MedifocusHealth

The role of surgery in the management of obstructive sleep apnea syndrome (OSAS) is still an area of debate within the medical community. Currently, there is a lack of conclusive evidence from rigorous clinical trials to support the routine use of surgery for the treatment of OSAS. In general, surgery is usually considered for patients with OSAS who meet the following criteria:

• Patients with moderate to severe OSAS who have failed to respond to medical therapy (e.g., CPAP, oral appliances)

• Patients with OSAS where the airway obstruction is caused by an obvious anatomical abnormality. The exact anatomical area where the airway collapses varies among individuals with OSAS. A general classification of patterns of airway collapse is as follows:

  • Type I = Retropalatal Collapse - Airway obstruction occurs only in the upper portion of the pharynx behind the soft palate

  • Type III = Retrolingual Collapse - Airway obstruction occurs only in the lower portion of the pharynx behind the base of the tongue and below the lower margin of the soft palate

  • Type II = Retropalatal-Retrolingual Collapse - Airway obstruction occurs in both the retropalatal and retrolingual regions.

Surgical Procedures for Obstructive Sleep Apnea Syndrome

In general, surgical procedures for obstructive sleep apnea syndrome may be grouped as follows:

• Palatal surgery
• Maxillofacial surgery
• Other surgical procedures

Palatal Surgery

Palatal surgical produres are indicated for patients with Type I (retropalatal) or Type II (retropalatal-retrolingual) airway collapse. These procedures include:

• Uvulopalatopharyngoplasty (UPPP) - This procedure involves surgically excising excess tissue at the back of the throat, parts of the soft palate, and the uvula.

• Laser-assisted uvulopalatoplasty (LAUP) - With this procedure the surgeon uses a laser to remove excess tissue from the back of the throat, the soft palate, and the uvula.

• Somnoplasty - With this procedure the surgeon uses radiofrequency energy to ablate (destroy) excess tissue from the back of the throat and the soft palate.

In general, these palatal surgical procedures are much more effective for controlling snoring than for controlling episodes of sleep apnea or hypopnea. Complications that may be associated with palatal surgical procedures include:

• Postoperative pain
• Nasal refux - discomfort or gagging/choking due to the backflow of liquids into the nose when swallowing
• Voice changes

Maxillofacial Surgery

Maxillofacial surgery may be recommended for patients with Type II or Type III anatomical abnormalities where retrolingual collapse is an underlying cause of the airway obstruction. The goal of maxillofacial surgery in these cases is to alleviate the cause of the airway obstruction by pulling the tongue muscle forward and away from the back of the throat. Various maxillofacial surgical procedures may be used to accomplish this goal including:

• Mandibular advancement
• Maxillomandibular advancement
• Genioglossal advancement
• Hyoid myotomy-suspension

Variable success rates for the treatment of OSAS with maxillofacial surgery have been reported in the literature. Maxillofacial surgery for OSAS is a technically challenging procedure that is associated with a prolonged recuperation period and may also be associated with postoperative complications (e.g., numbness of the tongue; malocclusion of the upper and lower jaws). It is, therefore, important for patients who are considering maxillofacial surgery as a treatment option to select a qualified oral/maxillofacial surgeon who is experienced with the surgical procedures used for the treatment of OSAS.

Other Surgical Procedures