Candidates to Barbed Reposition Pharyngoplasty

Barbed reposition pharyngoplasty (BRP) was devised as a palato-pharyngeal surgical procedure suitable for minimizing respiratory palatal flutter (palatal snoring) and for addressing palato-pharyngeal collapse in obstructive sleep apnea patients. BRP may be carried out as a single-level surgery or as a part of a multilevel surgical procedure, including transoral robotic surgery (TORS) for tongue base [1]. In our experience most of the patients went under this surgery after CPAP or mandibular advanced device (MAD) treatment drop out, but BRP may be also offered as a palatal revision surgery after UP3, LAUP, or ESP in case of failure. Besides, in an increasing number of cases, BRP is included in a multi-step treatment plan including MAD or positional devices (multimodal therapy) [2, 3]. The most common questions in sleep surgery are: “All patients are candidate to single-level velo-pharyngeal surgery?,” “Is there a perfect palate procedure which may me applied for everybody?,” “Is there a way for indicate to clinicians the best palate option in daily practice?,” “Which patients are the best candidates for BRP surgery?” In this chapter we discuss these aspects and provide useful information to select candidates to single-level velo-pharyngeal surgery as the BRP technique.