Surgery - Surgical Procedures
There are many different types of surgery for sleep apnea and snoring. But CPAP is the first treatment option for anyone who has sleep apnea. Oral appliance therapy also is an alternative treatment option for people with mild to moderate sleep apnea. The members of the sleep team will help you decide if surgery is right for you.
Surgery may be a multi-step process involving more than one procedure. You may need to continue using CPAP even when surgery successfully reduces the severity of sleep apnea. It is important to follow up regularly with your sleep physician after surgery.
Surgical options include:
Uvulopalatopharyngoplasty (UPPP)
This procedure, and other types of soft palate surgery, targets the back of the roof of your mouth. It involves removing and repositioning excess tissue in the throat to make the airway wider. The surgeon can trim down your soft palate and uvula, remove your tonsils, and reposition some of the muscles of the soft palate. UPPP and other soft palate procedures are the most common type of surgery for sleep apnea. But UPPP alone is unlikely to cure moderate to severe sleep apnea. It may be combined with surgeries that target other sites in the upper airway.
Radiofrequency Volumetric Tissue Reduction (RFVTR)
Radiofrequency ablation is a treatment option for people with mild to moderate sleep apnea. It uses controlled cauterization to shrink and tighten the tissues in and around the throat. It can be applied to the soft palate, tonsils and tongue.
Septoplasty and Turbinate Reduction
These surgical options open your nasal passage to improve the flow of air. Septoplasty straightens a bent or deviated nasal septum. This is the divider that separates the two sides of the nose. Turbinate reduction reduces or removes the curved structures that stick out from the side of the nose. They can be enlarged for a number of reasons, including allergies. Medications also can help reduce the size of turbinates.
Genioglossus Advancement
During sleep the tongue can fall back to block the space for breathing in your throat. This surgery moves the major tongue attachment forward, opening up space for breathing behind the tongue. It involves making a cut in the lower jaw where the tongue attaches. This piece of bone (but not the entire jaw) is then moved forward.
Hyoid Suspension
This surgery enlarges the space for breathing in the lower part of the throat. The hyoid bone is a U-shaped bone in the neck. The tongue and other structures of the throat like the epiglottis are attached to it. Hyoid suspension involves pulling the hyoid bone forward and securing it in place.
Midline glossectomy and lingualplasty
These two surgeries involve removing part of the back of your tongue. Making the tongue smaller can prevent airway blockage in some people with sleep apnea. These procedures are uncommon.
Maxillomandibular osteotomy (MMO) and advancement (MMA)
This type of surgery is a treatment option for severe sleep apnea. It moves your upper and/or lower jaw forward to enlarge the space for breathing in the entire throat. The procedures involve cutting the bone of your jaws, which then heal over the course of months. Your jaws may be wired shut for a few days. Your diet also will be limited for several weeks after the procedure.
Palatal implants
Palatal implants may be effective in some people with snoring or mild sleep apnea. Small, fiber rods are inserted into the soft palate to stiffen the tissue and prevent airway blockage.
Weight loss surgery
Bariatric surgery can promote weight loss and may improve sleep apnea in people who are obese. But weight loss surgery usually is recommended because of other health risks related to obesity. Prior to weight loss surgery you may be referred to a sleep physician for an evaluation and sleep study. There are many types of weight loss surgery. Some procedures reduce the size of the stomach, making it harder to eat as much food. Each surgery has different risks and benefits. People who are obese should work with their doctor to implement other weight loss strategies before considering surgery.
Laser-assisted uvuloplasty (LAUP)
This procedure is not routinely recommended as a treatment for sleep apnea. The surgeon makes cuts using a laser to scar and tighten the soft palate. The uvula is trimmed over a period of several visits. It is less painful and has fewer side effects than UPPP. But it is also less effective.
Tracheostomy
This surgery is an effective treatment for sleep apnea. But it is a drastic option that is used in rare, emergency situations. Other treatment options are preferable for almost all patients with sleep apnea. It involves placing a hollow breathing tube directly into your windpipe in the lower portion of the neck. This tube can be plugged during the day, allowing you to breathe and speak normally through your nose and mouth. At night the tube is opened to allow you to breathe without any blockage in your throat.