The purpose of segmental pharyngeal procedures to treat obstructive sleep apnea syndrome is to increase airway size and decrease collapsibility. Procedures also reduce total airway resistance and sites of flow limitation and choke point during sleep. Surgically, the challenge is to improve ventilatory structure while maintaining other normal functions of speech and swallowing. Palatal advancement pharyngoplasty is a method of enlarging the retromaxillary and retropalatal airspace by removing a posterior portion of midline hard palate (maxilla and palatine bone) and advancing the soft palate anteriorly into the defect. Conceptually, this has similarities to maxillary advancement, but does not require altering or moving dentition (Fig. 54.1).