Uyku Apne Sendromunda Kulak Burun Boğaz Cerrahisinin Önemi
Özet
Obstrüktif Uyku Apnesi Sendromu (OUAS), üst hava yolundaki faringeal kollapslar nedeniyle apne, hipopne ve horlama gibi semptomlarla seyreden bir hastalıktır. Altın standart tedavi pozitif hava yolu basıncı (PAP) cihazları olsa da, PAP tedavisini tolere edemeyen, reddeden veya anatomik engelleri bulunan hastalarda uyku cerrahisi önemli bir alternatiftir. Cerrahi kararda en önemli iki parametre Apne Hipopne İndeksi (AHI) ve Vücut Kütle İndeksi (BMI)'dir. Hastanın anatomik yapısına ve obstrüksiyon alanlarına göre nazal cerrahiler, yumuşak damak radyofrekansı veya palatal implant gibi minimal invaziv yöntemler ya da tonsillektomi, uvulopalatofaringoplasti (UPPP), lateral faringoplasti, dil kökü cerrahileri ve maksillomandibuler ilerletme gibi invaziv operasyonlar tercih edilebilmektedir. Bu cerrahi müdahaleler, AHI değerini düşürmeyi ve başta horlama olmak üzere semptomları azaltmayı hedeflerken, operasyon türüne göre kanama, ağrı, enfeksiyon ve doku hasarı gibi çeşitli komplikasyon riskleri de barındırmaktadır.
Obstructive Sleep Apnea Syndrome (OSAS) is a disorder characterized by pharyngeal collapses in the upper airway, leading to symptoms such as apnea, hypopnea, and predominant snoring. Although positive airway pressure (PAP) therapy is the gold standard treatment, sleep surgery is considered for patients who reject, cannot tolerate, or have anatomical obstructions preventing PAP device usage. Surgical decisions are primarily guided by two crucial parameters: the Apnea-Hypnea Index (AHI) and Body Mass Index (BMI). Depending on patient-specific factors, surgical options range from nasal surgeries and minimally invasive procedures like soft palate radiofrequency or palatal implants to invasive techniques including tonsillectomy, uvulopalatopharyngoplasty (UPPP), lateral pharyngoplasty, tongue base surgeries, and maxillomandibular advancement. These interventions aim to significantly decrease the AHI and alleviate symptoms, though they carry specific procedural risks such as pain, bleeding, infection, or mucosal damage.
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