Surgery

NASAL SURGERY

Nasal obstruction is a common finding in patients with obstructive sleep apnea and snoring. The cause of the obstruction may be due to turbinate tissue overgrowth, deviated septum, sinus disease or collapse/narrowing of the nasal valve. Nasal obstruction may result in mouth breathing which can intensify snoring. A thorough examination is required to determine the source of obstruction. Nasal surgery is highly successful in improving nasal breathing by reducing the size of the turbinates, correcting the deviated septum, relieving sinus disease or enlarging the nasal valve. In some patients, snoring can be dramatically reduced with these procedures.

Nasal obstruction can make tolerance of continuous positive airway pressure therapy (CPAP) much more difficult. In some instances, higher CPAP pressure is needed to overcome nasal blockage. Studies have shown that high CPAP pressures are associated with poorer acceptance of CPAP therapy. Nasal surgery is performed to improve a patient’s tolerance toward continuous positive airway pressure therapy and potentially reduce the pressure required to adequately treat their sleep apnea.

Nasal surgery for snoring and sleep apnea is usually an out-patient procedure. The procedure takes approximately 30 minutes. Our surgeons typically do not use nasal packing. Nasal surgery is generally associated with a mild amount of discomfort, which can be easily managed with medications for one to two days. Patients will experience nasal stuffiness for a few days and can usually return to work in three days.

UVULOPALATOPHARYNGOPLASTY (UPPP)

Very commonly, the uvula and soft palate are the source of snoring and airway obstruction. The uvula is the soft “finger-shaped” tissue that hangs down from the roof of the mouth. Both the soft palate and uvula consist of a complex of muscles covered by a mucous membrane. In patients with snoring or sleep apnea, this complex is too long or thick which may result in obstruction of the airway.

Uvulopalatopharyngoplasty, also known as UPPP, is designed to treat excessive tissue of the soft palate and/or uvula that is blocking the airway. There are many different variations of this surgical technique. One such variation is the Uvulopalatal Flap. This surgical technique is less invasive than traditional approaches. Instead of removing a large amount of tissue, the uvulopalatal flap repositions the tissue of the soft palate. This allows for a less painful recovery while achieving significant widening of the throat.

In order to determine which palatal surgery is best for you, our physicians need to evaluate your airway. Our surgical philosophy is to offer the technique which provides the best outcome. We do not believe in a “one-size fits all” model. Rather, we customize our surgical plan based upon your pattern of airway obstruction.

UPPP can be performed alone or in combination with other surgical procedures. If tonsils are present, a tonsillectomy can be performed at the same time. Typically, an over-night stay in the hospital is recommended. The surgery is usually completed in less than 45 minutes. Swelling and pain are expected after surgery. Medications will be provided to ease your recovery. Most patients will remain on a soft diet for 7-10 days after surgery.

GENIOGLOSSUS ADVANCEMENT

Tongue base obstruction is a common finding in patients’ with snoring and obstructive sleep apnea syndrome. The tongue is composed of muscles and during sleep these muscles may relax and lose some of their tone. This can cause the tongue to collapse and fall backwards into the airway. This motion may obstruct the airway. Have you ever noticed that snoring tends to be worse while you are lying on your back? In part, this is due to the muscles of the tongue falling backwards.

Unfortunately, many people are unaware that they have tongue base obstruction. In addition, many centers do not offer treatments for the tongue. Failure to recognize and properly treat tongue obstruction will result in persistent airway obstruction and snoring. Thus, our protocol includes a complete upper airway examination to determine if a patient has tongue base obstruction. This evaluation will also allow your physician to decide the best procedure to treat this problem.

One such procedure is genioglossus advancement. The genioglossus is a muscle of the tongue. This procedure is designed to “pull” the genioglossus muscle forward to prevent it from falling back into the airway during sleep. Have you noticed that bed partners often ask snorers to lay on their side or chest to stop the snoring? These positions reduce the chance of the tongue falling backwards. This is the basic concept of this surgical technique.

The procedure takes approximately 30 minutes and can be performed as an isolated procedure or in conjunction with nasal and palatal procedures. An over-night stay in the hospital is recommended. Swelling and mild pain are expected. Most patients are able to return to work within a week.

HYOID SUSPENSION

Hyoid suspension’s goal is to enlarge the airway by holding the muscles of the tongue forward. Several of the muscles of the tongue insert on the hyoid bone. The hyoid bone can be felt in your neck just above the thyroid cartilage (also referred to as the "Adam’s Apple"). A small incision in made in the neck and the hyoid bone is pulled forward. This motion pulls the muscles of the tongue base forward and reduces the chance of airway collapse during sleep.

The procedure takes 30 minutes and most patients can return to work within 2-3 days. Over-night hospitalization is recommended. Pain is minimal.