Surgical Treatments

The Takeaway

  • Surgical treatments for obstructive sleep apnea are less common than nonsurgical treatments. Limited success rates, risk levels, and recovery time should be well understood when considering surgical treatment.

Nasal Surgery

In general, operations performed to increase airflow through the nose, such as removal of nasal polyps or turbinates, or straightening a deviated nasal septum, do not completely cure obstructive sleep apnea (OSA) but may improve daytime and nighttime breathing through the nose and may enable better use of positive airway pressure.

Upper Airway Surgery

The most common operation performed is called a uvulopalatopharyngoplasty (UPPP). This operation attempts to widen the airway behind the tongue by removing excess tissue from the sides of the throat behind the tongue, shortening the soft palate, and removing the uvula (see Figure 9). The operation requires hospitalization and recovery may take several weeks. Variants of the operation can be performed on an outpatient basis with a laser (laser-assisted uvulopharyngoplasty, or LAUP) or by a radiofrequency probe (somnoplasty). Although snoring is frequently improved with these operations, only approximately 40% of persons undergoing UPPP have resolution or major improvement in their OSA. Furthermore, it is unclear whether the success rates from LAUP or somnoplasty are comparable to those for UPPP. Reported side effects from these operations include changes in voice and difficulty swallowing liquids.

Maxillomandibular Advancement (MMA)

In this operation, the upper and lower jaws are surgically fractured, and both are moved forward to enlarge the airway (see Figure 10). The published results on this operation are reported from only a few institutions, but their results suggest that the improvement rate is greater than for UPPP. However, the operation is substantially more complex than UPPP, with greater risk to the patient and a much longer recovery period.

Tracheostomy

A tracheostomy is a surgically created opening in the trachea below the level of the larynx, or voice box. This bypasses the area of obstruction in OSA. Individuals with a tracheostomy for OSA plug the opening during the day, allowing them to speak normally, but remove the plug for sleep. Tracheostomy was the primary treatment for severe OSA before the introduction of PAP therapy. It is still used for very severe cases that cannot be treated otherwise.

Other Procedures

Several other operations have been performed for OSA. These include radiofrequency reduction of the size of the tongue, stiffening the soft palate with stents, advancement of the front of the lower jaw, and relocation of the hyoid bone. None of these operations has been shown to have a high rate of success in the treatment of OSA. However, they may be of benefit in selected cases.

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This content was last reviewed on February 11, 2011