Upper Airway Surgery

A dental sleep specialist may recommend upper airway surgery when other treatment options are unsuccessful in eliminating the symptoms of sleep apnea or are not tolerated by patients. Surgery is site-specific, meaning it requires the identification of specific anatomic areas contributing to airway obstruction. Depending on the location and nature of the airway obstruction, the procedure may be minimally invasive or more complex. It may be necessary to remove the tonsils or other parts of the soft palate or throat. A detailed examination of the entire upper airway is necessary before your dentist can decide which surgical procedures are most effective.

Maxillomandibular Advancement

MMA is the most effective and acceptable surgical treatment of sleep apnea, with success rates ranging from 94 to 100 percent. The surgical procedure involves osteotomies (bony cuts performed by intraoral incisions) to advance the upper and lower jaws to pull forward and tighten the soft palate, tongue and other attached soft tissues. The process enlarges and stabilizes the entire upper airway. MMA requires an overnight hospital stay. Your jaw may be wired shut for several weeks, which may result in weight loss.

Anterior Inferior Mandibular Osteotomy With Hyoid Suspension

AIMO involves a chin bone osteotomy to pull forward the tongue and anterior neck muscles to enlarge and stabilized the airway behind the tongue base. The procedure is not as effective as MMA, but it will not change your bite and your jaw will not have to be wired shut. AIMO may be performed as an outpatient procedure or in combination with MMA and other procedures.

Surgery of the Soft Palate

There are various operations of the soft palate that can treat snoring, upper airway resistance syndrome and sleep apnea. The most commonly performed procedure is an Uvulopalatopharyngoplasty, which involves the trimming of a bulky soft palate. The UPPP is often performed in combination with removal of enlarged tonsils or adenoids. A Laser-Assisted Uvuloplasty is a modified version of the surgery that involves scarring cuts to tighten the soft palate and sequential trimming of the uvula over several appointments. While LAUP is less painful and has fewer side effects, it is less effective than UPPP in treating sleep apnea. Radiofrequency Volumetric Tissue Reduction, sometimes called Somnoplasty, shrinks the soft palate and tongue base using energy waves similar to microwaves. Each surgical procedure of the soft palate comes with potential for adverse side effects including throat swelling, nasal reflux of air during speech and fluid during drinking. Throat swelling usually occurs immediately after surgery. 

Nasal Surgery

Nasal obstruction may be treated by several nasal surgical procedures. Septoplasty straightens a deviated septum. Turbinate Reduction removes or reduces large turbinates and polyps. While these procedures may be performed independently as outpatient procedures, they are often used in combination with other procedures to treat snoring and sleep apnea.

Tongue Reduction Surgery

Procedure involves a wedge-shaped surgical reduction of the tongue base. It is not typically performed to treat sleep apnea and may have many potentially adverse side effects.

Weight Reduction Surgery

Bariatric surgery, such as gastric bypass, may be indicated as a last resort treatment of morbidly obese patients with sleep apnea. Cervicofacial liposuction is a relatively safe procedure that selectively removes excessive fatty tissue below the chin and anterior neck to reduce the weight against underlying soft tissues. Liposuction also helps minimize airway collapse behind the tongue base. It is usually in combination with other surgical procedures.

Tracheostomy

The operation bypasses the entire upper airway by creating an opening in the larynx or windpipe. Although tracheostomy has the highest therapeutic efficacy for sleep apnea, it has many psychosocial problems and is typically reserved as a last resort for the treatment of severe sleep apnea. Tracheostomy is particularly beneficial for patients with complicated medical conditions that prevent other above-listed surgical procedures.