While continuous positive airway pressure (CPAP) remains the gold standard for management of obstructive sleep apnea (OSA), surgical management is nonetheless a good alternative for patients that are unable to tolerate CPAP therapy. Pharyngoplasty is one such option. First described in 1976 by Dr. Ikematsu and popularized in the US by Dr. Fujita in 1981, the goal of the surgery is to suspend the velopharynx anterolaterally to improve patency of the airway for patients with collapse at the level of the velopharynx. Since its inception, it has undergone many iterations. This video demonstrates the steps to performing barbed reposition pharyngoplasty, a technique that has gained in popularity due to its short operative time and decreased post-operative morbidities. It utilizes the unique properties of V-loc sutures to evenly distribute tension when suspending the soft palate. Pharyngoplasty are best suited for patients with collapse at the level of the velopharynx and are not recommended for patients with significant posterior collapse at the level of the base of tongue.
45-year-old male with BMI of 33.1 and past medical history of OSA with poor sleep quality secondary to CPAP intolerance. Updated polysomnogram demonstrated moderate OSA with AHI of 15.7 with 1 central apnea. Physical examination demonstrated 1+ bilateral tonsil size and Friedman 3 palate position.
Pre-operative drug induced sleep endoscopy demonstrated mixed anteroposterior collapse of the velopharynx, partial lateral wall oropharyngeal collapse, with no significant collapse at the level of the base of tongue, hypopharynx, and epiglottis.