Hypopharyngeal Surgery in Obstructive Sleep Apnea: A Differential Pattern‑Based Surgical Decision

Background This study aimed to discuss the outcomes after surgical interventions for OSA in patients with hypopharyngeal collapse; the selection of the individual procedure was primarily based on the preoperative endoscopic examination (positional awake endoscopy and DISE) data. Surgeries were planned to combat the direction of collapse. Methods The study included adult patients with OSA who had apnea–hypopnea index (AHI) > 15. Patients were diagnosed by polysomnography and had upper airway mapping using positional awake endoscopy and DISE. The anteroposterior pattern of the collapse was managed by tongue base coblation reduction, the transverse collapse was managed by hyoidthyroidpexy, and the concentric type of collapse was managed by both techniques. Results No early or late major complications were reported. Within the groups, highly significant improvements were recorded as regards all objective and subjective data ( p = 0.0001). As regards the postoperative AHI, the comparison showed significant results between Group I and Group II, and Group II and Group III, while nonsignificant data were obtained between I and III with a statistical tendency toward III. Conclusion The pattern‐based surgical protocol reported subjective and objective favorable outcomes without significant morbidity. The protocol may aid in selecting appropriate surgical decisions and tailoring individual surgical maneuvers for OSA patients with HC, for whom the optimal surgical plan remains to be determined.