Pharyngoplasty Surgery in Madrid: pharyngeal reconstruction techniques
Medically reviewed by Dr. Iván Méndez-Benegassi Silva · ENT & Sleep Medicine Specialist · HM Hospitales, Madrid · License No. 282855946
Snoring and apnea are often caused by excessively lax throat muscles. Unlike old techniques that only "cut", modern pharyngoplasties reposition and tighten tissue to widen the airway. Dr. Méndez-Benegassi performs these procedures in Madrid (HM Hospitales).
Types of Pharyngoplasty
Barbed Repositioning Pharyngoplasty (BRP)
The most advanced technique. Uses barbed sutures that tighten the palatal and lateral wall muscles without knots, creating a wide and stable opening.
Barbed Snoring Pharyngoplasty (BRP + Anterior Palatoplasty)
A modular, non-resective technique that uses barbed sutures to transfer the rigidity of outer bony structures (posterior nasal spine, hamuli pterygoidei) to the collapsible soft inner tube of the airway, increasing wall tension precisely where drug-induced sleep endoscopy (DISE) confirms collapse—without sacrificing muscular integrity or complex functions like speech and swallowing.
Expansion Pharyngoplasty
Based on rotation of the palatopharyngeal muscle to "open" the velopharyngeal sphincter, preventing closure during deep sleep.
Lateral Pharyngoplasties
Pharyngeal remodeling surgeries that optimize the airway through lateral constrictor myotomy (Cahali) and anterolateral pillar repositioning (Li), stabilizing the throat walls to prevent their collapse during sleep.
⭐ Septal Cartilage Graft Pharyngoplasty (pioneering technique)
Dr. Méndez-Benegassi is a pioneer in Spain and one of the few surgeons worldwide who performs this technique. He uses the patient's own septal cartilage —harvested during the septoplasty— to graft 3-4 pieces into the soft palate, increasing its stiffness and reducing snoring. In a single, multilevel and outpatient procedure, both the nasal obstruction and the snoring are addressed at the same time. He uses his own modification of the technique that simplifies graft placement, reduces pain and bruising, takes about 30 minutes together with the septoplasty and requires no nasal packing. As it is autologous (the patient's own) tissue, there is no rejection; postoperative pain is minimal and the snoring improvement rate is very high. It is indicated in patients with a standard soft palate and without obesity — for example, women or young men.
Evidence and patient selection
Modern pharyngoplasties have solid recent evidence. A 2022 meta-analysis of barbed pharyngoplasty (20 studies, 762 patients) reported a single-level success rate of about 85% and an average drop in the apnea-hypopnea index (the number of breathing pauses per hour) of close to 24 events/h — roughly a 69% reduction — in selected patients, with few significant complications. These techniques were refined from their founding operations: lateral pharyngoplasty (Cahali, 2003, foundational), expansion sphincter pharyngoplasty (Pang & Woodson, 2007, foundational) — whose original randomised trial lowered the apnea-hypopnea index from about 44 to 12 in selected patients — and barbed reposition pharyngoplasty (Vicini et al., 2015, foundational).
The decisive factor is not the technique in the abstract but selecting the right patient: when the collapse is at the palate or the lateral pharyngeal walls (confirmed with a sleep endoscopy, DISE), results are good; outside that indication, they are not. Dr. Méndez-Benegassi uses specific signs during the DISE to predict this. For example, the tongue-palate (TP) sign: in his own teaching series, patients without that contact (TP-negative) responded to isolated lateral pharyngoplasty far better than those with it (TP-positive), which is why the surgery is only proposed when the airway pattern predicts a good response.
References: Saenwandee et al., barbed pharyngoplasty for obstructive sleep apnea: a meta-analysis (Am J Otolaryngol, 2022; 43(2):103306); Pang KA et al., clinical outcomes of expansion sphincter pharyngoplasty — a 17-year systematic review (Eur Arch Otorhinolaryngol, 2024; 281(5):2691–2698). Foundational technique papers: Cahali, lateral pharyngoplasty (Laryngoscope, 2003); Pang & Woodson, expansion sphincter pharyngoplasty randomised trial (Otolaryngol Head Neck Surg, 2007; 137:110–114); Vicini et al., barbed reposition pharyngoplasty (Eur Arch Otorhinolaryngol, 2015; 272(10):3065–3070). DISE TP-sign data from Dr. Méndez-Benegassi’s own teaching material.
Frequently asked questions
Is it the same as uvulopalatopharyngoplasty (UPPP) or palate/uvula surgery?
They belong to the same family of palate operations, but they are not identical. Classic uvulopalatopharyngoplasty (UPPP) mainly removed tissue (uvula and part of the soft palate). Modern pharyngoplasties are reconstructive: instead of just cutting, they reposition and tighten muscle to widen the airway, which tends to mean less pain and better preservation of function.
Does the recovery hurt? How many days?
The most noticeable thing is a sore throat for several days, like a strong tonsillitis, that eases gradually over one to two weeks. A soft, cool diet is recommended during the first days. A transient nasal-sounding voice and some difficulty swallowing in the first days are also common and usually settle on their own.
Is it for snoring or also for apnea?
It can be used for both. In selected patients it reduces snoring, and when the obstruction is at the level of the palate and the pharyngeal walls it can also help treat obstructive sleep apnea, often as part of a wider plan. What it can achieve in each person depends on where and how the airway collapses, which is why an individual assessment is needed.
What are the risks?
As with any pharyngeal surgery, there can be bleeding, infection, a transient nasal-sounding voice, temporary difficulty swallowing and a feeling of something in the throat. Less commonly, some patients keep a degree of palatal discomfort or scarring. The specialist explains the risks for your specific case before deciding.
When is this surgery indicated and when is it not?
It is considered when the obstruction is at the palate or the lateral pharyngeal walls and other measures (such as CPAP or an oral appliance) are not tolerated or not enough. It is less suitable when the main collapse is elsewhere, in significant obesity or when the airway pattern predicts a poor response. A sleep endoscopy (DISE) helps confirm whether it is the right technique.
Does it need a hospital stay?
It is usually performed as day surgery or with a short admission, depending on the technique, the patient and whether it is combined with other procedures. The specialist confirms in each case whether you can go home the same day or whether an overnight stay is advised.