The velopharyngeal region is the primary site of obstruction in OSA patients with grade I°-II° tonsils; patients with low-grade tongue base collapse respond better to DISE-guided surgery, and combining tongue base surgery with velopharyngeal surgery may improve outcomes in patients with high-grade tongue base collapse and CCC/O collapse.
Retrospective DISE analysis of 112 OSA patients with grade I°-II° tonsils found that retrovelar obstruction was the most prevalent obstruction site.
The proportion of oropharyngeal lateral wall collapse increased with OSA severity.
Surgical success was numerically higher in the low-grade tongue base collapse group than in the high-grade group, but the difference was not statistically significant.
Postoperative AHI and the percentage of time with oxygen saturation below 90% were significantly lower in the low-grade tongue base collapse group.
Among patients with complete concentric collapse of the retrovelar space (CCC) or complete oropharyngeal lateral wall collapse (O), success was higher in the low-grade than the high-grade tongue base group, without statistical significance.
In high-grade tongue base collapse patients with isolated CCC/O, velopharyngeal surgery combined with partial glossectomy was effective in 4 of 6 patients, whereas all 3 patients who had velopharyngeal surgery alone were ineffective.
The authors conclude that the velopharyngeal region merits careful consideration in surgical planning for OSA patients with small tonsils, and that tongue base surgery combined with velopharyngeal surgery may improve outcomes in high-grade tongue base collapse with CCC/O.
This study looked at people with obstructive sleep apnea who have small tonsils. Researchers used drug-induced sleep endoscopy, in which a camera views the throat while the person is sedated, to see where the airway closes. Among 112 patients, the most common site of blockage was the soft palate region behind the palate (the retrovelar area), seen in roughly two-thirds to over 80% of patients depending on the subgroup. Collapse of the side walls of the throat became more common as sleep apnea became more severe. Forty-five patients went on to have surgery planned from the endoscopy findings and were followed afterward. Patients whose tongue base collapsed less had a higher success rate (76.9%) than those whose tongue base collapsed more (52.9%), though this difference could have been due to chance. After surgery, the less-collapsing group had significantly better sleep apnea scores and spent less time with low blood oxygen. In a very small group with high tongue base collapse and a specific complete-collapse pattern, surgery on both the palate/throat and the tongue base worked in 4 of 6 patients, while palate/throat surgery alone worked in none of 3. This research suggests that the palate and throat region is the main trouble spot in sleep apnea patients with small tonsils, and that the degree of tongue base collapse may influence how well surgery works. The study was retrospective and the surgical groups were small, so the findings about combined surgery are preliminary and would need confirmation in larger studies.
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Upload Your LabsZhao C, Wang H, Chen Y, Yu G, Wang Y. (2026). [Evaluation of airway obstruction and surgical outcomes in OSA patients with small tonsils through drug-induced sleep endoscopy].. Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology head and neck surgery. https://doi.org/10.13201/j.issn.2096-7993.2026.11.007