Review of Surgical Treatments of Sleep Apnea
Unfortunately, it is difficult to determine with much certainty which procedure is required from the onset. Therefore frequently a serial approach to surgery is taken. These procedures have a relatively low success rate in comparison to other treatment options. They are often highly invasive procedures and can be very expensive. All surgical procedures are invasive, non reversible and carry some degree of risk.
Uvulopalatopharyngoplasty (UPPP)
The uvula and portions of the soft palate are removed to widen the airway to help prevent collapse. Since the UPPP only treats the throat walls and has a modest success rate, many surgeons will also perform a procedure to pull the tongue forward at the same time as the UPPP. This includes procedures called Genioglossus Advancement and Hyoid Suspension.
Laser assisted UPPP (LAUP)
This is a variation of the UPPP that can be done in the office over several visits. The pain of this procedure and the need for up to five treatments has limited this technique's popularity. Over the last few years, a number of new methods of palatal treatment have been created, all of which are invasive.
Somnoplasty
Radio frequency waves are used to cause contraction of the excessive tissues and open the upper airway. This is similar to a LAUP.
Maxillo-Mandibular Osteotomy (MMO)
In cases where UPPP and combined procedures have failed, more aggressive surgical approaches have been used. Maxillo-mandibular Advancement Surgery requires cutting the upper and lower jawbones free from their attachments to the skull, pulling them forward and reattaching them in place with metal plates and screws. The teeth remain in good alignment and the net effect is to pull the tongue and its related structures forward, increasing the room in the back of the throat.
Pillar Palatal Implants
Pillar palatal implants are tiny plastic rods inserted into the soft palate to reinforce or stiffen it to prevent the soft palate from obstructing the airway. This is useful when a patient’s OSA is caused by lack of palatal tone or excess soft palate tissue.
Rhinoplasty and Septoplasty
Rhinoplasty, or nose job surgery, is a procedure performed to correct or improve the appearance of the nose. It is often performed in combination with other procedures, such as a septoplasty, to correct breathing obstruction related to a deviated septum. Additionally, reconstruction of the nasal framework can improve nasal airflow when there is structural collapse. This is an important clinical indication for OSA due to decreased airway obstruction.
Tonsillectomy and Adenoidectomy
A common cause of OSA is airway obstruction due to adenotonsillar hypertrophy. Thus, two operations that are sometimes undertaken to treat OSA include a tonsillectomy and an adenoidectomy. The former means removal of the tonsils while the latter is a removal of the adenoids, both of which can reduce airway obstruction in many patient cases.