Surgery for Snoring and Sleep Apnea.

Surgery for snoring or obstructive sleep apnea (OSA) is looked at as a last resort for people who have tried the anti snoring pillows and other non-surgical OSA /anti snoring devices, and not found them to be of benefit.    Here we’ll look at the snoring surgery and what it’s designed to do.

Snoring and Sleep Apnea Tests.

It’s also important that the cause of the snoring/sleep apnea has been correctly identified.  This is usually done by sleep studies, also known as polysomnography (say polly –som-nogg-raffy) and establishes the diagnosis.

Also a surgeon may want to be sure about what’s happening in a patient’s nose/mouth/throat that’s causing the snoring or sleep apnea, so a test called nasendoscopy (say nase-en-dossc’py) may be performed before any anti snoring surgery.  Here the person is given sedation and a small camera is put into the nose and back of the throat so that the surgeon can see exactly where the collapse is happening.

Surgery for the Soft Palate

If the snoring is coming from the soft palate at the back of the roof of the mouth, surgery aims to reduce this by removing some of the tissue there (including the tonsils if necessary).  The surgeon will probably also remove the uvula at the back of the throat as this causes a lot of the vibration noise in snoring.

The several options for anti snore surgery when the palate is a problem.  They have complicated names, but they are:

  1. Uvulopalatopharyngoplasty (say oovulo-pallaytoe-farr-ingoe-plasty) or UPPP.
  2. Laser assisted uvulopalatoplasty (LAUP) – laser surgery for snoring.
  3. Palatial stiffening operations (CAPSO).
  4. Radio-frequency ablation (say abblay-shun) (RFTA/Somnoplasty).
  5. Injection snoreplasty.
  6. Pillar Procedure.

Your surgeon will take your medical history and make an examination before choosing which treatment is right for you.  Not all surgeons are expert in all procedures and will have differing opinions on how beneficial they are.

UPPP is one of the most common procedure for obstructive sleep apnea and consists of removal of the tonsils, uvula and the back edge of the soft palate.  The surgeon may also re-align the area the tonsils sit in at the back of the throat.

LAUP is commonly used for snoring and is where the surgeon uses a carbon dioxide (CO2) laser to cut away the uvula.  Most people need more than 1 surgery, and 2-5 sessions is normal.

CAPSO.  Burned or scared tissue is often fibrosed. Fibrosed means it is stiff and not as elastic as normal tissue in the body.  In a CAPSO procedure, electrical cautery burns the soft palate and causes this fibrosis as it heals.  It can be done as an out-patient procedure under local anaesthetic and usually only needs one treatment.  It can be repeated if it needs to be.

RFTA or Somnoplasty also aims to shrink the uvula and more than one treatment may be needed but it can be performed in the out-patient clinic with a local anaesthetic.

Injection Snoreplasty  uses a chemical injection into the soft palate to reduce its size.  There hasn’t been much research done on this procedure so far so it is not widely used.

Pillar Procedure.  This involves implanting 3 very small woven pillars into the soft palate.  It’s a surgery that is good for snoring and for mild to moderate sleep apnea.  The woven pillars help to reduce the vibration of the soft palate and make it firmer by adding support.

Although it sounds like a big surgery, it’s actually minimally invasive and can be done in the clinic.

Snoring Surgery for the Nose

If the nose is the problem for the snorer, then several procedures can help to reduce any obstructions in the nasal passages.  However it’s rare than this will cure sleep apnea, but it may make CPAP treatment more tolerable.

Sometimes it’s necessary to have throat and nasal surgery.

The options for nasal surgery are:

  1. Septoplasty
  2. Septorhinoplasty (say septo-ryenoe-plasty)
  3. Turbinate reduction.

Septoplasty.

If the centre structure of the nose – the septum – is not straight, then the air can’t flow in and out easily and can be noisy, especially when you’re asleep.  Some people are born with a deviated septum and sometimes injury can cause it.

Septorhinoplasty changes the shape of the nose as well as correcting the kink in the septum.

Turbinate reduction is done in a number of ways.  The turbinates are like little shelves on the inside of the nose that warm and filter the air as it enters the nasal passages.  They usually get bigger when you’ve got a cold and then shrink again, but some people and permanently enlarged turbinates and this can lead to difficulty breathing.

A small amount of the turbinate is sometimes re-positioned by removing some of the bone of the ‘shelf’.

Snoring Surgery for the Tongue.

If the tongue is falling back and blocking the airway, causing snoring or OSA, then a procedure called the Tongue Suspension Procedure, also known as Repose can be done.

This is achieved by putting a small screw into the lower jaw.

Other surgeries may include reducing the volume of the tongue base.

Other snoring surgeries involve repositioning the lower jaw by lifting it forward slightly and securing it with a bone graft, pins and plates to the bone.  It’s called maxillary-mandibular advancement.

This aims to improve the shape of the jaw so that the tongue and back of the throat (the pharynx) is better supported.

Complications of Snoring Surgery.

Generally surgery is safe – your specialist wouldn’t do it otherwise.  But surgery of any kind carries a degree of risk.  The bigger the operation, generally the bigger the risk, but these risks will also depend on the snorer and his/her general health.

Common complications can be:

  • Infection
  • Extensive bleeding
  • Swelling of the tissues so that breathing/swallowing are uncomfortable or more difficult
  • Crusting of blood in the throat or nose
  • Difficulty swallowing after tongue surgery
  • Nerve damage in more extensive operations

What to Expect After Snoring Surgery.

  • Unfortunately there is no guarantee of success with snoring surgery.  It may be successful for a time but the problem may return when the body gets used to the changes and especially if you gain weight.
  • Pain after the operation is to be expected.  It can be treated with over-the-counter pain killers.
  • After surgery involving a general anaesthetic, you will probably stay in hospital overnight and go home the next day.

Elspeth Raisbeck

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