Lu Xiaofeng, Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University: There are three ways of OSAHS surgery: 1. Soft tissue volume reduction surgery, such as resection of soft palate, turbinate, tongue root, UPPP, etc. This kind of operation is mainly aimed at patients with obvious hyperplasia and hypertrophy of soft tissue around the upper airway, such as patients with stage ⅲ tonsil hypertrophy, adenoid hypertrophy or mass; Or mild to moderate OSAHS patients. For patients without obvious space occupation, the effect is incomplete or poor. This kind of operation is to gain space by removing the occupying space, so the greater the quality, the better the operation effect. For patients with no obvious space occupation, this operation is not an ideal way to increase the upper airway space at the expense of the function of the corresponding soft tissue. For example, a person living in a small space, in order to get enough room for activities, takes the way of reducing or throwing furniture to get space, unless the things occupying the space are completely useless (such as lumps or tonsils), or you need to make some sacrifices. 2. Craniomaxillofacial frame surgery, that is, the craniomaxillofacial bone is cut, and the space is increased by moving forward and expanding horizontally, such as orthognathic surgery and distraction osteogenesis of upper and lower jaws. This operation is mainly aimed at: (1) patients with craniomandibular malformation and OSAHS; ⑵ Patients with poor or failed soft tissue volume reduction surgery. Bone surgery can effectively and stably expand the upper airway space, so the operation effect is good and it is a more thorough and effective method. However, the surgical trauma is relatively large, which will also cause facial changes (the movement of craniofacial bones in a certain range will cause facial changes, but it will not be deformed, but only facial changes). Similar to the above metaphor, in order to increase the space, it can also be done by expanding. This method has little effect on the function, and the space obtained is also guaranteed, but it needs to be rebuilt by knocking on the wall, and the project is relatively large. 3. Weight-loss surgery, that is, reducing food intake, digestion and absorption through abdominal gastrointestinal shunt, and reducing soft tissue volume through weight loss. This method is mainly used for severely obese patients with body mass index greater than 33 or 35, and conservative weight loss method is ineffective. This kind of surgery has a good and stable weight loss effect, but it will change the gastrointestinal function and have certain complications. According to the sleep report you provided, you have severe OSAHS. According to our experience, unless you have obvious space occupation in the upper airway (such as third degree tonsillar enlargement), the treatment effect for severe OSAHS is incomplete or ineffective, whether it is plasma ablation or partial soft tissue resection to reduce volume. It may feel "effective" within 3 or 5 months after operation, but OSAHS remains after half a year. The "effectiveness" mentioned above is just an illusion. The reason is that the tension of the upper airway open muscle is improved by surgery. We know that the space of the upper airway is related to three factors: 1. The size of the craniofacial bones. 2. The number of soft tissues in the frame. 3. Keep the upper respiratory tract unblocked and keep the muscles tense. Therefore, once the surgical wound is completely healed, the pain and local scar stimulation are weakened and disappeared, and the stimulation to muscles is lost, the excessive opening of the upper airway caused by surgical stimulation will end, and the upper airway stenosis or obstruction will come back. Strictly speaking, this is not a recurrence, but an incurable disease. Effectively treat your severe OSAHS: 1. Positive pressure ventilation (the first choice for patients without space occupation or skeletal deformity). 2. Craniomandibular frame surgery (such as maxillary and mandibular advancement, if you can't tolerate or accept positive pressure ventilation). 3. Lose weight (if obesity is obvious). 4. Combined application of soft tissue volume reduction surgery+oral appliance+weight loss/positive pressure ventilation therapy and other methods. The choice of operation should be careful, and the position, nature and degree of upper airway obstruction should be clear before operation. Different parts and degrees of obstruction require different operations.