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- evaluation
- BMI: fat的累積會集中在lateral wall & tongue base
- Modified Mallampati score: stage 2, 3必帶有一些hypopharynx 的成份
- Mandible 位置： 直接觀察、間接靠牙齒咬合（Angle classification,但會受之前的牙齒處置而影響判斷）、image( lateral cephalometry: retrognathia--> small SNB angle; narrowed tongue base to post. Pharyngeal wall --> posterior airway space; increased distance between hyoid & mandible)
- lateral pharyngeal wall: 目前只有MRI作研究上的評估用
- Awake fibroscopic endoscopy: 可比較張口和閉口時、臥姿或坐姿時、吸氣和呼氣時、Mullar's maneuver
- drug induced sleep endoscopy(DISE): 用propofol induced unconscious sedation可造就等同睡眠狀態下的呼吸道狀況。但hypopharynx的obstruction極為複雜，三個部位會互相影響（lateral pharyngeal wall, epiglottis, tongue base),即理論上針對tongue base做的debulky會對tongue base hypertrophy related OSAS有最大的改善，但事實上對其它部位造成的hypopharyngeal obstruction也會有幫助。--》DISE對retropalatal obstruction的手術預後的預測比hypopharynx好
- Tongue advanced/ stablization：
- genioglossus advancement（在mandible打洞，然後把genioglossus insertion處的genial tubercle往前拉1-2公分，如此可以加強genioglossus tension)
- Mortised genioplasty：把anterior mandible的下緣部分往前拉，則可同時增加genioglossus, digastric m., myelohyoid m.的張力
- For BMI<30, low AHI較有用
- complication: hematoma, incisional dehiscence, infection, dental injury, dental numbness & paresthesia, mental n. Injury, mandible fracture
- Hyoid suspension procedure
- 把hyoid懸吊在thyroid cartilage or mandible上
- For BMI<30 or low AHI較有用
- Complication: seroma, hematoma, infection, dysphagia(due to local edema, injury to superior laryngeal n. or hypoglossal n.), hyoid fracture, suspension material breakage, pharyngocutaneous fistula)
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