Tailored Palatal Surgery in Obstructive Sleep Apnea: The Role of Drug-Induced Sleep Endoscopy in Surgical Decision-Making

The surgical treatment of obstructive sleep apnea (OSA) has evolved beyond traditional uvulopalatopharyngoplasty, which often yields inconsistent success reports. This article presents a systematic surgical protocol that tailors the type of pharyngoplasty to fit specific airway collapse patterns identified by drug-induced sleep endoscopy (DISE). In this protocol, all surgical candidates undergo DISE to evaluate the collapse pattern, with a focus on retropalatal circumferential collapse. Based on these findings, patients are selected for one of three procedures: uvuloplasty with soft palatal webbing flap pharyngoplasty for mild cases, relocation pharyngoplasty for moderate cases, or expansion sphincter pharyngoplasty for severe cases. This personalized strategy has been reported with notable improvements in surgical outcomes in appropriately selected patients. This highlights that a one-size-fits-all approach is insufficient and that a surgical strategy guided by a thorough DISE assessment is essential to select the appropriate technique and maximize success in OSA surgery.