If nonsurgical treatment fails to help you sleep through the night without interruptions in breathing, specialists at NYU Langone may recommend surgery to reduce obstructive sleep apnea and snoring. Some people may have several causes of obstruction, and more than one procedure may be necessary. A surgeon may recommend removing tissue from the soft palate or advancing or reducing the tongue.
Our doctors carefully evaluate the anatomy of your upper airway and nose before recommending any invasive procedure, ensuring that it is the most appropriate option for you.
For people with mild symptoms of obstructive sleep apnea, a surgeon may recommend a procedure to remove soft tissue in the throat, reducing the possibility of airway collapse. He or she may also recommend a procedure that involves inserting small strips of plastic into the soft palate. The scar tissue that forms as a result of surgery stiffens the walls of the upper airway, preventing the structures from collapsing while you sleep.
These procedures can be performed in a doctor’s office and do not require an overnight stay at a hospital.
During laser-assisted uvulopalatoplasty, doctors inject a local anesthetic to numb the throat, then direct a highly focused beam of light onto the uvula and parts of the soft palate. The heat of the laser quickly and precisely removes these tissues. This procedure can enlarge the space at the top of the throat, opening the airway so that you breathe more easily during sleep.
Cautery-assisted uvulopalatoplasty is similar to laser-assisted uvulopalatoplasty, except that doctors use a tiny needle with a low-voltage electric current. The electric current generates heat that removes the selected soft tissues.
A doctor may recommend Pillar® palatal implants for people with small uvulas and mild obstructive sleep apnea. In this procedure, a surgeon numbs the throat with a local anesthetic and uses a needle to implant three small stiff strips of plastic into the soft palate. Over the next two or three months, scar tissue forms around the plastic and stiffens the tissues in the soft palate, preventing them from collapsing while you sleep.
After surgery, your throat feels sore for a few days. A doctor may recommend over-the-counter or prescription medication to relieve pain.
For people with more severe obstructive sleep apnea, a surgeon may recommend a procedure that requires general anesthesia and admission to a hospital. Depending on your anatomy, a surgeon may recommend a combination of procedures.
Uvulopalatopharyngoplasty is a procedure to remove the uvula, tonsils, and parts of the soft palate. Doctors use small surgical instruments to excise the tissues blocking the airway, increasing its size and thereby improving airflow and reducing apnea episodes. In addition, scar tissue that develops as a result of the procedure can stiffen the walls of the airway and prevent the soft palate from collapsing while you sleep.
This procedure can cause discomfort, and your throat may be very sore for a few weeks. Our pain management specialists provide medication as recommended by your doctor to ensure that you are comfortable while you heal. Doctors estimate that complete recovery takes six to eight weeks.
If the tongue becomes flaccid while you sleep and collapses toward the back of the throat, it can block the upper airway. To help relieve your obstructive sleep apnea, our surgeons may recommend a procedure to make the back of the tongue smaller, advance it toward the front of the mouth, or remove a small piece of tissue along the bottom part.
A surgeon may perform tongue surgery in addition to uvulopalatopharyngoplasty if multiple structures in the airway are causing the obstructions. Your surgeon can determine whether both procedures are necessary based on the results of a physical exam.
Surgeons perform these procedures using general anesthesia. Most people remain in the hospital overnight for observation while the tongue starts to heal.
After surgery, doctors suggest a diet of very soft foods for three weeks and may prescribe pain medication to help you recover comfortably.
Nasal obstruction sometimes causes or contributes to sleep apnea. If the cause is structural—for example, if a deviated septum is obstructing the airway—doctors may recommend surgery. These procedures require no external incisions; surgeons access the nasal passages through the nostrils using small surgical instruments. The nose doesn’t look different after surgery.
Nasal surgery is performed using general anesthesia, and most procedures take about one hour. Most people return home the same day and completely recover in about a week.
In maxillomandibular advancement, surgeons reposition the upper jaw, called the maxilla, and the lower jaw, called the mandible, shifting them forward permanently. This pulls the soft tissues of the back of the tongue and the soft palate away from the throat, creating more room for air to flow.
Generally, doctors recommend this procedure only for people who have not benefited from soft palate surgery or whose anatomy suggests that soft palate surgery alone may not correct the obstructions causing sleep apnea. For example, a person with a very narrow space between the back of the tongue and the throat—called the retrolingual space—may be a candidate for maxillomandibular advancement.
Surgeons perform this procedure using general anesthesia. Most people remain in the hospital for two or three days so doctors can monitor the airway. During this time, pain management specialists ensure that you have appropriate medication to recover comfortably.
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