Seeking Feedback on Surgery Plan
I'm hoping to get feedback on surgical options to treat my OSA/UARS. My sleep quality is terrible due to constant arousals. I've tried all possible non-surgical options and nothing has provided enough relief.
I did a CBCT that seems to show a regular sized airway when I am awake and upright. DISE showed (1) the center 1/3-1/2 of the soft palate collapsing against the back of the throat, and it tends to stick and require some force to manually unstick in the morning (the sides of the retropalatal space are narrowed but still open for airflow) and (2) the tongue mostly blocking the airway (VOTE score was V1apT2). A sleep study also indicates a primarily obstructive cause with RDI around 17, though not much desaturation due to low arousal threshold. I've included CBCT and DISE report snapshots and a snapshot of raw data from my sleep study showing some arousals. The DISE report indicates open airway on my side, but I think it just takes more time for my airway to be blocked because sleeping on my side doesn't help much and the sleep study had comparable RDI on back and side. RDI is ~3x higher in REM vs non-REM. Taking all of the above together, it appears that my OSA is the result of obstruction from soft tissue collapse at the soft palate and tongue levels coupled with a low arousal threshold.
I'm therefore trying to decide between MMA and soft tissue surgery. I'm leaning toward a soft tissue approach given my airway appears structurally large enough if I can stop the soft tissue from collapsing, and to avoid MMA which is a more significant surgery with material risks. For soft tissue surgery, I'm considering doing (1) Australian modified palatopharyngoplasty to address the soft palate collapse, (2) genioglossal advancement as the main procedure to address tongue collapse, and (3) one tongue radiofrequency treatment to bolster the GA, all in one surgery session. I'm not sure yet if the surgeon I'd likely use plans to do the GA the old fashion way (cutting and rotating a rectangular piece of bone) or the newer way (cutting a trapezoidal shape and using plates/screws to anchor the bone piece in a forward position.
Grateful if others can provide feedback on whether this seems like the right approach / suggestions for improving the plan.
Edit: The photos appear to have been stripped, so here are links:
https://imgur.com/7FSzZPy; https://imgur.com/ZKwlAOA; https://imgur.com/NjFOLdz; https://imgur.com/Q6Vn22o; https://imgur.com/sF8WLB9; https://imgur.com/jfXopTu; https://imgur.com/B1aE8cn; https://imgur.com/q23sxaH; https://imgur.com/QvYFjqZ; https://imgur.com/FfyY4SS; https://imgur.com/pCtkJBa