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Sleep Apnea Surgery

The Head & Neck Surgery Center specializes in the surgical treatment of patients with significant snoring problems and Obstructive Sleep Apnea. In cases where non-surgical management of obstructive sleep apnea has had limited success, or results in discomfort and non-compliance, surgical options may provide the best opportunity for relief of this often debilitating condition.

Obstructive Sleep Apnea (OSA) can result from many factors. The size of the jaw, an enlarged tongue, trauma to the nasal passageways, enlarged tonsils, or issues with the soft palate can all contribute to airway obstructions and impact the degree of snoring or Obstructive Sleep Apnea that a person experiences. Age, male gender, excess weight, and lifestyle habits such as alcohol, smoking, as well as the use of sedatives, antihistamines and other prescription drugs can all influence snoring and OSA as well.

If you have participated in a sleep study and have been diagnosed with Obstructive Sleep Apnea the first course of treatment is often one of several non-surgical methods, the most common of which is a Continuous Positive Airway Pressure (CPAP) device. The CPAP device uses a mask to facilitate the passage of air into the breathing passage in order to prevent the collapse of the airway and ensure a consistent flow of air. The CPAP device helps to treat the symptoms of OAS but it does not provide a permanent solution. If patients find the device to be uncomfortable and limit its use, or if they cannot get an effective fit, obstructed nighttime breathing will continue.

Why Surgery for Obstructive Sleep Apnea?

In cases where non-surgical measures such as the CPAP have had limited effectiveness, surgical options may provide the best opportunity for relief of OSA. Surgical treatment of snoring and OSA is based on a number of factors but the underlying approach is to modify the source of the airway obstruction in order to prevent the narrowing or complete obstruction of the airway passage. The three principal areas at which airway blockage can occur are the nose, the soft palate, and the regions around the base of the tongue. In many cases more than one of these areas may be impacting airway flow and can be addressed concurrently in order to promote permanent improvement in airflow. Where airflow devices such as the CPAP are a temporary solution one significant advantage of surgery for OSA is that is that it presents a permanent solution to an ongoing condition and does not require long-term compliance with a physical device.

Consultation with a Sleep Apnea Surgeon

The underlying cause of snoring and OSA are unique to each patient; in some cases the condition may be the result of several conditions that are present at the same time. Every patient considering surgical treatment for snoring and OSA will meet with Dr. Rizwan Aslam, a fellowship trained and board-certified Head and Neck surgeon, who will conduct a comprehensive examination and review all appropriate treatment options with you. Because each patient’s physical makeup and degree of OSA are unique, and the cause of the problem may be the result of a combination of obstructions, several treatment options may need to be considered. In all cases the goal of surgical management of OSA is to enlarge the airway and prevent snoring and airway collapse during sleep.

Surgical Management of Obstructive Sleep Apnea

Nasal Procedures, Soft Palate Procedures and Tongue Based Procedures are all options for the treatment of severe snoring and Obstructive Sleep Apnea (OSA). All procedures, whether done on an inpatient or outpatient basis, are performed in a safe and fully staffed hospital setting under the appropriate choice of anesthesia delivered by a board-certified anesthesiologist.

 

Nasal Procedures

Septoplasty
The nasal septum is comprised of thin bone in the front and cartilage in the back; together they form the wall that separates the two nasal passages that support the nose and direct airflow. The septum can bend to one side as part of normal pattern of growth or can be the result of a trauma to the nose; the resulting condition, referred to as a deviated septum, can significantly impact airflow and lead to snoring or OSA. Surgery to correct this condition is referred to as Septoplasty, Submucous Resection of the Septum, or Septal Reconstruction.

Rhinoplasty and Nasal Valve Surgery
The nostrils and corresponding area of the nose are referred to as the nasal valve. Airflow through the valves can be impacted by their formation during growth or as the result of trauma to the nose. The resulting restriction in airflow can contribute to OSA. Rhinoplasty and nasal valve surgery are commonly used to treat nasal obstruction that originates at the external nose.

Removal of Sinus and Airway Polyps
Sinus and airway polyps are abnormal tissue growths that develop in mucus membranes and can result in airflow restrictions, contributing to snoring and OSA. When polyps obstruct the nasal airway, or recurring sinus infections result in nasal obstruction, removal of the polyps or surgery in the sinus cavities may be necessary.

Turbinate Reduction
The turbinates in the nose are designed to warm and moisturize the air that is drawn in as you breathe. There are three turbinates in each nostril (lower, middle, and upper) and are comprised of bone surrounded by soft tissue. Reduction of the size of an enlarged turbinate can increase the size of the nasal passageway and result in improved airflow. Turbinate reduction can be accomplished with a variety of surgical techniques including radiofrequency reduction.

 

Soft Palate Procedures

Lingual Tonsillectomy
The lingual tonsil tissue is located on the back of the tongue and is different from the tonsil tissue that is located on the sides of the throat and is visible when the mouth is open. In some cases enlargement of the lingual tonsil tissue can impact airway flow and contribute to snoring and OSA. The lingual tonsillectomy procedure reduces the size of the lingual tonsil and results in an enlarged airway behind the tongue.

Lateral Pharyngoplasty
Lateral Pharyngoplasty is often performed in conjunction with a Lingual Tonsillectomy and incorporates a combination of tissue repositioning of the soft palate (roof of the mouth) and reduction of the lateral pharyngeal tissues (side of the throat). The result of this procedure is to increase the size of the airway and improve airflow without impacting normal breathing, speaking and swallowing functionality.

Uvula Surgery (UPPP)
An enlarged uvula and soft palate tissues can contribute to snoring or disrupted breathing during sleep. Uvulopalatopharyngoplasty, or UPPP, is a surgical procedure performed to remove the uvula and is often performed in conjunction with other soft palate modifications and tonsil reduction.

Laser-Assisted Uvulopalatoplasty (LAUP)
Laser-Assisted Uvulopalatoplasty involves a gradual removal of the back edge of the palate and reduction in size of the uvula. If the tonsils are present and are suspected of contributing to snoring and OSA they are addressed at the same time. LAUP is a short procedure if most often performed in the office under local anesthetic, and may require more than one treatment.

 

Tongue Based Procedures

Tongue Surgery
In many cases as a person gains weight fat deposits in the tongue increase as well, causing the tongue to enlarge and contribute to snoring and OSA. Several surgical procedures are available to reduce the size of the base of the tongue and increase air flow including performing a submucosal lingualplasty, in which the base of the tongue is reduced in size, and somnoplasty, a tongue based radio-frequency ablation procedure that results in the contraction of excess tissue.

Make an Appointment

To make an appointment or schedule a second opinion consultation with Dr. Aslam please contact our Patient Representative.

Head and Neck Surgery Specialists   504.988.1965   1.888.284.3726   headandnecksurgery@tulane.edu