Sleep specialists may advise surgery as an option when lifestyle changes, mouthpieces and noninvasive treatments don’t do the trick. Depending on the nature of surgery needed, procedures could include operations on the nose and throat, jaw or tongue.
CPAP is the go-to treatment option for sleep apnea, yet surgical options may also be suitable if it does not suit or offer enough benefit for patients.
Tracheostomy
Persons suffering from severe, life-threatening sleep apnea may require surgically creating a hole (tracheostomy) in their necks in order to breathe during sleep. A plastic tube will then be placed through this opening – keeping it covered during the day, but uncovering it at night to allow air through without going through your upper air passage and into your lungs directly. You will also have an inner cannula that slides in and out of the outer tube in order to block secretions and swallowed liquids from entering into your lungs; coughing up liquid or mucous that builds up over time is necessary in order for this system to function effectively – therefore twice daily cannula changes are essential and keeping everything clean!
At this procedure, you will be asleep under anesthesia or taken medications to make you more comfortable. A surgeon will then make an incision in the front of your throat (larynx), removing a section of cartilage to create an opening large enough for a tube and attach it to a breathing machine for assistance if necessary (ventilator). Finally, this tube will connect directly with its counterpart located within your neck opening.
As it’s common for tracheostomy tubes to remain in place for months or years, most will eventually close on their own but some remain permanent. If you have one in place, your doctor will provide instructions for keeping it clean and free from infection by changing its dressing twice daily and moistening with gauze; there may also be speaking valves installed that enable you to speak without covering up its opening with your fingertip.
Uvulopalatopharyngoplasty (UPPP)
Surgery involving this approach entails surgeons removing excess tissue in the back of the throat to open up airways and shorten or trim uvula or tonsils as well as trim fat from the palate to open breathing passageways more freely, thus decreasing snoring and improving breathing for people suffering from obstructive sleep apnea. Though less effective than CPAP therapy, surgery might help ease symptoms in some people who don’t respond well to more conservative therapies such as CPAP therapy.
Palatal Z-plasty surgery can also help patients who suffer from an elongated soft palate and uvula to reduce vibration in the back of the mouth that contributes to snoring or breathlessness while sleeping. This surgery can either be performed alone or alongside tonsillectomy.
Maxillomandibular advancement, or MMA, is another surgical solution to address obstructive sleep apnea. Doctors break both upper and lower jaws to move them forward to open up an individual’s airway wider. Although more complex than UPPP, MMA has proven extremely successful; according to a 2021 BJBMS study MMA significantly decreased episodes of snoring and apnea while improving morning headaches and lowering blood pressure levels.
Surgery may help improve breathing during sleep, but many experts advise people first using CPAP, nasal expansion strips or an oral device before considering further procedures.
Studies indicate that surgery treatments for sleep apnea tend to focus on treating tongue, jaw or mouth-nose dysfunctions; however, not everyone tolerates them well. If surgery treatments work for you and can improve nightly rest as well as daytime fatigue levels, consulting an otolaryngologist who specializes in nose and mouth conditions may provide valuable help; for example a sleep endoscopy might be recommended or CT or MRI scanning might provide further evaluation for blockages in your airway system.
Maxillomandibular Advancement (MMA)
Surgical interventions for sleep apnea focus on extracting or repositioning tissues in the nose, throat and mouth to treat sleep apnea symptoms. Success and complications vary with these procedures – most being second line treatments when patients cannot tolerate CPAP treatments; an experienced physician can determine which surgical option will work best by carefully reviewing symptoms and history.
Procedures designed to widen the upper airway typically involve altering the upper jaw and palate to widen it further. Studies have demonstrated these surgeries’ efficacy against OSA for people of various anatomy types; one of the most frequently performed types of sleep surgery for obstructive sleep apnea (OSA), called Uvulopalatopharyngoplasty (UPPP), involves extracting the uvula while also shortening soft palate length. With an 87% success rate, this procedure remains one of its kinds of operation.
Maxillomandibular advancement, commonly referred to as bimaxillary advancement or orthognathic surgery, involves moving both jaw bones forward to create more space in the area around the tongue and soft palate in the throat. It has proven highly successful among sleep apnea surgeries for severe to moderate OSA sufferers; however, due to potential facial changes caused by such operations; not suitable for everyone due to changes in facial shape and appearance; additionally doctors manipulate facial nerves during this craniofacial operation for minimal pain experience by most patients experiencing minimal or no discomfort whatsoever during this craniofacial operation.
At its core, sleep apnea is an ongoing condition. To have the best chance at recovery from it and prevent its worsening, the more knowledge and action taken against it. Consult an ENT doctor or sleep specialist if CPAP therapy doesn’t seem effective enough in helping.
Midline Glossectomy
Sleep apnea is a potentially serious disorder which causes interrupted breathing during sleep, impacting both your physical and mental wellbeing, as well as damaging relationships, as well as leaving behind symptoms such as snoring, irritation, memory problems, mood swings headaches fatigue as well as increased risks for accidents and death.
Surgery may help alleviate symptoms for some individuals suffering from severe obstructive sleep apnea; in general however, doctors recommend trying noninvasive methods first such as CPAP therapy or oral appliances before considering surgical options to remove tissue and widen airways.
Uvulopalatopharyngoplasty (UPPP), the most popular surgery to address both snoring and sleep apnea, involves surgical removal of tissue located behind the mouth and at the top of throat; usually this also includes removal of tonsils and adenoids as part of this procedure. Studies show this form of surgery to be up to 86% effective in decreasing obstructive sleep apnea symptoms.
Midline glossectomy, an outpatient procedure using various techniques to reduce the size of the back of the tongue, may be another option for reducing its base. Surgeons take great care not to damage nerves and blood vessels that provide supply for this system and most people find this procedure easy to swallow post-surgery. Before having this surgery done, speak to your physician regarding recovery times and specific restrictions relating to activities following it; in certain instances your physician might also suggest speech and language rehabilitation because surgery could alter how you speak or change how certain sounds are pronounced post-surgery.
Genioglossus Advancement
Obstructive sleep apnea patients often suffer from tongue collapse during sleep, obstructing the airway. Genioglossus advancement surgery aims to make sleep less likely by moving the genioglossus forward; this process usually occurs under general anesthesia at either a hospital or outpatient surgery center.
Surgeons make an incision inside of the lower lip to access a small rectangular segment attached to the genioglossus muscle and pull forward through an opening in it to secure its placement; this reduces tongue collapse during sleep while improving airway stability and decreasing airway obstruction. After closing with stitches, patients are typically monitored closely for any sign of infection for several days afterwards.
Genioglossus advancement alone may not be sufficient to treat OSA effectively in most patients; additional procedures, including MMA or orthognathic surgery may be necessary for optimal outcomes. A genioglossus advancement could be combined with mylohyoid suspension, hyoid osteotomy or anterior mandibular osteotomy to produce optimal results.
As with any surgical procedure, complications may arise with genioglossus advancement. Hemorrhage from the floor of the mouth may occur if taking antiplatelet or anticoagulant medications; infection is another possibility and damage to mental nerves caused by reciprocating saws used to cut inferior border of mandible can also happen if surgeon cuts too deeply into mouth floor; usually these complications are minor and treatable with antibiotics; it’s also recommended that talking should only be necessary until incision heals completely to avoid possible infections. To help avoid potential infection it’s important that only necessary talking occurs until incision has healed completely. To help ensure healing it’s important that communication remains as usual until all symptoms have subsided before speaking about potential issues is achieved.
