Surgery for Sleep Apnea and Snoring

Palate Surgery and Tonsillectomy
Uvulopalatopharyngoplasty (UPPP) or Expansion Sphincter Pharyngoplasty (ESP) are surgeries that:

• Reshape the palate and uvula muscles and tissue at the back of the mouth and throat.
• Tonsils can be removed as part of the surgery.
• The palate is reshaped and positioned to prevent collapse of this portion of the airway in sleep.
• Newer techniques are often used including expansion sphincter pharyngoplasty and lateral pharyngoplasty to expand the shape and size of the throat and palate region. Evidence shows in certain patients these newer approaches are more effective than older techniques.

Risks of Palate Surgery:

• Bleeding
• Infection
• Difficulty swallowing
• Changes in speech or taste
• Narrowing in the throat from scar tissue
• Tooth or lip injury
• Continued snoring or sleep apnea

What to expect after palate surgery:

• Significant throat pain and swallowing difficulty for 2 weeks.
• Need to take 2 weeks off work.
• Staying hydrated during the healing period is important.
• No strenuous activity or heavy lifting for 2 weeks.

Lingual Tonsillectomy​

• If enlarged, tonsil tissue at the back of the tongue (lingual tonsil) is removed in surgery.
• Can be done at the same time as palate surgery, or done separately.
• In some patients, a special approach called Transoral Robotic Surgery (TORS) is used.

Epiglottoplasty

• Done to reshape the epiglottis in certain patients if the epiglottis causes blockage of the airway in sleep.
• Sleep endoscopy is used prior to surgery to determine epiglottis involvement in sleep apnea.
• Epiglottis is shortened and reshaped.
• Can be done with lingual tonsillectomy surgery.

Hyoid Suspension

• An approach to treat lower throat airway collapse.
• The hyoid is a bone in the neck that suspends many neck and throat muscles.
• Often done in combination with jaw advancement or tongue suspension surgery.
• Targets epiglottis level collapse.

What is Upper Airway Stimulation?

• A fully implanted system that is placed under the skin of the neck and chest.
• A remote is used to turn on the device at nighttime.
• When sleeping, the device stimulates the tongue increasing muscle tone and opening the airway in sleep.

How do I know if Upper Airway Stimulation is right for me?

1. You have been diagnosed with obstructive sleep apnea on a sleep study.
2. You have NOT been able to tolerate positive airway pressure therapy (CPAP or BiPAP) after a trial at home.
3. You complete office evaluation by a surgeon who performs surgery for sleep apnea to discuss whether it would be helpful.
4. You have a short evaluation called drug-induced sleep endoscopy which is done with a little sedation medication in the operating room and an exam on your upper throat is done while you take a short nap.

Hypoglossal Nerve Stimulator Implantation Surgery Risks

• Bleeding
• Infection
• Tongue weakness/trouble swallowing
• Tongue numbness/tingling
• Lower lip weakness
• Scar formation on the neck or chest
• Change in speech
• Collapsed lung (Pneumothorax)
• Need for additional procedures
• Device malfunction requiring replacement

• Oral Maxillofacial Surgery Specialists to evaluate your dentition and candidacy for jaw advancement surgery.

• In this surgery, the upper and lower jaw are moved to reconfigure the structure of the jaw and allow for increase in support and space of the upper airway.

   

• This is a type of evaluation done for certain sleep surgery candidates.  The procedure is performed in the operating room and sedation medication is given through an IV.
• A small endoscope is placed through the nose to examine the upper throat during sleep.
• DISE evaluates for patterns of collapse during sleep and gives the surgeon information about potential surgical options and help choose the surgical approach.  DISE is part of the evaluation for potential candidacy and benefit of hypoglossal nerve stimulation implant surgery.

We offer a variety of in-clinic procedures are offered for patients with primary snoring (no sleep apnea on sleep study) or mild sleep apnea. All patients should be evaluated for sleep apnea with a sleep study prior to any procedures. Many of these treatments require multiple stages and have out-of-pocket expenses.

1. Laser or Cautery Assisted Uvulopalatopharyngoplasty
2. Palate Implants (Pillar)
3. Palate suspension
4. Radiofrequency ablation to the soft palate (snoreplasty)

• Medical management of congestion
• Discussion of allergic rhinitis management
• A variety of procedures can be done for nasal breathing. Evaluation of the nose and passageways for breathing is part of the sleep surgery evaluation. Some procedures done for improved nose breathing include:
  • Inferior turbinate reduction
  • Septoplasty
  • Endoscopic sinus surgery
  • Rhinoplasty