Surgical Correction of Sleep Apnea (OSAS)

 

West Houston ENT and Sleep Center offers the latest techniques in the surgical correction of Obstructive Sleep Apnea to help relieve your symptoms.  This includes minimally invasive tongue suturing techniques that allow for a more rapid return to work.  These are non-ablative and reversible procedures.

Working closely with our oral maxillofacial surgeon colleagues, we offer a customized surgical treatment plan ranging from simple palatal implants to complete maxillomandibular advancement procedures.  Not all surgeries are appropriate for every patient.  Choosing the right procedure combination makes the difference between treatment success and failure. 

 

Nasal Surgeries

Because nasal obstruction can exacerbate Sleep Apnea, it is important to address any difficulties you may have breathing through your nose.  Patients commonly live with chronic nasal obstruction for years and come to accept it as a normal way of life.  Fortunately, simple office-based procedures can often give marked improvements in nasal airflow.  A thorough nasal evaluation is included in every consultation.

Nasal surgery options include:

• Turbinate Reduction
• Septoplasty, and
• Adenoidectomy for children and adolescents

 

 

Palate Procedures

Upper airway obstruction can occur at the level of the soft palate.  If it is determined this is an area of obstruction in your airway during sleep, there are two main procedures available to address the retropalatal obstruction:   The PILLAR Procedure, and Uvulopalatopharyngoplasty (UPPP) with tonsillectomy. UPPP surgery effectively shortens and stiffens the palate to help relieve retropalatal obstruction and eliminate snoring.  If you still have your tonsils, the procedure is always combined with a tonsillectomy. 

The normal procedure time for a UPPP surgery is 45 minutes in an operating room suite.  Recovery time is six weeks to completely heal, and you can usually return to work in one week. Post-operative pain is moderate but less if you had a prior tonsillectomy, and the procedure is normally covered by insurance. 

 

Base of Tongue Procedures

Procedures developed to improve the retrolingual airway are aimed at reducing the size of the tongue, supporting the tongue during its relaxed state, or advancing the tongue position away from the back of the throat.  These procedures are often done in combination to maximize patient outcomes.
Base of Tongue procedures include:

Tongue Base Reduction:

• Radiofrequency (RF) Tongue Base Reduction - By using high frequency radio waves to heat the deep muscle at the base of the tongue, RF ablation reduces tongue base volume through scarring.  This procedure is minimally invasive requiring no incisions.  It is usually performed in conjunction with other sleep surgery techniques. The procedure takes approximately 15 minutes in the operating suite and recovery time is six weeks to completely heal. Post-operative pain is moderate and the procedure is normally covered by insurance.
• Coblation Tongue Base Reduction - Plasma technology is applied to the tongue base in this technique to reduce its size.  A special wand is used to make several tunnels into the tongue base, removing deep tongue muscle and creating surrounding channels of thermal injury.  During healing, the tongue base contracts through scar formation increasing the size of the airway. The procedure takes approximately 15 minutes in the operating suite and recovery time is six weeks to completely heal. Post-operative pain is moderate and the procedure is normally covered by insurance.
• Partial Midline Glossectomy - Applying the same plasma technology used in tonsillectomies, the mid-portion of the tongue base is removed.  This directly decreases the size of the tongue base and improves the posterior airway space. The procedure takes approximately 45 - 90 minutes in the operating suite and recovery time is six weeks to completely heal. Post-operative pain is similar to that of a tonsillectomy (moderate) and the procedure is normally covered by insurance.
  
• Lingual Tonsillectomy - Lingual tonsils (also known as tongue tonsils) live at the base of our tongue and can become large just as the more well-known pharyngeal tonsils; those tonsils we can see in the mirror in the back of our throat.   Using Coblation, a technology incorporating plasma formed in a saline bath, this tissue can be removed with minimal post-operative pain.  Removing obstructing lingual tonsil tissue can have large impacts on the severity of Sleep Apnea in select patients. The procedure takes approximately 45 - 90 minutes in the operating suite and recovery time is six weeks to completely heal. Patients usually return to work in under a week.  Post-operative pain is moderate and the procedure is normally covered by insurance

Tongue Base Suspension
Tongue Base suspension is a minimally invasive suturing technique that helps support the tongue with a permanent suture.  As the tongue relaxes during sleep, gravity tends to pull the tongue backwards into the throat, causing obstruction and narrowing of the airway.  The suture acts as a hammock supporting the tongue during sleep.  The suture cannot be felt and does not limit normal tongue motion while awake. The procedure takes approximately 45 minutes in the operating suite and recovery time is three weeks to completely heal. Post-operative pain is mild and the procedure is normally covered by insurance.

 

Hyoid Suspension

The hyoid bone is a floating bone above the voice box and below the chin.  The bone sits in front of the base of the tongue and has attachments to the tongue.  Hyoid suspension is a suturing technique that helps bring the tongue away from the back wall of the throat by pulling the hyoid bone in a forward direction. The procedure takes approximately 60 minutes in the operating suite and recovery time is three weeks to completely heal. Post-operative pain is mild to moderate and the procedure is normally covered by insurance.

 

Craniofacial Surgery

We work closely with oral maxillofacial surgeons who specialize in orthognathic surgery for the treatment of Obstructive Sleep Apnea. This provides you with every available tool to surgically treat and cure your OSAS.

Craniofacial/Orthognathic Surgery includes:

• Genioglossus advancement
• Sliding Genioplasty
• Maxillomandibular advancement
  

 

These are more aggressive surgeries performed to increase the posterior airway space.  They are often combined with UPPP, hyoid suspension, and base of tongue procedures to provide maximum results.

If you feel you require a surgical solution to solve your breathing problems, we encourage you to be evaluated by Dr. Ludwick today. You can also Request an appointment online.