November 23, 2007, Newsletter Issue #146: Types of Sleep Apnea Surgery

Tip of the Week

There are different ways to go about sleep apnea treatment with surgery. These sleep apnea surgeries focus on one or more of the following three areas:

1. The soft palate
2. The uvula, tonsils and adenoids
3. The tongue

More complex sleep apnea surgery can be performed to adjust the mouth, nose and facial bones.

Types of Sleep Apnea Surgery:

Radiofrequency - the volume of soft tissue is reduced. This sleep apnea surgery is usually performed in an office and requires a local anesthetic. A probe is inserted into the tissue, transmitting radiofrequency energy. During the healing process (which takes up to three weeks), scar tissue forms and causes the tissue's overall size to decrease.

Nasal surgery - nasal surgery has proven to be a successful way of improving nasal breathing. However, in patients with moderate to severe obstructive sleep apnea (OSA), this surgery alone does not usually show significant improvement.

Uvulopalatopharyngoplasty - soft palate redundancy is a frequent cause of airway obstruction in OSA. This is the most common surgery to treat the soft palate. The tissue from the soft palate and/or back of the throat is removed to increase airway size.

Genioglossus Advancement - the tongue is a frequent cause of airway obstruction in OSA. The tongue can collapse towards the back of the throat during sleep, creating OSA. The collapsibility of the tongue can be improved with genioglossus advancement. During this surgery, the tongue can be repositioned so that it is less likely to relax into the airway during sleep.

Hyoid Advancement - the collapsibility of the tongue can be improved with hyoid advancement. Several tongue muscles attach to the U-shaped bone located in the neck. In surgery, the bone is pulled forward, which in turn pulls the tongue forward as in genioglossus advancement.

Maxillomandibular Advancement - the airway is confined by the upper and lower jaw. This surgery moves the upper and lower jaw forward so the entire airway can be enlarged. In general, jaws do not need to be wired after surgery. However, chewing is not allowed for 4 weeks.

Maxillomandibular Expansion - patients with OSA often have narrowed jaws, which result in displacement of the tongue towards the back of the throat and airway obstruction. The upper and lower jaws can be widened to improve the airway.

Tracheostomy - used in persons with severe, life-threatening sleep apnea. In this procedure, a small hole is made in the windpipe and a tube is inserted into the opening. This procedure is an extreme measure that is rarely used.

Other procedures: for those who have sleep apnea because of a deformity of the jaw, surgical reconstruction can help. Surgical procedures to treat obesity are sometimes recommended for sleep apnea patients who are morbidly obese.

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