About Sleep Medicine & Surgery
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Sleep Medicine and Surgery
Sleep surgery is surgery done to treat sleep disordered breathing. Sleep surgery procedures are performed by surgeons specially trained in craniofacial surgery, oral maxillofacial surgery or otolaryngology
Indications for sleep medicine and surgery- Obstructive sleep apnea
- Snoring
- Nasal congestion
- Upper airway resistance syndrome
- Nasal congestion
- Continuous Positive Airway Pressure (CPAP)
- Oral appliances
Types of sleep surgical procedures include:- Uvulopalatopharyngoplasty (UPPP): This procedure involves removing excess tissue in the throat to make the airways wider. The excess tissue may be repositioned in the throat. The surgeon may trim down the uvula and soft palate, remove your tonsils and reposition some of the soft palate’s muscles. This procedure is also known as UPPP and if used alone, it is unlikely to cure severe sleep apnea. It can be combined with other surgeries that target other sites in the upper airway.
- Radiofrequency Volumetric Tissue Reduction (RFVTR): it is also known as radiofrequency ablation. This treatment option is for people with mild to moderate sleep apnea. It involves applying controlled cauterization to the tonsils, tongue, and soft palate. This shrinks and tightens the tissues in the throat.
- Septoplasty and Turbinate Reduction: These open the nasal passage to improve the air flow. Septoplasty straightens a deviated or bent nasal septum (a divider which separates the two sides of the nose). Turbinate reduction removes or reduces the curved structures that stick out from the nose’s side. These can be enlarged for various reasons such as allergies.
- Genioglossus Advancement: This procedure moves forward the major tongue attachment forward. This opens up space for breathing behind the tongue. It involves making an incision in the lower jaw and moving it slightly forward.
- Hyoid Suspension: The hyoid bone is a U-shaped bone in the neck which has the tongue, epiglottis, and other throat structure attached to it. Hyoid suspension pulls thee hyoid bone forward and secures it in pace. This enlarges the breathing space in the lower part of the throat.
- Midline glossectomy and lingual plashy: These procedures involve making the tongue smaller by removing part of the back of your tongue. This prevents blockage of the airway in people with sleep apnea. However, these procedures are not common.
- Maxillomandibular osteotomy (MMO) and advancement (MMA): This involves moving forward your upper and/or lower jaw. This enlarges the breathing space in the entire throat. This procedure is recommended for people with severe sleep apnea. It involves cutting the bones of your jaws. Your jaws may be wired shut for a few days and healing takes several months with your diet being limited for as long.
- Palatal implants: This involves inserting small fiber rods into the soft palate. This stiffens the tissue and prevents blockage of the airway. This option may be ineffective for people with mild sleep apnea or snoring.
- Bariatric surgery: This is a weight loss surgery which reduces sleep apnea. This is usually recommended for people who are obese.
- Laser-assisted valvuloplasty (LAUP): This involves making an incision using a laser to scar and tighten the soft palate. It is not commonly recommended. The uvula is trimmed over several visits.
- Tracheostomy: This option is very effective for treating sleep apnea. However, it is only used in rare cases. It involves placing a hollow breathing tube directly into your windpipe in the lower part of your neck. During the day, the tube can be plugged. This allows you t speak and breathes normally through your mouth and nose. At night, the tube is unplugged to allow you to breathe without any blockage.
- Nerve stimulation: This involves implanting a device in the upper chest. The device senses the breathing pattern and then mildly stimulates the airway muscles to keep the airway open.
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