Nasal Surgery for Obstructive Sleep Apnea

Nasal obstruction is a significant upstream contributor to obstructive sleep apnea (OSA) and a major impediment to positive airway pressure (PAP) therapy adherence. By increasing upstream nasal resistance, structural nasal pathology amplifies negative inspiratory pressure within the pharynx, predisposing susceptible individuals to retropalatal and retroglossal airway collapse and elevating required CPAP pressures. Nasal surgery, while not curative for pharyngeal OSA, plays a critical adjunctive role in reducing nasal resistance, improving PAP tolerance, and enabling multilevel surgical strategies. This chapter presents five principal nasal surgical techniques for OSA management. Radiofrequency volumetric tissue reduction (RFVTR) of the inferior turbinates delivers submucosal thermal energy to achieve fibrotic tissue contraction in a minimally invasive, mucosal-sparing fashion, with approximately 80% of patients maintaining symptomatic benefit at 36 months and documented improvements in CPAP compliance. Endoscopic septoplasty corrects cartilaginous and bony septal deformity to restore laminar nasal airflow; although meta-analyses demonstrate modest mean reductions in apnea–hypopnea index, clinically meaningful improvements in sleepiness and PAP adherence justify its role as a foundational adjunct. Microdebrider-assisted turbinoplasty (MAT) achieves submucosal debulking with epithelial preservation, offering efficacy comparable to radiofrequency and laser techniques with a favorable complication profile. Nasal valve stabilization addresses dynamic collapse of the upper lateral cartilage through suture suspension to the bony piriform aperture, restoring physiological valve function without external scarring or grafts. Additionally, transoral endoscopic adenoidectomy is described as a direct-visualization technique enabling anatomy-sparing, hemostatic adenoidal removal with superior clearance compared with traditional blind curettage, particularly relevant in pediatric OSA. Surgical indications, step-by-step technique, postoperative care, and complication management are detailed for each procedure.