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Surgical procedures

In certain cases, or when CPAP therapy is poorly tolerated or ineffective, various surgical procedures may be suggested by a physician or ENT specialist to correct anatomical features that contribute to upper airway obstruction. These surgeries are designed to reduce or eliminate the symptoms of obstructive sleep apnea or make CPAP therapy more tolerable.

There is still little evidence of the long-term effectiveness of these procedures in treating obstructive sleep apnea, rarely making them a first-line treatment. In some cases, CPAP therapy will still be required after surgery.

Orthognathic surgery

This procedure is used to reposition the jaws and unblock the upper airway. It involves advancing the maxilla and mandible (maxillomandibular advancement) in order to increase the pharyngeal area and facilitate airflow.

It can be performed when a patient has a significantly recessed maxilla or mandible in addition to a recessed facial profile. The maxillofacial surgeon will also assess whether to use this procedure based on the history of the disease, the patient’s motivation and a clinical examination.

According to a meta-analysis conducted by researchers at Stanford University, this surgery has a success rate of more than 85 % [1] in patients with severe sleep apnea.

Uvulopalatopharyngoplasty (UPPP)

This surgical procedure clears the airway by removing the uvula, soft tissue from the palate and back of the throat, and tonsils if present. This area of the upper airway is where the obstruction occurs in the majority of patients with sleep apnea.

By removing these vibrating tissues, UPPP helps eliminate snoring, but does not always prevent the throat from collapsing. Its success rate for treating apnea is about 40%. Widely used over the past 25 years, this procedure is increasingly being replaced by less invasive methods.

Tonsillectomy and adenoidectomy

The tonsils and adenoids are lymphatic tissues in the throat. When they are large or swollen, which happens more often in children, they can block airflow and cause obstructive sleep apnea.

In such cases, an ENT specialist may recommend removing the tonsils and/or adenoids. A tonsillectomy and an adenoidectomy are the most common procedures to treat children with obstructive sleep apnea.

Bariatric surgery

Because fatty tissue that accumulates in the neck can block the flow of air through the airway, obesity is considered one of the main risk factors for obstructive sleep apnea. In obese individuals, significant weight loss can help reduce or eliminate apnea symptoms.

If no weight loss technique works, bariatric surgery may be considered. However, this solution is reserved for severe obesity (BMI of 40 or more). Based on a review of scientific research, more than 75% of patients experienced an improvement in their sleep apnea after bariatric surgery.[2]

Sources2
  1. Holty, Jon-Erik C. and Christian Guilleminault. “Maxillomandibular advancement for the treatment of obstructive sleep apnea: A systematic review and meta-analysis,” Sleep Medicine Reviews, vol. 14, No. 5, p. 287-297, 2010. www.maxillo-facial.pro/wp-content/uploads/2017/02/STANFORD.pdf
  2. Sarkhosh, K., N.J. Switzer, M. El-Hadi et al. “The Impact of Bariatric Surgery on Obstructive Sleep Apnea: A Systematic Review,” Obesity Surgery, vol. 23, No. 3, p. 414-423, 2013. doi.org/10.1007/s11695-012-0862-2