There are many surgical options to treat obstructive sleep apnea. The type of surgery that is chosen is dependent on an individual's specific anatomy and severity of sleep apnea. People often want surgery because it promises a cure with a single treatment. Surgery sounds easier than losing ten pounds and more convenient than wearing a dental appliance or mask every night. However, surgery is not the "miracle cure" either. Most surgeries are safe; however every surgery no matter how small carries risks. Most surgeries require time off from work to heal and some are quite painful for up to three weeks. Some of the potential general risks of surgery include:
- scar tissue
- loss of work
- change in voice
- problems swallowing
- failure to cure sleep apnea
- anesthesia risks (including allergic reaction, stroke, heart attack, and death)
- other unforeseen surgical complications
Surgery should be considered only after all the risks, benefits, and alternatives to surgery are understood. Some insurance companies require a three weeks trial of treatment with CPAP before they will even consider authorizing surgery for sleep apnea. This is not an unreasonable approach. CPAP, if tolerated, controls most sleep apnea, and this is better than all surgical options. It is difficult to have a serious, permanent complication using CPAP as compared to the possible of such a complication with surgery.
Any surgical treatment for sleep apnea must address the anatomic problem areas. There may be one or several areas that compromise airflow and cause apnea. Surgical treatments can address the nose, palate, tongue, jaw, neck, obesity, or several of these areas at the same time. Each surgery's success rate is determined by whether or not a specific airway collapse or obstruction is prevented. Therefore, the ideal surgery is different for each patient and depends on each patient's specific problem. Some surgical options include:
- nasal airway surgery
- palate implants
- tongue reduction
- genioglossus advancement
- hyoid suspension
- maxillomandibular procedures
- bariatric surgery
- combinations of the above
Many people have several levels of obstruction therefore these surgerical techniques frequently are performed together, for example, uvulopalatopharyngoplasty with genioglossus advancement and hyoid suspension.
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