Sleep Apnea Treatment Options: Oral Surgery
Sleep apnea is a common sleep disorder that interrupts regular breathing and affects restorative sleep. It is a condition that affects millions of Americans and, if left untreated, can lead to dangerous medical complications such as hypertension and heart disease. While the most effective sleep apnea treatment is CPAP therapy, there are other options available. In addition to oral appliances, another treatment option is surgery to help keep the airway clear for regular breathing.
Why Would Surgery be Necessary for Sleep Apnea?
After having a sleep study or taking an at-home sleep test, the diagnosis of sleep apnea is typically prescribed treatment with continuous positive airway pressure or CPAP. This utilizes forced air pressure delivered through a mask to help keep your airways open during sleep. While CPAP is the first line treatment for people with moderate to severe sleep apnea, it doesn’t always work for everyone.
The most common reasons for CPAP treatment failure is compliance. While CPAP works well, it only works when it is worn. If a person is uncomfortable wearing the mask, they or their doctor may decide that a CPAP is just not the best course of treatment in their case. When CPAP treatment fails, your doctor may recommend different surgical options as a last resort. Which surgery they recommend will depend on the cause of your obstruction.
Below are some of the most common oral surgeries for sleep apnea, what is involved, and how they can help.
Uvulopalatopharyngoplasty, or UPPP, is the most common surgical procedure for sleep apnea. This procedure is designed to remove excess tissue at the back of the mouth and throat that can cause airway blockage. A surgeon can reposition or trim tissue in the throat to widen the airway, trim down the soft palate and uvula, take out the tonsils, and reposition soft palate muscles in order to help prevent the collapse of tissue that often causes obstructive sleep apnea.
Blockages in the nasal cavity can contribute to sleep apnea. If this is a contributing factor to your sleep apnea, your physician may recommend surgery to treat these blockages. Which surgery you need will depend on the location in the nasal cavity. The three areas that typically affect sleep apnea are the nasal valve, the septum, and the turbinates. The most common nasal procedure for sleep apnea is septoplasty with turbinate reduction. This procedure straightens out the septum and reduces the size of the turbinates. By making these changes, the airway opens up and more air is allowed to pass through the nose.
When nasal valve collapse occurs, deviated cartilage from the septum can be put in place to strengthen the valve and prevent it from collapsing, thus returning an unobstructed flow of air through the nose.
The Pillar Procedure
In cases of snoring and mild sleep apnea, the Pillar Procedure places three small rods into the soft palate. The introduction of a foreign body initiates an inflammatory response in the surrounding tissue that tightens up the soft palate. This stiffness reduces the risk of loose tissue relaxing and blocking the airway.
Laser-Assisted Uvuloplasty (LAUP)
While this procedure is not as effective for sleep apnea, it is used in milder cases. In this procedure, the surgeon uses a laser to make cuts into the soft palate in order to tighten it up, similar to the Pillar Procedure.
Radiofrequency Volumetric Tissue Reduction (RFVTR)
For people with mild to moderate sleep apnea, radiofrequency volumetric tissue reduction (RFVTR), or radiofrequency ablation, uses energy waves to reduce the size of the soft palate and tongue base. This allows for a more open airway.
The hyoid bone is a small bone in your neck where the tongue muscles and pharynx attach. During sleep, tongue muscles relax and, in patients with a large tongue base, this can cause airway blockage. During hyoid repositioning surgery, the hyoid bone is surgically repositioned to reduce the chance of this blockage.
Similar to a traditional tonsillectomy that removes the tonsils, a lingual tonsillectomy goes one step further and also removes tonsil tissue at the back of the tongue. This procedure is performed to open up the airway in the lower part of the throat.
Midline Glossectomy and Lingualplasty
These two procedures focus on the tongue and how it blocks the airway. Done together, they remove part of the back portion of the tongue, making the airway larger and reducing the effect of tongue blockage.
Genioglossus Advancement (GGA)
Genioglossus advancement (GGA), is another procedure that focuses on the tongue in order to open the airway. In this procedure, the surgeon tightens up a tendon in the front of the tongue. This tightened tendon keeps the tongue from sliding back and blocking the airway. This procedure can be done alone, but it is often performed along with UPPP or hyoid repositioning.
Maxillomandibular Osteotomy (MMO) and Advancement (MMA)
In cases of severe sleep apnea, maxillomandibular osteotomy and advancement are the most effective surgical treatment options. These procedures cut the bones of the jaw in order to move the upper and lower jaws forward, allowing for a bigger opening in the throat and a much larger airway. This is major surgery and requires the jaw to be wired shut for several weeks in order to allow for healing.
Anterior Inferior Mandibular Osteotomy (AIMO)
Anterior inferior mandibular osteotomy (AIMO) is another procedure that focuses on the jaw size. In this procedure, the chin bone is divided in order to pull the tongue forward. This enlarges the airway opening and provides more stabilization to the tongue, reducing the risk of it falling back and blocking the airway. Unlike MMO and MMA, this procedure does not typically require the jaw to be wired.
A tracheostomy is an effective treatment for severe sleep apnea but is typically only used in emergency situations. This procedure places a hollow breathing tube into the windpipe in the lower neck. The tube is plugged during the day so that you are able to breathe and speak normally, but the tube is opened at night to allow for unobstructed breathing.
While CPAP is still the preferred method of treatment for sleep apnea, surgical options may be necessary in some cases. Speak with your physician to determine what your best course of treatment is.