Uyku Apne Sendromunda Kulak Burun Boğaz Değerlendirilmesi ve Cerrahisine Giriş
Özet
Obstrüktif uyku apne sendromu (OSA), faringeal kollaps ve üst solunum yolu kas yanıtı gibi karmaşık fizyolojik endotitlere sahip çok faktörlü bir hastalıktır. Sürekli Pozitif Havayolu Basıncı (CPAP) standart tedavi yöntemi olmasına rağmen, hastaların uzun süreli uyumu düşüktür. CPAP tedavisini tolere edemeyen veya reddeden hastalar için üst havayolu cerrahisi (UAS) sıklıkla önerilir; bu cerrahi müdahaleler üst havayolunu genişletmeyi ve stabilize etmeyi amaçlar. Uygun hastaların belirlenmesinde Friedman evreleme sistemi, dil pozisyonu ve palatin tonsil hipertrofisi gibi klinik parametreler cerrahi başarı oranını tahmin etmede kritik rol oynar. Üst havayolu endoskopik muayenesi (DISE) ve sefalometrik görüntüleme teknikleri, obstrüksiyon seviyelerini ve lateral duvar çökmelerini doğru değerlendirmek için kullanılır. Orofarenks seviyesinde uvulopalatofaringoplasti (UPPP) gibi klasik ablatif yöntemler yüksek komplikasyon riskleri taşırken; barbed repozisyon faringoplasti (BRP) ve ekspansör sfinkter faringoplasti (ESP) gibi modern cerrahi yaklaşımlar daha başarılı sonuçlar vermektedir. Hipofarenks bölgesindeki dil kökü tıkanıklıklarında ise trans-oral robotik cerrahi (TORS), maksillomandibular ilerletme (MMA) ve hipoglossal sinir stimülasyonu (HNS) gibi yenilikçi tedaviler çok seviyeli havayolu iyileşmesi sağlamaktadır.
Obstructive sleep apnea syndrome (OSA) is a multifactorial disorder characterized by complex physiological endotypes, including pharyngeal collapse and upper airway muscle responsiveness. Although Continuous Positive Airway Pressure (CPAP) is accepted as the standard first-line treatment, long-term patient compliance remains low. For patients who refuse or cannot tolerate CPAP, upper airway surgery (UAS) is frequently recommended, aiming to expand and stabilize the airway anatomy. In selecting suitable candidates, clinical parameters within the Friedman staging system, such as tongue position and palatine tonsil hypertrophy, play a critical role in predicting surgical success rates. Upper airway endoscopic evaluation (DISE) and cephalometric imaging techniques are utilized to accurately assess obstruction levels and lateral wall collapses. At the oropharyngeal level, classic ablative procedures like uvulopalatopharyngoplasty (UPPP) carry high complication risks, whereas modern surgical approaches such as barbed reposition pharyngoplasty (BRP) and expansion sphincter pharyngoplasty (ESP) yield more successful outcomes. For tongue base obstructions in the hypopharyngeal region, innovative treatments including trans-oral robotic surgery (TORS), maxillomandibular advancement (MMA), and hypoglossal nerve stimulation (HNS) provide multi-level airway improvement.
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