Health Column: Surgical options for improving sleep

Before the invention of the CPAP in 1981, the main treatment for obstructive sleep apnea was a tracheotomy, meaning doctors had to create an opening in thee trachea, or windpipe, in the front of the neck, above the top of the breastbone.

More than 25 years later, the treatment option is hardly used, thanks to the invention of other surgical treatments. It’s important to remember, though, that the goal of surgery as a sleep-related treatment tool is still much the same as it was: to open the upper airway so more air flows more easily into the lungs.

Surgical procedures of today that might be considered as part of a sleep patient’s treatment regimen include nasal surgery, removing enlarged tonsils and adenoids, somnoplasty, uvulopalatopharyngoplasty, laser-assisted UP, genioglossus advancement, maxillary-mandibular advancement and radio-frequency ablation.

Nasal surgeries may involve widening the nares where air first enters the nose. The nasal septem, which separates the inside of the nose into two parts, needs to be fairly straight because otherwise, there will be decreased airflow. The treatment to correct this problem is called septoplasty. Other structures in the nose also can be enlarged, usually because of allergies, and may also need to be treated surgically to assist breathing.

Moving down the head just a bit, enlarged adenoids, located above the soft palate, can restrict airflow, as can enlarged tonsils. Often, these conditions cause obstructive sleep apnea in children. Another treatment option is somnoplasty, which uses a thin probe to apply heat to localized areas of obstruction, whether in the nose, palate or tongue. When these areas heal, scar tissue forms and shrinks, tightening and widening affected areas and airways.

Uvulopalatalpharyngoplasty, or the shortened version of UPPP, is a procedure that removes excess tissue that results from the uvula and the back of the soft palate extending too low. Snoring, a frustrating ill for individuals and their sleeping partners, often improves after UPPP. If in the procedure, the surgeon uses a laser, the name changes to a laser-assisted uvula palatoplasty, or LAUP.

Genioglossis advancement is a procedure named after the tongue, medically known as the genioglossus muscle. Like all muscles, it has a tendon and that tendon normally attaches to the lower inside of the floor of the mouth. After the surgeon creates a small window in the bone that makes up the lower jaw, the surgeon then attaches the tendon of the front of the tongue to the bone through that window, pulling the tongue forward. This makes space behind the tongue, allowing more air to get in.

And finally, maxillo-mandibular advancement is a procedure done under general anesthesia to move the upper jaw and the lower jaw forward so the airway is opened and made larger. The jaw bones then are held in place by screws and plates. Healing can take weeks, and chewing is discouraged for some time. There is some post-operative pain and swelling, although it, and numbness of the area, are usually temporary.

Dr. Fredric M. Radoff is a neurologist specializing in sleep disorders medicine at The Center for Sleep Medicine, a partnership of Blount Memorial Hospital and East Tennessee Medical Group.

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