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Obstructive Sleep Apnea Syndrome and Snoring: What Is the Role of Surgery?

This paper evaluates the different surgical treatments used in obstructive sleep apnea syndrome and snoring. This critical analysis is based on an extensive review of the literature and the authors’ experience. In snoring patients, the success rate of surgery focusing on the soft palate does not exceed 50–60%, and the risk of pharyngeal narrowing is high. Therefore, this treatment should be selectively performed. More conservative approaches are now under development. The surgical treatment of the obstructive sleep apnea syndrome is controversial. Surgery of the soft palate is associated with a high rate of complications and, therefore, is restricted to a limited number of cases. The compliance with continuous positive airway pressure is low, especially among young patients. Therefore, maxillofacial surgery has regained interest with two opposite concepts. Some authors favor a step-by-step approach, while others proceed in a one-stage surgery. The latter is more aggressive, but its success rate is superior (90%). Results and indications of hyoid myotomy and suspension associated with genioplasty (phase 1) and maxillomandibular osteotomy and advancement (phase 2) are reviewed in detail.