Sleep Apnea Surgery- Ear Nose And Throat (ENT)

What is sleep apnea?

Sleep apnea is a type of sleep disturbance that has negative health outcomes. It makes your breathing occasionally stop while you're sleeping. This is identified with the relaxation of the muscles in your throat during sleep. Whenever you stop breathing, your body awakens, making you miss out on quality sleep.

What are the different procedures?

There are numerous surgical procedures for treating sleep apnea, and they depend upon how extreme your sleep apnea is and your general health condition.

Radiofrequency volumetric tissue reduction

If for some reason, you are not able to wear a breathing device like a continuous positive airway pressure (CPAP) machine, the doctor may recommend radiofrequency volumetric tissue reduction (RFVTR), a procedure that can shrink or remove the tissues at the back of the throat to open up your airway.

Uvulopalatopharyngoplasty

This is one of the most well-known surgical procedures for treating sleep apnea, yet not really the most effective. It includes removing extra tissue from the highest point of your throat and the back of your mouth. Like a RFVTR, it's generally done if you can't utilize a CPAP machine or other device, and will be utilized as a snoring treatment.

Maxillomandibular advancement

This method is also known as jaw repositioning. It includes pushing your jaw forward to have more space behind the tongue. This can open up the airway.

Anterior inferior mandibular osteotomy

This surgical procedure partitions your chin bone into two sections, enabling your tongue to push forward. This opens up your airway while setting your jaw and mouth.

Genioglossus advancement

This procedure works by marginally fixing the tendons in the front of your tongue. This can keep your tongue from rolling back and disturbing your breathing. It's generally done along with other procedures.

Midline glossectomy and base of tongue reduction

This kind of procedure includes removing a bit of the back of your tongue. This increases your airway. Studies show that it is 60 percent more effective than the other procedures.

Lingual tonsillectomy

This method removes both your tonsils and tonsillar tissue close to the back of your tongue. This may be done to open to up the lower portion of your throat for easier breathing.

Septoplasty and turbinate reduction

Septoplasty includes straightening your bent nasal septum, which can fix your nasal cavities, making it easier to breath. A turbinate reduction includes lessening the size of the turbinates to open up the airways.

Hypoglossal nerve stimulator

This method involves joining an electrode to the nerve that controls the tongue, called the hypoglossal nerve. The electrode is associated with a device that is like a pacemaker. When you stop breathing, it stimulates the muscles of your tongue to keep them from obstructing your airway.

Hyoid suspension

If your sleep apnea is caused by an obstruction close to the base of your tongue, your doctor may propose a procedure called a hyoid suspension. This includes moving the hyoid bone and its adjacent muscles in your neck nearer to the front of your neck to open up your airways.

Why Is Sleep Apnea Surgery Required?

After some time, sleep apnea can build your risk of having hypertension, metabolic problems, and other medical issues, so it's essential to treat it. If medications don't help, you may require a surgical procedure.

Which Doctor to Consult?

It is essential to consult a surgeon with sleep surgery experience. Converse with an ENT doctor for a complete assessment, and to know what treatment might be best for you. Sleep apnea can improve your health and quality of life significantly, and you can talk about your issues with your ENT doctor.

What to expect during the procedure?

Screening patients before surgery is important. Patients often fill up a sleep apnea survey, which enables doctors to figure out who is at high risk. To avoid complications after a medical procedure, it's important that you answer the questions honestly.

Depending on your answers, you may need to undergo a sleep study. Sleep apnea is diagnosed with a sleep history and an overnight sleep study test known as a polysomnogram. The test is usually performed in a sleep laboratory under the supervision of a technologist, though it may also be done at home.

Preparing for surgery if you have sleep apnea

If you have sleep apnea, there are a few things you can do to get ready for your surgical procedure that will diminish your risk for complications after surgery. According to doctors, when the diagnosis of sleep apnea is made, treatment for sleep apnea should be done prior to surgery. The gold standard treatment for sleep apnea is positive airway pressure (PAP). Continuous positive airway pressure (CPAP) involves wearing a mask over the nose and mouth while sleeping.

During and after surgery

During the surgery, medical personnel will monitor your vital signs until after the procedure. You will continue to receive PAP after your surgery, while in the recovery area.

Post-operative care

After the surgery, aside from monitoring your vital signs and continuing PAP treatment, the medical staff will monitor for signs of obstruction and difficulty of breathing. Supplemental oxygen is given to patients until they can maintain their baseline oxygen levels on room air. 

Complications

Patients with sleep apnea who are undergoing any surgical procedure are at an increased risk for having respiratory and cardiovascular complications in the period following surgery.

Complications may include irregularities in heart rhythms, oxygen inadequacy, hypertension, diabetes, stroke, and heart attacks. It is best that you ask your doctor about possible complications so that you can prepare well for your surgery.

References

• Surgery for Sleep Apnea: Procedures, Success Rate, and Risks. Healthline. https://www.healthline.com/health/surgery-for-sleep-apnea#procedures. Published 2019. Accessed January 10, 2019.
• ENT Health. https://www.enthealth.org/be_ent_smart/surgery-for-obstructive-sleep-apnea/. Published 2019. Accessed January 10, 2019.
• Scheduled for Surgery? Here’s Why You Need Sleep Apnea Screening. Health Essentials from Cleveland Clinic. https://health.clevelandclinic.org/scheduled-for-surgery-heres-why-you-need-sleep-apnea-screening/. Published 2019. Accessed January 10, 2019.

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