Expansion sphincter pharyngoplasty

Obstructive sleep apnea is caused by dynamic collapse of upper airway structures, with the velum and lateral oropharyngeal walls being common locations of collapse. Targeted surgical techniques to this area have evolved over decades, from traditional uvulopalatopharyngoplasty to modified tissue-sparing techniques including expansion sphincter pharyngoplasty (ESP). ESP's goal is to obtain superolateral rotation of the palatopharyngeus muscle while preserving partial attachment to the superior pharyngeal constrictor, thereby creating lateral wall tension and reducing airway obstruction. A partial inferior uvulectomy may be performed to optimize the airway aperture as needed based on anatomy. ESP outcomes are mostly reported in patients with small tonsils and lateral wall collapse on pre-operative evaluation. It is likely also beneficial for those with large tonsils who have redundant or bulky oropharyngeal lateral wall tissue making them less likely to respond to tonsillectomy alone. Post-operatively, patients achieve durable reductions in objective and subjective measures without long-term morbidity.