Sleep Education
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Obstructive Sleep Apnea in Children
Obstructive Sleep Apnea

What is it?

Surgery may be used to help someone with obstructive sleep apnea. The most common options reduce or eliminate the tissue in your throat. This tissue collapses and blocks your airway during sleep.

These surgeries focus on one or more of the following three areas:

  1. The soft palate
  2. The uvula, tonsils and adenoids
  3. The tongue

More complex surgery can be performed to adjust other bone structures. These include the mouth, nose and facial bones.

Surgical procedures that may be used to treat obstructive sleep apnea include:

  1. Maxillomandibular osteotomy (MMO) and advancement (MMA)

Cuts are made into the bones of the jaw. The upper and lower jaws are pulled forward and soft tissue is tightened. This enlarges the entire upper airway. An overnight hospital stay is required. The jaws may be wired shut for several weeks.

  1. Anterior Inferior Mandibular osteotomy (AIMO) with hyoid suspension

The chin bone is divided to pull forward the tongue. The hyoid bone (U-shaped bone in the back of the neck) is also adjusted. The jaws do not have to be wired shut, and there is no change in bite. It is not as effective as MMA.

  1. Uvulopalatopharyngoplasty (UPPP)

The soft palate is trimmed down in size. The tonsils and uvula may also be removed.

  1. Laser-assisted uvuloplasty (LAUP)

Cuts are made to scar and tighten the soft palate. The uvula is trimmed over a period of several visits. It is not as effective as UPPP and is usually done for snoring, not sleep apnea. It is less painful and has fewer side effects than UPPP.

  1. Radiofrequency Volumetric Tissue Reduction (RFVTR)

This may also be called somnoplasty. Energy waves are used to shrink the soft palate and tongue base. This energy is much like a microwave.

  1. Laser midline glossectomy (LMG) and lingualplasty:

These two procedures are rarely performed. They enlarge the airway by removing part of the back half of the tongue.

  1. Septoplasty and Turbinate Reduction

Both of these options are used to open the nasal passage. Septoplasty straightens a bent septum that is blocking the flow of air. The septum is the bony divider between the two nostrils.

Turbinate reduction reduces or removes large turbinates and polyps. Turbinates are curved bones along the wall of the nasal passage. Polyps are growths of tissue that stick out from the mucous lining of the nose.

  1. Tracheostomy

An opening is cut into the windpipe in your neck. A hollow tube is inserted to keep the hole open. The patient breathes through the tube. This bypasses the entire upper airway. It is the most effective procedure. But, it is also the most drastic. It is rarely used to treat obstructive sleep apnea. It is only used in emergency situations.

  1. Cervicofacial liposuction

Extra fatty tissue is removed below the chin and at the back of the neck. This reduces the weight pressing against the soft tissue of the throat. It also helps lessen airway collapse behind the base of the tongue.

  1. Gastric bypass

This form of bariatric surgery may be used as a last resort for people who cannot overcome obesity. It reduces the size of the stomach. This forces the patient to eat less.

Who gets it?

These surgeries are used to help some people who suffer from sleep apnea. There are better options that should be considered first. Some people find relief through lifestyle or behavior changes that include the following:

  • Weight loss
  • Change of sleep position
  • Medication to relieve nasal obstruction
  • Avoidance of alcohol in the evening

The most common treatment that is used for most people with obstructive sleep apnea is CPAP. This stands for continuous positive airway pressure. It is delivered through a mask worn over the nose. The air gently blows into the back of the throat. This keeps the airway open so you are able to keep breathing as you sleep.

Another option is to wear an oral appliance while you sleep. It is used to move the jaw forward or hold the mouth open. It is usually made of soft plastic and fits over your teeth like a sports mouth guard.

For some patients, these options will not work. In these cases, surgery may be the best and only choice. These patients have a physical abnormality that is blocking their airway. The surgery will be “site-specific” and will seek to eliminate the cause of the obstruction.

Possible side effects?

There is no guarantee that surgery will end sleep apnea. More than one operation may be needed to correct the problem. Negative aspects of a surgery can include the following:

  • Overnight hospital stay
  • Pain
  • Having the jaws wired shut for several weeks
  • Throat swelling

The result of a surgery also may not be permanent. For some surgical patients, the sleep apnea problem may reoccur at a later time. You will need to follow-up with a doctor for a long time after the surgery. Consult with a sleep specialist and either an Ear, Nose and Throat surgeon or a dental surgeon to find out if this is the best option for you.

Reviewed by Norman J. Wilder, MD
Updated on May 11, 2006

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