:74-80. doi: 10.1159/000470869. Epub 2017 Jul 17. PMID:28738391 . Karger. Jul, 2017.

Abstract：

Surgery for OSA can be divided into intrapharyngeal surgery, extrapharyngeal surgery and bariatric surgery. General surgeons perform bariatric surgery for pathologic obese OSA patients. Odontogenic surgeons implement maxillomandibular advancement (extrapharyngeal surgery) for OSA patients with retrognathia. ENT surgeons are more interesting in soft tissue surgery (intrapharyngeal surgery) for snoring and OSA. It is crucial to understand the purpose of the operation for adult OSAS: to cure the disease, to improve the clinical symptoms, to improve survival rate, or to facilitate the sequential treatment such as CPAP or oral appliance. Intrapharyngeal surgery usually improves but rarely cures OSA in terms of apnea/hypopnea index. It deserves full discussion with patients to avoid unnecessary procedure and unrealistic expectation. All patients suggestive of OSA need comprehensive physical examination, drug-induced sleep endoscopy (DISE), image study, and polysomnography to identify obstruction levels and disease severity. The principle of intrapharyngeal surgery for OSA shifts from radical excision to suspension/ relocation for functional reconstruction of oropharyngeal structure. The procedures involve a functional septoturbinoplasty of the nose; suspension palatoplasty (anterior-posterior collapse) and relocation pharyngoplasty (lateral collapse) of the velopharynx; coblation endoscopic lingual lighting (CELL), transoral robotic surgery (TORS) and Repose suspension of the tongue; transoral laser microsurgery and TORS of the larynx. TORS is particularly helpful in treating obstruction from hypertrophic lingual tonsils. CELL is useful in tissue volume reduction of the upper tongue. Repose tongue suspension is highly successful in thin and collapsible tongue. Hypoglossal nerve stimulation for OSAS is on the horizon and attracts a lot of interest. Besides intrapharyngeal surgery, ENT doctor needs to make an integrated treatment plan for OSA patients that include oropharyngeal myofunctional therapy, medication for nasal allergy, lateral sleep, nasal breathing training, and practical body weight control to improve surgical outcomes in short-term and long-term follow up.