Sleep Apnea Surgery

People who struggle with the complex issue of obstructive sleep apnea may sometimes be referred for surgery. Sleep apnea surgery involves correcting or altering the facial structure in order to improve breathing and lessen the symptoms of sleep apnea.

Sleep apnea surgery encompasses a wide range of surgical procedures that can be used to treat various physical causes of sleep apnea. These surgical techniques include:

• Uvulopalatopharyngoplasty (UPPP): Removal of part or all of the uvula, soft palate and surrounding throat tissue, as well as the tonsils and adenoids
• Laser-assisted uvulopalatoplasty (LAUP): Removal of part or all of the uvula using a laser, with less additional tissue removed than in a traditional UPPP
• Pillar palatal implant: Insertion of 3 pieces of polyester string into the soft palate to reduce movement and vibration
• Tracheostomy: Insertion of breathing tube in the neck, used only for severe cases but with 100% success rate
• Genioglossus: Adjustment of the tongue position to allow better airway access
• Adenotonsillectomy: Removal of tonsils and adenoids, typically performed in children and adolescents, often highly effective
• Various other surgical procedures involving the adjustment of the chin, jaw, nose or tongue positions

The surgical correction of sleep apnea is often only recommended as a last resort if various other treatments have proved ineffective. Some of the other treatments traditionally relied upon include oral appliances, oxygen pressure systems, weight loss, discontinuation of sedative use, side sleeping and the avoidance of alcohol, caffeine and heavy meals in the 2 hours before bedtime.

People who don't improve with these treatment methods may be recommended for various sleep apnea surgical procedures, depending on their specific facial and nasopharyngeal anatomy.

Sleep apnea surgery works by opening the airway so it is more stable and will not narrow and obstruct during sleep. Surgery may stiffen, remove or reposition tissues in and around your throat. Depending on the cause of your sleep apnea and anatomy, your sleep apnea surgery may focus on the:

• Soft palate and uvula
• Tonsils and adenoids
• Tongue
• Upper and lower jaw

Some complications that may occur as a result of sleep apnea procedures include impaired function of the mouth and throat muscles, infection, changes in vocal frequency, changes in your sense of smell and the recurrence of apnea.

However, the benefits of surgery typically outweigh the risks. People who have sleep apnea surgery may experience:

• Better, more restful sleep
• Better management of diabetes
• Lower risk of heart problems
• Lower risk of stroke
• Lower risk of mortality
• Reduced risk of depression

The sensitive nature of the sleep apnea surgical areas contributes to many of these surgical procedures being completed under general anesthetic.

For procedures involving surgical removal of the uvula, tonsils or soft palate tissue, such as UPPP, LAUP or adenotonsillectomies, incisions are made at the back of the mouth. The specific tissues are removed and the remaining tissue reshaped as necessary to provide complete closure. The reshaped tissue is closed along the incision lines using dissolvable sutures.

Other procedures involving the surgical reshaping of the chin, jaw, nose or tongue will also involve incisions made within the mouth for limited visible scarring. Some jaw and chin procedures may require small, carefully hidden exterior incisions.

Once the incisions are made, the treatment area will be reshaped by the removal or addition of tissue, and then secured in place using plates, screws, wire and internal sutures if necessary. After the affected bone, muscle or other tissues have been secured, the internal incisions are closed using dissolvable sutures and the external incisions are closed using regular sutures.

Any external incisions may be covered in a bandage. Some swelling and bruising may occur in the first few days, but typically resolves in 5-10 days and the swelling diminishes in 2-5 weeks. External sutures may be removed in a week, and the stitches within the mouth should dissolve on their own in 7-10 days. There may be specific diet and activity restrictions for some of the procedures.

Due to the range of severity for both the condition and its corrective surgical treatments, the recovery of each person will be unique. Before and after the procedure, your doctor will walk you through a detailed description of your recovery process, including specific estimated timelines for healing, activity level and diet.

People with sleep apnea and other sleep disorders are evaluated and treated by a multidisciplinary team of physicians that includes:

• Neurologists
• Otolaryngologists
• Plastic surgeons
• Pulmonologists
• Psychiatrists who specialize in sleep problems

The team evaluates each person and tailors medical and/or surgical therapy to fit his or her health condition and lifestyle.

Our physicians are among the most experienced and well-trained in the country. Always on the leading edge of research and innovation, we offer the most advanced procedures available.

Some of the surgeries we perform for sleep disorders include:

• Genioglossal advancement or suspension (tongue surgery)
• Hyoid myotomy (surgery on a small bone in the upper neck just above the Adam’s apple)
• Inspire
• Nasal surgery to improve continuous positive airway pressure (CPAP) results
• Pillar implants (mesh implants in the soft palate)
• Tonsillectomy
• Uvulopalatopharyngoplasty (UPPP)