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Pharyngoplasty represents one of the most widely performed surgical procedures for the treatment of obstructive sleep apnea (OSA) in the presence of palate-oropharyngeal collapse. The learning curve for pharyngoplasties is steep and success is conditional on the correct use of the sutures and the careful application of the surgical steps in a narrow surgical field. The use of synthetic models may be conveniently and safely employed for hands-on surgical practice in pharyngoplasties, especially when fresh frozen cadaveric specimens are not available. We present the "Pharyngolab", a new simulator for pharyngoplasties.

Purpose Positional therapy (PT) has become more reliable for obstructive sleep apnea (OSA) patients with the use of new devices. The objectives of this study were to determine the preoperative prevalence of positional OSA (POSA) in our population of surgically treated patients and the proportion of patients who developed POSA after surgery and might improve with additional positional therapy. Methods This was a retrospective study of surgically treated OSA patients from 1999 to 2017. The Cartwright definition was used to define POSA. All patients completed a sleep study before and 6 months after surgery and a complete upper airway (UA) exploration (awake +/- DISE). A total of 125 patients were included. Results The global prevalence of POSA before surgery was 31.2%. In those who were cured by surgery, the preoperative prevalence of POSA was 38.3%. Having POSA was not related with surgical success outcome. For patients not cured by surgery, the proportion of POSA significantly increased from 25.64 to 53.85% after surgery. Eighteen patients of them (23.1%) achieved AHI < 5/h in a lateral position. In those patients, PT with Night-Shift (TM) was suggested, 50% of them accepted it and 88.9% of them experienced excellent satisfaction. Lateral velum collapse and the absence of concentric collapse at the tongue base had statistical relationships with the development of POSA. Conclusions The prevalence of POSA is increased after surgery in patients with persistent OSA after surgery. In these patients, the development of POSA gives an extra therapeutic chance as 23.1% of these cases can be successfully treated by using PT.

To review whether drug-induced sleep endoscopy (DISE) aids in obstructive sleep apnea surgical planning, if it changes the initial proposal, and if so, does it contribute to increased surgical success or unnecessary morbidity? A DISE and surgical outcomes multicenter cohort study (n = 275) reported no association for surgical outcomes with velopharyngeal and epiglottic collapse. Oropharyngeal and tongue base collapse on the other hand were associated with lower odds of surgical response. DISE changes surgical planning mainly in regard to the approach of the tongue base and epiglottis, as these structures usually do not collapse in the awake state. The decision of velopharyngeal surgery usually does not change, as the vast majority demonstrate velopharyngeal collapse in DISE. Whether DISE increases or not, surgical success is controversial, with conflicting published data. However, poorer surgical outcomes have been associated with velopharyngeal concentric, oropharyngeal lateral wall, and tongue base collapse.