Sleep apnea is a form of sleep disruption that causes your breathing to periodically stop while you’re sleeping. Besides causing you to lose out on quality sleep, sleep apnea can lead to some serious health consequences. Over time, it can lead you to develop high blood pressure, metabolic issues, and other health issues.
There are numerous surgical options to treat sleep apnea for patients who nonsurgical treatments such as CPAP therapy do not work. The surgery should be tailored to the area of obstruction in each patient. Common sites of obstruction are in the upper respiratory tract including the nose, tongue, and throat.
Common Surgical Procedures
Nasal Surgery — Three anatomic areas of the nose can contribute to obstruction: the septum, the turbinates, and the nasal valve. Septoplasty and turbinate reduction are the two most common nasal surgical procedures. It creates more room in the nose to allow air to pass without effort.
UPPP — Within the last 25 years, uvulopalatopharyngoplasty, or UPPP, has been the most common sleep apnea procedure performed. This surgery removes excess tissue from the soft palate and pharynx. If present, the tonsils are also removed. Sutures are then placed to keep the area open and prevent collapse. The upper airway, referred to as the oropharynx, is the most common site of obstruction for sleep apnea patients.
Soft Palate Implants — Known as the Pillar Procedure, this surgery is minimal invasion and can reduce snoring and improve mild cases of sleep apnea. During the surgery, three polyester rods are placed into the soft palate, which creates an inflammatory response of the surrounding soft tissues and stiffens the soft palate. A stiffer soft palate is less likely to make contact with the back wall of the pharynx during sleep, reducing snoring and apnea.
Hyoid Advancement — The hyoid is a small bone in the neck where the muscles of the pharynx and tongue base attach. Sleep apnea patients often have a large tongue base. Because muscles are relaxed during deep sleep stages, the base of the tongue falls back, which can create an obstruction. The surgery will reposition the hyoid bone by placing a suture around it and suspending it to the front of the jaw bone. This expands the airway and prevents collapse. It is a minimally invasive procedure that is performed with two small incisions in the neck and usually takes under an hour.
Tongue advancement — In this procedure, the genioglossus muscle is moved forward, limiting the tongue’s backward fall during sleep. The genioglossus advancement surgery involves making a rectangular cut in the jawbone where the genioglossus muscle attaches. The piece of bone is moved forward with the muscles attached. This procedure addresses the same site of obstruction as the hyoid advancement. However, the genioglossus advancement surgery is more invasive and requires an overnight hospital stay.
Tongue base reduction — The base of the tongue is a common site of obstruction in sleep apnea patients. Reducing the amount of tissue from the tongue can successfully reduce sleep apnea. One method is through applying radiofrequency waves, which creates a surge of energy, causing the surrounding tissue to shrink. This can require several treatments though it is a minimally invasive surgery that can sometimes be performed while the patient is away. Another way to reduce the tongue base is through direct excision. Known as a midline glossectomy, the tongue base tissue is removed by electrocautery or coblation.
Lower Jaw Advancement — An abnormality in the maxillofacial skeleton is a widely recognized risk factor of obstructive sleep apnea. Sleep apnea patients often have small, narrow jaws that lead to a diminished airway dimension and creates a nocturnal obstruction. Maxillomandibular advancement enlarges the upper airway by expanding the skeletal framework that encircles the airway, The surgery mobilizes the upper and lower jawbones. Patients have to have their teeth wired shut for several weeks while the bones heal. This surgery can be painful and has a number of potential risks and complications though the success rate is near 90%.
Tracheostomy — This surgery creates a passageway for air to get to the lungs from a trachea in the neck, therefore bypassing any potential sites of obstruction in the upper airway. Permanent tracheostomy, as a long-term treatment of obstructive sleep apnea, remains an option for obese patients.
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