Sleep, Surgical procedures for obstructive sleep apnea,uvulopalatopharyngoplasty, UPPP, laser-assisted uvulopalatoplasty, LAUP, somnoplasty, maxillofacial surgery, tracheostomy, sleep disorders, sleep apnea

In severe cases of apnea, surgery may be necessary to increase the size of the breathing passages or to correct structural abnormalities in the upper airway.
Physical problems that can be corrected surgically include:

Enlarged tonsils or adenoids (common in children)

Nasal polyps or other growths

A deviated nasal septum

Unusually formed jaw or soft palate

Nasal operations used to remove blockages in the nose as the only treatment of snoring and obstructive sleep apnea are usually not effective. Nasal surgery, however, may be one part of an overall plan for surgical treatment of obstructive sleep apnea.

The usual surgical procedures for obstructive sleep apnea are:

Uvulopalatopharyngoplasty (UPPP)

Laser-Assisted Uvulopalatoplasty (LAUP)

Somnoplasty

Other surgical procedures

Maxillofacial surgery

Tracheostomy

Uvulopalatopharyngoplasty (UPPP)

This surgical treatment for apnea consists of cutting away excess tissue at the back of the throat, including the uvula, the tonsils, and parts of the soft palate. The UPPP procedure was widely used until follow-up studies by sleep specialists found that it completely eliminated apnea in only about 10 percent of all cases. UPPP does reduce snoring. But this can be dangerous, it creates a false sense of safety because the victim and the bed partner may think that everything is fine since he or she does not snore anymore. Snoring is the warning that something is wrong. In a few cases, apnea actually becomes worse, probably as a result of scarring at the back of the throat. Some patients have reported negative side-effects of the surgery, such as nasal sounding speech and the regurgitation of liquids into the nose when swallowing.

Laser-Assisted Uvulopalatoplasty (LAUP)

This procedure involves using a laser device to eliminate tissue in the back of the throat. Like UPPP, LAUP may decrease or eliminate snoring but not sleep apnea itself. Again, elimination of snoring, the primary symptom of sleep apnea, without influencing the condition itself may carry the risk of delaying the diagnosis and possible treatment of sleep apnea in patients who elect LAUP. Patients undergoing this approach generally report severe postoperative pain.

Somnoplasty

This is a new surgical technique that uses microwave energy. It is being studied in hopes of improving the success of surgery at controlling obstructive sleep apnea. The procedure is quite simple. After a local anesthetic is administered, small needles are inserted into the tissue that needs shrinking. A very precise and controlled dose of radio frequency waves is delivered to the target tissue only at the needle tips. The area around the needle tips is coagulated and absorbed, leaving only a tiny internal scar. This treatment results in an overall reduction in tissue volume. Recent clinical trials show that it works on the base of the tongue, which is the primary culprit in most cases of obstructive apnea. FDA has approved the technique for treating obstructive sleep apnea.

This approach has several advantages over conventional surgery.

	It does not require an operating room or hospitalization.
	It is easily done as an outpatient procedure.
	The treatment itself takes only a few minutes and is bloodless and painless.
	Although there is some swelling immediately after the procedure, post-treatment pain is much less severe than that from ordinary surgery, and what little pain there is can be controlled easily with medications.
	Because there is so little discomfort, patients are willing to come back for successive treatments.
	There also is no wound on the tongue or sutures that can come undone.

Other surgical procedures

There are several other surgical procedures to treat obstructive sleep apnea. They aim to increase the size of the throat at the base of the tongue. They may involve cutting into the bones of the face and jaw. In properly selected cases they are more effective than UPPP alone but they may also carry a greater risk of complications.

Maxillofacial surgery

This is a procedure developed at Stanford University that provide a cure of obstructive sleep apnea in a majority of cases. This combines the standard UPPP with a procedure to pull the large tongue muscle forward and away from the back of the throat. This is accomplished by cutting out a small rectangle of bone in the front of the jaw, to which the tongue muscle is attached. The surgeons then pull this piece of bone out, rotate it 90 degrees, so it cannot fall back, and trim and fix it permanently. This maneuver pulls the tongue forward and adds more than a centimeter to the airway diameter, without any visible external changes.

Well over 1,000 patients have undergone this surgical procedure at Stanford. Postoperative sleep tests show that 60 to 70 percent are entirely cured.

Tracheostomy

This is done only in extremely advanced cases of obstructive sleep apnea to alleviate life-threatening situation. This procedure involves creating an opening in the trachea (wind- pipe) at the base of the neck, below and in front of the Adam's apple. A tube is inserted into the opening. The tube remains closed during waking hours, allowing normal speech and breathing through the upper airway. At night, a valve on the tube is opened so that air can flow directly to the lungs, bypassing the sleep induced upper airway blockage.

Although this procedure is highly effective, it is an extreme measure that is poorly tolerated by patients and rarely used.

Surgical procedures to treat obesity are sometimes recommended for sleep apnea patients who are morbidly obese.

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