Surgery for Sleep Apnea

Surgery is the red flower that blooms among the leaves and thorns that are the rest of medicine. -   Dr. Richard Selzer

A simple outpatient surgery might help those suffering from mild sleep apnea. The main aim of this surgery is to remove the tissues that cause obstruction.  This includes removal of tonsils, adenoids and any other blockages.   The following list outlines the major surgeries that are performed to treat sleep apnea.

Uvulopalatopharyngoplasty (UPPP): The term uvulo refers to the uvula, ( which is the piece of flesh in the back of the throat), palato is the palate, and pharyngoplasty is plastic surgery to the pharynx. This surgery removes the soft tissue on the back of the throat and palate, increasing the width of the airway at the throat opening. This method helps in reducing snoring but not apnea, as the tissues deep inside the throat are not removed.  This surgery is highly recommended to patients suffering from mild apnea. It can be also be done using laser and is referred to as laser assisted uvuloplasty (LAUP).

Mandibular maxillar advancement surgery: The term mandibular relates to the lower jaw bone, and maxillar means the upper jaw. A surgical correction is performed on certain facial abnormalities, where the upper and lower part of the jaw is moved forward from the rest of the facial bones.  This enlarges the space between the tongue and the soft palate and in turn helps in free supply of air.  This is especially recommended for those with severe sleep apnea with craniofacial abnormalities.

Genioglossus Advancement surgery: In this form of surgery a small portion of the lower jaw which is attached to the tongue, is moved forward so that the tongue is pulled away from the airway which is blocked.

Hyoid Suspension surgery: In this surgery the hyoid bone in the neck and the point where tongue muscles are attached, are pulled forward in front of the larynx.

Somnoplasty: This is the most recent form of surgery which is being adopted to treat sleep apnea.  In this method the tongue, throat and soft palate is pierced with a special electrode which is in the form of a needle and is connected to a radio frequency generator.  The inner tissue, which blocks the upper airway, shrinks as it is heated to a temperature between 158 to 176 degrees for half an hour. This surgery is also called radio frequency volumetric tissue reduction of the palate.

Snoreplasty:  This is also a recent advancement for reducing or eliminating snoring. Also called Injection Snoreplasty, a topical anesthesia is injected to numb the back of the throat and palate. This causes the mouth to stiffen during the next three weeks, thereby stopping the fluttering of the palate, that causes the noise of snoring. 

Turbinectomy: In this form of surgery removing bone and soft tissues opens up the nasal passage. This surgery is highly useful If the air passage is blocked due to deviated nasal septum, swelling of the turbinate due to allergy, chronic inflammation, chronic sinusitis, nasal polyps, swelling of the adenoids or any other tumor obstructing the nose.

Pillar procedure: This procedure is adopted to reduce snoring and to help patients suffering from mild to moderate sleep apnea.  Three small inserts are injected into the soft palate to offer support for the tissues in the throat.

Tracheostomy: This is the last resort for those who suffer from persistent and severe sleep apnea.  It is also a very age old form of surgery in the field of medicine.  In this surgery a small incision is made in the neck and a tube with a valve is inserted.  This valve is kept closed during the day time and opened up during the night to allow free flow of the air, thereby bypassing the blocked pathway.

The forms of surgeries discussed above are recommended for Obstructive Sleep Apnea.  Help is also available in terms of Support Devices for treating both Obstructive and Central Sleep Apnea.

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