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> Adam Matuszyk
> A...@b...com.pl

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Surgical Approaches to Obstructive Sleep Apnea:
Obstructive sleep apnea (OSA) is a serious
condition in which breathing
stops during sleep, sometimes hundreds of
times a night. Cardiovascular
problems may result. Symptoms include
snoring, excessive sleepiness,
poor performance at home or work,
moodiness and depression. The
most common treatment is nasal continuous
positive airway pressure
(CPAP), a device that keeps the airway
open during sleep. However,
sometimes surgery for OSA is recommended.

Obstructive sleep apnea is caused by the
momentary collapse of tissues
in the throat affecting the upper airway
leading from the nose. Often, the
exact location and cause of the collapse
is difficult to identify. However,
if an obstruction to the airway can be
identified and conservative
treatments have not worked, surgery may be
performed. Multiple
operations directed at different levels of
the airway may be necessary to
increase the size and reduce the
“floppiness” of the airway.

Types of Surgery

Uvulopalatopharyngoplasty (UPPP or U3P)
surgery removes the
tonsils, uvula (the fleshy tissue that
hangs in the back of the mouth), and
a portion of the soft palate at the roof
of the mouth. Remaining tissues
are pulled up and outward to enlarge the
throat. If the location of the
throat blockage does not involve other
areas, approximately 50% of
patients are helped by UPPP by itself. The
operation is more successful
for snoring. Most patients treated
surgically for OSA will require UPPP
and other procedures.

Risks of UPPP surgery include a severe
sore throat and, in rare cases,
nasal speech, difficulty swallowing or
regurgitation of liquids in the nose.

Laser-assisted uvulopalatoplasty (LAUP)
utilizes a laser to primarily
stiffen palate tissues to treat snoring.
As a newer procedure, long-term
results on sleep apnea are not completely
known.

Somnoplasty uses radiofrequency waves to
shrink and stiffen palate
tissues to treat snoring.

Nasal surgery may be necessary to repair a
deviated septum, remove
polyps, shrink nasal tissues or correct
other blockages. By itself, nasal
surgery does not usually cure sleep apnea,
but it may be part of surgical
treatment and make the use of CPAP more
effective.

Tongue base surgeries help alleviate
obstruction in the lower throat
behind the tongue. Laser surgery or
somnoplasty shrinks the size of the
back of the tongue and offers a 30-70%
success rate. Somnoplasty can
be performed as an outpatient procedure
under local anesthetic with
little pain or loss of work time. However,
multiple sessions are required.

Another tongue base surgery pulls the
muscle attachment of the tongue
from the back toward the front of the chin
to enlarge the lower throat
area. A small screw or fixation plate
secures the muscle attachment in
place. This procedure significantly
improves the results of OSA surgery,
particularly if lower airway or tongue
obstruction is present. Risks
include numbness to the front middle
teeth. Rarely, loss of a tooth or
jaw fracture may occur.

Reconstructive jaw surgery involves moving
the upper and/or lower
jaw forward. Orthodontic work may then be
necessary to ensure teeth
fit together properly. In severe cases of
OSA, this treatment has a
success rate of over 90%. Following
surgery, the jaws may be wired
shut for a short time, and a liquid diet
is necessary for four to six weeks.

Other OSA surgeries include hyoid
suspension and tracheotomy. The
hyoid bone is a small, C-shaped bone in
the upper neck above the
Adam’s apple. Many muscles of the throat
and tongue attach to this
bone. The hyoid can be pulled forward to
enlarge the airway.

Tracheotomy, which bypasses the airway by
placing an opening in the
throat from the outer skin to the
windpipe, is reserved for patients with
life-threatening disease or other special
medical conditions. The airway
is sealed during the day using special
tubes so that normal speech and
swallowing may be resumed. It is opened at
night to allow breathing
without sleep apnea.

Clearly, surgery for obstructive sleep
apnea must be considered
carefully on a case-by-case basis. The
individual’s anatomy and
symptoms will largely determine any course
of surgical treatment.


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CAVE CANEM ! ! !