Sleep Apnea Surgery

Surgical therapy for treating Obstructive Sleep Apnea Syndrome is based on identifying the sites of airway obstruction, which may include regions of the nose, soft palate and tongue base. The procedures that are effective in clearing specific areas of blockage include methods to remove or reposition tissues that partially or completely block the upper airway during sleep. These procedures include varied forms of reconstruction that is dependent on the needs and anatomy of the individual patient. Most of these procedures have been used for years and clinical outcomes have verified their use. Newer techniques are continuously being evaluated and are only utilized when there is sufficient medical evidence to support efficacy and safety.

Both techniques, old and new, may be selected by the individual physician and patient to meet the patients' needs. These may include tracheotomy (hole in the throat), glossectomy (surgical removal or laser evaporation of a portion of the tongue), or radiofrequency shrinkage of the obstructive tissues of the upper airway (nose, palate or tongue). Osteodistraction of the upper and lower jaws is an orthodontic like movement that advances the jaws to open the airway during sleep.

In addition to the above, surgical techniques developed at our center are used to improve the upper airway at the three levels of possible obstruction (nose, palate & base of tongue). These are nasal reconstruction (nose), uvulopalatopharyngeoplasty (UPPP) or uvulopalatoflap (UPF), (soft palate) mandibular osteotomy with genioglossus advancement, hyoid myotomy and suspension, and maxillomandibular (Bi-maxillary) advancement (tongue base). See the brief description below.

Nasal reconstruction improves the opening inside the nose by straightening the nasal septum and shrinking the fleshy tissue inside the nose (turbinate), thus improving nasal airway. UPPP involves the removal or repositioning of the uvula, part of the soft palate, and tonsils if present. Mandibular osteotomy with genioglossus advancement as well as hyoid myotomy and suspension improve the obstruction in the back of the tongue without actually operating on the tongue itself. Maxillomandibular (Bi-Maxillary) advancement is a very effective surgical technique to significantly enlarge the upper airway and limit obstruction during sleep. The procedure accomplishes this goal by moving the upper and lower jaws forward, thereby pulling the tongue base forward, thus enlarging and opening the airway.

For a more complete review of the Powell Riley Protocol, continue to MANAGEMENT OF SLEEP-DISORDERED BREATHING.