Surgical management of obstructive sleep apnea
In OSA, CPAP is almost inevitably the preferable form of treatment, and therefore should be tried first. Exceptions may be in rare cases of severe psychological aversion, or fitting failure due to cranio-facial anomalies or claustrophobia.
Type of surgeries:
- To improve the nasal airway
Septoplasty surgeries are often done to assist with CPAP compliance and it rarely corrects OSA without another intervention. It includes: turbinate reduction, rhinoplasty, polypectomy
- To improve the palatal oropharyngeal airway
Uvulopharyngopalatoplasty (UPPP) involves removal of tonsils, adjacent soft palate and tightening (by sutures) the lateral and posterior pharyngeal walls. Circumferential narrowing in the airway from excessive scaring is a long-term complication of the surgery.
Laser Assisted Uvulopalatoplasty (LAUP), may be done as UPPP (but without tonsillectomy or suturing) leaving a ‘Roman Arch` palate.
Transpalatal Advancement Pharyngoplasty (TPAP) 1cm of the back of the hard palate is removed
- To improve the Retrolingual airway
Genioglossus Advancement (GGA) Genioglossus muscle, which is the part of the tongue attaching it to the chin, is brought forward and rotated by about 1 cm.
Hyoid Suspension or Advancement (HS A), Hyoid bone is advanced over the upper thyroid cartilage which involves moderate neck dissection
Direct tongue base surgery: Very dangerous and done in a very few centers
Tongue Base Radiofrequency (TB RF) which destroys tongue base tissue by about 17%
- To improve both the airway at both the oropharyngeal palatal level and the retrolingual level
Maxillomandibular Advancement (MMA) which pulls the whole face forward at least 1cm. Complications include airway problems with dental and occlusal changes
Most surgery improves only one area of upper airway (at a time) while most sleep apnea patients have multiple areas of airway collapse. Therefore, multiple surgeries may be required, and despite those surgeries CPAP may still ultimately be necessary. Especially in more severe OSA, surgery is relatively ineffective in controlling the condition when compared to CPAP. Also all surgery carries serious risks, including death, and airway surgery more than many other forms. CPAP carries virtually no risks. Nevertheless, CPAP splints the whole upper airway open and it is the least invasive treatment for OSA. If you have had performed, any of the surgeries above but still have signs and symptoms of sleep apnea, call Cansleep services to book a diagnostic test to see if you still need CPAP therapy or not.
By Bahareh Ezzati (RRT)