January 26, 2012Written byFiona Tapp Verified by Medical Review Board 0 Comment
Surgery can be the perfect treatment for people with mild to moderate cases of Sleep Apnea, but it may not have such a great effect on more severe cases of the disorder. Surgery for Sleep Apnea may be the right choice for patients who want a quick fix for their health problems.
Why Choose Surgery?
CPAP, and other non-invasive treatments, can be uncomfortable for many apnea sufferers. It can be difficult to get used to breathing treatments, and it may be hard to find time in your day to exercise your respiratory muscles. Surgery may be the right choice for patients who want a quick fix for their health problems. Some mild cases of Sleep Apnea can essentially be erased by undergoing the right procedure and is often recommended by ear, nose, and throat specialists (also called Otolaryncologists or ENTs). An ENT can give you thorough information and research on surgeries; medical professionals can help you rate your options.
What is the Downside of Surgery?
No surgery is certain so any surgery is a risk. Other forms of treatment will still need to be observed when surgery does not make a significant difference. Surgery may also make Sleep Apnea symptoms worse, so it is important to weigh the pros and cons. In addition, many apnea-improving surgeries are reconstruction surgeries and may actually change the size, shape, and appearance of your face.
What Types of Surgery are Available?
Nasal Surgery: In many cases, breathing obstruction is caused by physical obstructions in the nasal passages. People who experience nasal obstructions get the feeling that they “can’t breathe through their nose”. Nasal obstruction can be caused by many different factors like overgrowth of turbinate tissues, the collapse or narrowing of the nasal valve, and having a deviated septum. Nasal surgery can remove the turbinate tissue growth in the nasal passage, correct a deviated septum, and enlarge the nasal valve in adults with Obstructive Sleep Apnea. In addition, many CPAP users have regulated nasal surgeries to remove the excess tissue and reduce their tolerance to the air pressure. Nasal surgery is generally a simple procedure, usually out-patient. It takes around one hour to complete with general anesthesia. Patients who undergo nasal surgery usually feel some slight pain and discomfort for a few days following the surgery. Most people can return to work in three to four days. Bleeding and risk of infection are common, but rare side-effects of nasal surgery.
Genioglossal Advancement: Genioglossal Advancement with Hyoid Myotomy and Suspension (GAHM) is more commonly known as facial reconstruction surgery that focuses on the tongue. This form of surgery is used to reposition the tongue by moving it forward in the mouth. When the tongue is pulled slightly forward, there is a bigger opening in the back of the throat; it becomes less likely for the tongue to collapse into the throat and obstruct successful inspiration. GAHM is not a common surgery for Sleep Apnea and is only recommended in specific cases. GAHM are only performed on apnea patients with overtly large tongues that are a major source of their apnea episodes. The exact technique of the procedure will vary from surgeon to surgeon, and will change with each person’s unique anatomy.
Mandibular Advancement: Maxillomandibular Osteotomy and Advancement can be describes as facial reconstruction surgery regarding the maxilla (the upper jawbone) and the mandible (the lower jawbone). Apnea patients often choose mandibular advancement surgeries to shift the jawbone forward. The entire airway can be enlarged and become freer as a result of moving the upper and lower jawbones forward. Patients with moderate to severe Sleep Apnea are the main benefactors of this type of surgery. In addition, many people who suffer from craniofacial abnormalities experience apneas; they choose to undergo the surgery in an effort to correct the deformity and its contributions to apnea. After mandibular surgery, patients usually spend two to three days in the hospital for recovery, and full recovery will take at least three weeks. Patients who had this surgery often complained of pain, swelling, and numbness in the lower jaw, lips and chin. It is important to remember that this surgery will slightly change your appearance.
Uvulopalatopharyngoplasty: UPPP surgery involves removing some of the soft tissue in the back of the throat. Apnea patients often experience obstruction due to an excess of tissue in the uvula, the soft palate, and the soft tissues behind the soft palate. During UPPP, all or part of the uvula may be removed as well as parts of the soft palate. After the excess tissue is removed during UPPP, the width of the airway at the back of the throat is wider and there is an improvement in the functioning and movement in the soft palate. Some of the muscle action in the back of the throat is also blocked to prevent airway collapse. UPPP success rates are not very high and it is the most painful of all Sleep Apnea surgeries. The surgery takes several weeks to recover from and can have some serious consequences including, but not limited to: infection, changes in the voice, problems swallowing, fluid regurgitation through the mouth or nose, impaired sense of small, excess mucus in the throat and velopharyngeal insufficiency (damaged functioning in the soft palate and throat muscles).
Somnoplasty: Somnoplasty is also referred to as Radio Frequency Tissue Volume Reduction (RFTVR). Somnoplasty can open the airway, reduce obstruction, and reduce the habit of snoring by removing tissue in the uvula and soft palate. Unlike UPPP, the surgery uses low levels of radiation. The radiation treatment uses radiofrequent heat to burn areas that lay below ling of soft tissues in the throat, also called the mucosa. The burn-areas are controlled by the surgeon and are later reabsorbed by the body. As a result, the volume of the burned tissue is reduced and there is more room in the airway. The procedure takes around thirty minutes and is performed under local anesthesia. It is a type of robotic surgery and can also be used to remove cancerous tissue. Side-effects of Somnoplasty include nasal regurgitation, velopharyngeal insufficiency, changes in voice, bleeding, impaired healing, and injury to the mucus membranes of the soft palate, uvula, and mouth.
Tonsillectomy and/or Adenoidectomy: The removal of the tonsils and excess tissue, Tonsillectomy, and the removal of the adenoids, Adenoidectomy, are popular surgical procedures for OSA, especially in children. Large tonsils/adenoids can contribute to airway obstruction when the tonsils block the opening of the airway. These procedures are extremely common and are considered low-risk operations. It is an out-patient surgery and the recovery time is around two weeks. The procedure is most effective in adults when it accompanies UPPP.
Tracheostomy: Once the most popular surgery for Sleep Apnea, Tracheostomy is now a last resort surgery for apnea patients. The procedure only takes place in severe and life-threatening cases of Sleep Apnea. The surgery consists of making an opening in the airway by cutting an opening in the neck. A tube is inserted into the airway and oxygen is forced into the airway through the tube. While this procedure is almost always successful, it is uncomfortable and it requires having an opening in the throat the size of a quarter. Many different medical and psychological problems are associated with Tracheostomy recovery.
Pillar Palatal Implant: This is a non-invasive surgery for people with mild to moderate cases of Sleep Apnea. The main goal of the procedure is to reduce snoring, and it should not be expected to greatly reduce apneas. The Pillar Palatal Implant helps reduce snoring by reducing movement and subsequent vibrations of the soft palate. The surgery consists of having three short polyester strings inserted into the soft palate. The procedure only requires local anesthesia, and it can be performed by a doctor, in his office, in around ten minutes.