Surgery procedures for the treatment snoring and sleep apnea are an option for the person who has been diagnosed by a sleep study as having a sleep-related breathing disorder. Possible candidates for surgery may be someone who refuses or does not tolerate medical therapies such as nasal CPAP or BiPAP, or oral appliances that pull the jaw or tongue forward. Surgery is also indicated to treat sleep apnea and snoring in patients who have an underlying specific anatomic abnormality that is contributing to the sleep apnea.

Surgical Therapeutic Options:

1. Palatal surgery - Uvulopalatopharyngoplasty (UPPP) or Laser-assisted uvulopalatoplasty (LAUP)

Uvulopalatopharyngoplasty - This is designed to open the airway behind the palate. If tonsils are present they are also removed, and redundant palatal tissue is also removed. The incision is closed with sutures. The procedure is performed under general anethesia. There is usually a one day or two day hospital stay.

Laser-assisted uvuloplasty - This is designed to open the airway behind the palate. An outpatient procedure under local anesthesia for patients with simple snoring or mild sleep apnea. It requires multiple procedures where the laser cuts the palate and the area heals by scarring.

2. Nasal surgery - Septoplasty, turbinate reduction or nasal valve surgery This is designed to improve nasal obstruction of any kind. It entails either fixing a deviated septum, reducing the size of large nasal bones called turbinates, or by preventing the collapse of the nostril area called the nasal valve. If done alone it may be performed as an outpatient procedure, but if done along with other airway surgery, it is an inpatient procedure.

3. Genioglosuss tongue advancement - This is designed to improve the airway behind the base of the tongue. The genioglosuss is the main tongue muscle which holds the tongue forward. During sleep, this muscle relaxes and often allows the tongue to fall into the airway. It attaches to the middle of the lower jaw. If a segment of bone containing this muscle is pulled forward and stabilized, it can open the airway space behind the tongue. This procedure does not move the teeth or the jaw. This is performed under local, intravenous sedation or general anesthesia. Patients are managed with a one or two day hospital stay, often with the first hospital day in the intensive care unit.

4. Hyoid suspension - This is designed to improve the airway behind the base of the tongue. The hyoid is a bone in the neck where some tongue muscle attach. If the hyoid bone containing these muscles is pulled forward in front of the voice box, it can open the airway space behind the tongue. This is performed under local, intravenous sedation or general anethesia. Patients are managed with a one or two day hospital stay.

5. Maxillomandibular advancement - This procedure is designed to open the airway behind the palate as well as behind the base of the tongue. This is performed if previous procedures have not completely improved the obstructive breathing episodes and/or the patient has persistent symptoms of daytime sleepiness and fatigue. This operation cuts the bone of the upper and lower jaw and pulls these structures forward. This is performed under general anesthesia. Patients are managed with a two day hospital stay with the first hospital day in the intensive care unit.

6. Tracheotomy - This procedure is designed to provide an airway by bypassing the areas of upper airway obstruction. AN incision is placed in the neck below the voice box and a plastic or metal tube is placed into the windpipe through the incision. This procedure is performed under local, intravenous sedation or general anesthesia. The patient is recovered in the hospital for about three days until becoming comfortable with the care of the tracheotomy tube. This is often a temporary condition to protect the patients airway while other airway procedures are being performed.

Postoperative follow-up

The wounds need to be inspected until complete healing has occurred. Fiberoptic visualization of your airway and plain X-rays aid in evaluating the caliber of your airway postoperatively. If you have moderate or severe sleep apnea you need to use nasal CPAP, nasal BiPAP, or a tracheotomy until a repeat sleep study reveals your disorder is cured. Approximately four to six months postoperatively, a repeat sleep study is performed to evaluate the surgical result.