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Introduction Yotot

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adinath
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Operative Techniques in Otolaryngology (2012) 23, 1

Introduction
Although the prevalence of obstructive sleep apnea has modification. Drug-induced sleep endoscopy (Kezirian and
been increasing, this common disorder remains difficult to colleagues in this issue), Sleep-magnetic resonance imaging
manage by medical and surgical specialists. Continuous analysis (Shott and colleagues in this issue), and upper
positive airway pressure therapy is readily available in airway structural element analysis (Woodson and col-
many forms but despite its availability and efficacy, contin- leagues in this issue) are techniques that may help to pre-
uous positive airway pressure is not accepted or regularly cisely focus our interventions. Standardization of airway
used by many patients. Alternative treatments including classification, as proposed by Kezirian and colleagues, may
surgery, oral appliances, and expiratory positive airway also aid in the analysis of the effectiveness of specific
pressure devices thus play an important role in the manage- procedures and in comparison of studies.
ment of obstructive sleep apnea. In this era of personalized By using new instruments and techniques, we can refine
medicine, effective therapy must be fitted to the patient to and innovate the reconstruction of the nasal and pharyngeal
achieve a successful outcome.
airway, often with lower morbidity. By using robotic instru-
Upper airway reconstruction is sought by many patients
mentation for upper and lower pharyngeal surgery, Vicini
who are unable to use appliances nightly or who are unable
and colleagues report improved visualization and ability to
to lose sufficient weight. Airway reconstructive surgery
manipulate tissues in otherwise-difficult loci. By using the
improves the apnea-hypopnea index but often does not
normalize it. Some have argued that surgery is not suffi- coblation radiofrequency device, Woodson and colleagues
ciently effective, or does not usually cure obstructive sleep report that volumetric reduction of the tongue base and
apnea and thus should not be used. However, if one con- lingual tonsils is achieved with lower rates of morbidity
siders that obstructive sleep apnea is a chronic disease, the compared with conventional approaches. Palatal advance-
goal of treatment is improvement in symptoms and func- ment pharyngoplasty and expansion sphincter are tech-
tion, and surgery usually achieves this target. Resolution of niques that effectively modify the shape and size of the
a chronic disease is not a common outcome of any chronic pharynx. Nasal valve stabilization technique of Weaver may
disease therapy. Furthermore, surgery is most often under- be easily performed and has low morbidity.
taken in patients who will otherwise remain untreated, I invite you to read the articles in this journal, the product
symptomatic, and are at increased risk for medical sequelae of great efforts by an international group of sleep surgery
and motor vehicle accidents. experts. I wish to thank Dr Michael Friedman for the op-
The challenge of modern airway reconstruction is to portunity to serve as editor of this issue.
improve effectiveness while lowering risks and morbidity to
improve acceptance. Effectiveness may be improved by the Ofer Jacobowitz, MD, PhD
identification of the loci and structures for targeted surgical Guest Editor

1043-1810/$ -see front matter © 2012 Published by Elsevier Inc.


doi:10.1016/j.otot.2011.10.001

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