Airway Anatomy and Surgical Management in Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder caused by recurrent collapse of a structurally vulnerable upper airway during sleep. The nasal cavity, soft palate, lateral pharyngeal walls, tongue base, hyoid complex, and craniofacial skeleton each influence airway caliber and stability. A detailed knowledge of their anatomy is essential for surgical planning. This narrative review summarizes key anatomic features relevant to upper pharyngeal surgery, including the role of nasal obstruction and the internal nasal valve, palatal muscle and parapharyngeal fat, and the lateral palatal space as a target for reconstructive palatal and lateral wall procedures. We further outline lower pharyngeal strategies, such as genioglossus advancement, hyoid myotomy- suspension, and tongue base reduction, which address retroglossal collapse and adverse skeletal- soft tissue relationships. Maxillomandibular advancement and hypoglossal nerve stimulation are discussed as anatomy-driven multilevel and neuromodulatory options. Across these modalities, an anatomically grounded, phenotype-based approach is central to optimizing patient selection, minimizing complications, and improving long-term surgical outcomes in OSA.