General guidelines for surgical intervention include significant symptoms of snoring and daytime somnolence; documented failure in continuous positive airway pressure (CPAP) trials; and documented failure of conservative measures, such as dental appliances, changes in sleeping position, and sleep hygiene in general. Apparent obstruction at the level of the soft palate must be determined by fiberoptic nasopharyngo-laryngoscopy, and Müller maneuver or sleep endoscopy. Adequate medical clearance and a thorough review with the patient of the procedure, its implications, and potential outcomes and complications are essential components of the preoperative workup.
Specific criteria for ZPP include patients classified as stage II or III, according to Friedman's anatomic staging system (Table 36.1). ZPP is an aggressive procedure because it produces a significant widening of the retropalatal space, and it is associated with significant temporary VPI and the risk for permanent VPI. It should be reserved for patients with moderate to severe OSAHS, with moderate to severe symptoms. It is not a surgical option for snoring alone. Additionally, Friedman described a technique for revision in patients who previously underwent UPPP and subsequently failed. This technique involves principles similar to ZPP; taking into account the modified, postoperative anatomy of the pharyngeal airway .
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