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Reported outcomes include reductions in apnea hypopnea index (AHI) and improvements in Epworth Sleep Scale, with benefits possibly independent of surgical timing.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/should-adjunct-palatopharyngeal-surgery-be-performed-with-hypoglossal-nerve-stimulation-for-osa-treatment/440218/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/should-adjunct-palatopharyngeal-surgery-be-performed-with-hypoglossal-nerve-stimulation-for-osa-treatment/440218.png","ImageObject",300,407,{"name":42,"@type":43},"Muffet","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-08","2026-09-29",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",9,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why are some patients with OSA not initially eligible for hypoglossal nerve stimulation (HNS)?","Question",{"text":63,"@type":64},"HNS eligibility is guided by criteria including moderate-to-severe OSA (AHI 15–100), PAP intolerance, BMI \u003C40 kg/m2, and absence of complete concentric collapse (CCC) of the velopharynx on DISE. Patients showing CCC on DISE are typically limited in treatment options.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How might adjunctive palatopharyngeal surgery affect CCC findings on DISE for HNS candidates?",{"text":68,"@type":64},"Studies suggest palatopharyngeal surgery can modify the upper-airway collapse pattern, converting CCC to anterior–posterior (AP) collapse or even eliminating collapse on DISE. This may potentially turn previously ineligible patients into suitable HNS candidates.",{"name":70,"@type":61,"acceptedAnswer":71},"What outcomes have studies reported after palatopharyngeal surgery, with or without subsequent HNS?",{"text":72,"@type":64},"Across cited studies, palatopharyngeal surgery was associated with improvements such as reductions in mean AHI and, in some reports, decreases in Epworth Sleep Scale. Long-term benefit is also described, including sustained OSA severity improvement at follow-up measurements.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},440218,1790920756,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":26,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":97,"preview_page_count":4},962090768927,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","The Laryngoscope  \nTRIOLOGICAL SOCIETY BEST PRACTICE  OPEN ACCESS   \nShould Adjunct Palatopharyngeal Surgery Be Performed With Hypoglossal Nerve Stimulation for OSA Treatment?  \nMaria V. Suurna  | Betzamel Lopez  \nDepartment of Otolaryngology-Head and Neck Surgery, University of Miami Health, Miami, Florida, USA Correspondence: Maria V. Suurna ([maria.suurna@miami.edu](maria.suurna@miami.edu))  \nReceived: 2 May 2025 | Accepted: 21 May 2025  \nFunding: The authors received no specific funding for this work.  \nKeywords: complete concentric collapse | drug-induced sleep endoscopy | hypoglossal nerve stimulation | obstructive sleep apnea | OSA | palatopharyngeal surgery | tonsillectomy | upper airway surgery  \n1 | Background  \nHypoglossal nerve stimulation (HNS) is an effective treatment of obstructive sleep apnea (OSA) in patients who do not tolerate positive airway pressure (PAP) therapy. Patient selection for HNS is guided by well-defined criteria including moderate to severe OSA defined by apnea hypopnea index (AHI) of 15– 100 events per hour, PAP intolerance, a body mass index below 40 kg/m2 , and absence of complete concentric collapse (CCC) of the velopharynx determined by drug-induced sleep endoscopy (DISE) . These eligibility requirements limit treatment options for patients who present with CCC on DISE. However, emerging evidence suggests that adjunctive palatopharyngeal surgery can modify the pattern of upper airway collapse, potentially converting previously ineligible patients into suitable HNS candidates [1–5]. Moreover, these surgical interventions may enhance treatment outcomes even in patients without CCC when performed in combination with HNS. This review presents the current evidence supporting adjunctive palatopharyngeal surgery for patients with OSA considering HNS implantation.  \n2 | Literature Review  \nRecent literature suggests that CCC of the velopharynx is no longer considered a strict contraindication for HNS implant, asthe pattern of airway collapse can be modified by palatopharyngeal surgery. In a retrospective study by Hasselbacher et al. [1], 15 patients with CCC underwent uvulopalatopharyngoplasty with tonsillectomy and were reassessed using polysomnography  \nand DISE. At 3 months postoperatively, 93% of patients demonstrated a change to anterior–posterior (AP) collapse of the soft palate, with a reduction in mean AHI from 34.7 to 20.2 events/h. The surgical technique used in this study consisted of cold steel tonsillectomy, followed by lateralization of the posterior faucial pillars and suturing of the anterior and posterior faucial pillars. The distal uvula mucosa was resected while preserving uvulopalatal muscles in all cases.  \nIn the retrospective analysis study by Weidenbecher et al., 20 patients with CCC of the velopharynx on DISE who were initially excluded as candidates for HNS subsequently underwent expansion sphincter pharyngoplasty, which included tonsillectomy, followed by bilateral inferior transection of the palatopharyngeal muscle and creation of a superiorly based muscle flap that was rotated and pulled anteriorly and laterally and affixed to the hamulus of the pterygoid. Postoperatively, all 20 patients (100%) demonstrated resolution of the CCC of the velopharynx and conversion to AP collapse on DISE. These patients proceeded with HNS implant placement, achieving a mean reduction in AHI from 53.9 to 8.2 events/h and a decrease in Epworth Sleep Scale (ESS) score from 13.3 to 5.7 with the therapy use [2] .  \nA prospective cohort study by Liu et al. involving 12 patients with CCC of the velopharynx demonstrated that following a modified palatopharyngoplasty, all 12 (100%) patients converted from CCC pattern to either no collapse or to an AP collapse, resulting in a decrease of AHI from a mean of 55 to 33.1 events/h without additional interventions. The modified palatopharyngoplasty in this study was a tissue-sparing technique utilizing  \nThis is an open access article under the terms o","cbCaieZKXNZd1IMh","https://ap.wps.com/l/cbCaieZKXNZd1IMh","pdf",107991,"English","# Background\n## Literature Review","[{\"question\":\"Why are some patients with OSA not initially eligible for hypoglossal nerve stimulation (HNS)?\",\"answer\":\"HNS eligibility is guided by criteria including moderate-to-severe OSA (AHI 15–100), PAP intolerance, BMI \\u003c40 kg/m2, and absence of complete concentric collapse (CCC) of the velopharynx on DISE. Patients showing CCC on DISE are typically limited in treatment options.\"},{\"question\":\"How might adjunctive palatopharyngeal surgery affect CCC findings on DISE for HNS candidates?\",\"answer\":\"Studies suggest palatopharyngeal surgery can modify the upper-airway collapse pattern, converting CCC to anterior–posterior (AP) collapse or even eliminating collapse on DISE. This may potentially turn previously ineligible patients into suitable HNS candidates.\"},{\"question\":\"What outcomes have studies reported after palatopharyngeal surgery, with or without subsequent HNS?\",\"answer\":\"Across cited studies, palatopharyngeal surgery was associated with improvements such as reductions in mean AHI and, in some reports, decreases in Epworth Sleep Scale. Long-term benefit is also described, including sustained OSA severity improvement at follow-up measurements.\"}]","Should Adjunct Palatopharyngeal Surgery Be Performed With Hypoglossal Nerve Stimulation for OSA Treatment? | PDF",1790691533]