Surgical Approach to Snoring and Sleep Apnea

Introduction

There are different types of surgical procedures for treating snoring and sleep apnea. The medical professionals decide the surgical option depending on the underlying cause. Some individuals have occasional snoring. But frequent snoring becomes a long-term habit. Though it is harmless, it can be a sign of sleep apnea. Snoring eventually leads to a repeated pause while breathing in and out.

What Is Sleep Apnea?

Sleep apnea occurs due to the relaxation of breathing muscles. As a result, breathing stops during sleep, and the individual wakes up from sleep. It changes the metabolism of the body and increases blood pressure. Severe sleep apnea may cause systemic diseases. The surgical approach is necessary for such conditions.

What Is Snoring?

The relaxation of tissues present in the airway results in snoring. It causes the narrowing of the airways and prevents airflow. The vibration of the tissues produces snoring. The sound varies depending on the volume of obstructed airflow. Individuals with enlarged tonsils have mild snoring during sleep.

What Are the Various Surgical Methods to Prevent Sleep Apnea and Snoring?

The surgeries are performed to prevent sleep apnea and the problem of snoring. They are as follows;

• Maxillomandibular Advancement - The upper jaw (maxilla) and lower jaw (mandible) are repositioned to establish space behind the tongue. The airways open and reduce the severity of sleep apnea. This procedure also prevents snoring. This is also known as jaw repositioning, as it involves the forward positioning of the jaws.

• Mandibular Osteotomy - The chin is divided into two to push the tongue forward. This procedure stabilizes the jaw and the tongue to open the airway. Because of this, the individual recovers from sleep apnea rapidly.

• Genioglossus Advancement - Breathing interferes with sleep due to the tongue fallback. The tendons present on the tongue are tightened to prevent fallback. A small part of the bone attached to the tongue is removed and positioned forward. It makes the tongue stiff so that the tongue stays in its normal position. This procedure is performed along with jaw advancement surgeries. This surgical advancement of the tongue is used to treat snoring and sleep apnea.

• Tonsillectomy - The tonsils present on both sides of the tongue are called lingual tonsils. The removal of these tonsils and the issues related to the tonsils is called a tonsillectomy. It unfolds the lower throat and helps in the breathing mechanism.

• Septoplasty and Turbinate Reduction - The septum is present between the two nostrils. It contains bone and cartilage. Deviated septum interferes with breathing. It is straightened using a septoplasty procedure. The walls of the nasal passages are called turbinates. The deformity in the turbinates is corrected by reduction to support breathing. It keeps the nasal tissue moist. These procedures are performed simultaneously. It is effective against snoring and mild sleep apnea.

• Nerve Stimulator - Hypoglossal nerve provides the nerve supply to the tongue. An electrode is attached to the muscles of the tongue. The electrodes give a stimulus when there is a pause in breathing. This action prevents the tongue from falling back. So the airways remain open during sleep. This method can be used to treat both apnea and snoring.

• Hyoid Suspension - The hyoid bone is present in the neck. Deformity in the hyoid bone obstructs the airway. So the hyoid bone and the adjacent muscles are positioned for opening the air passages. It is a more complex surgery, and the surgeon must be skillful.

• Glossectomy - A part of the tongue from the back is removed. It creates a large space in the air passage. Some individuals with high body mass index have a large tongue. In such conditions, the base of the tongue is reduced to promote airflow.

• Radio Frequency Volumetric Tissue Reduction (RFVTR) - The excess throat tissue interferes with the breathing process. It acts as a hindrance while using breathing devices like continuous positive airway pressure (CPAP). Radiofrequency waves are used to shrink the excess tissue present in the back of the throat. It widens the airways and prevents snoring.

• Uvulopalatopharyngoplasty - The extra throat tissue leads to snoring during sleep. The excess palatal tissues and throat tissues called uvula are removed in the uvulopalatopharyngoplasty. It is a painful procedure and hence performed under local anesthesia. The recent advancement in uvulopalatopharyngoplasty is the use of a laser for removing soft tissues. It can also be performed under radiofrequency waves. This procedure is known as ablation. Recovery of the patient takes up to two to three weeks for uvulopalatopharyngoplasty.

• Palatal Implant - This surgery is also known as the pillar procedure. It is used to treat mild sleep apnea as well as snoring. The small rods are placed in the soft palate. A soft palate is present in the upper part of the mouth. These rods are made up of plastic or polyester. The length of these implants is 18 millimeters. After placing an implant of 1.5 millimeters in diameter in the tissue, it is allowed to heal. The palate becomes rigid after healing. The stiff tissue does not vibrate while breathing and prevents snoring.

What Are the Risks After Surgery?

• If the anesthesia exists for a long time, it relaxes the throat muscle and makes the sleep apnea worse. Then endotracheal intubation must be performed to assist respiration.

• There is a high risk of bleeding during surgery. It leads to bacterial contamination.

• The individual may have discomfort and dryness in the throat.

• There is difficulty breathing due to pain and sore throat.

• The voice becomes hoarse due to the modifications in the throat.

Conclusion

A surgical approach to snoring and sleep apnea is performed only if the individual does not respond to other non-surgical procedures. Surgeries are invasive procedures and are performed only for severe cases of sleep apnea and snoring. Mild cases can be treated with the help of breathing devices. Respiratory illnesses like flu or cold trigger sleep apnea and snoring. Respiratory diseases should also be treated to get rid of snoring and central sleep apnea.