If you suffer from sleep apnea and are considering surgery, you have several options. These include UPPP, MMA, Hypoglossal nerve stimulation (HGNS) and Tongue base reduction. Before you decide which type of surgery is right for you, make sure you know the risks and benefits.
UPPP
While the UPPP procedure can improve the symptoms of sleep apnea, it is not for everyone. While approximately half of patients see a noticeable improvement in their symptoms following the surgery, the benefits often fade after a few months. Some people with severe cases may need to undergo additional treatments.
This procedure involves the removal of the tonsils and uvula and reshaping the soft palate and uvula to improve the airway. Sutures are then placed to hold the soft palate in place and open the airway. Most patients spend one night in the hospital following the procedure. They will be given pain medications and steroid medications to reduce swelling. They may also be prescribed antibiotics. Afterwards, patients should stay hydrated by drinking lots of water. Flavored sports drinks are also recommended. For the first two weeks, patients should only eat soft foods.
A significant percentage of patients with a pre-UPPP AHI of 30 or less achieved a postoperative AHI of five or less. These patients were more likely to be successful than those with an AHI greater than thirty. A comparison of patients with and without UPPP surgery showed that the procedure had a significant effect on the severity of sleep apnea.
UPPP surgery is an alternative to continuous positive airway pressure therapy (CPAP). It involves the removal of excess tissue in the mouth or throat. The surgical procedure is known as uvulopalatopharyngoglossoplasty and requires general anesthesia. The surgeon will then remove the tonsils and uvula. In some cases, the surgeon will also remove the soft palate. The patient will need to recover from the procedure and may spend a short hospital stay.
Although UPPP can effectively treat apnea, it is not a cure. The surgery has several risks, including the risk of complications, including early postoperative complications. Patients undergoing UPPP may experience transient velopharyngeal insufficiency (TVI), which is a common side effect of the procedure. Some patients may also experience acute bleeding or nasal regurgitation after undergoing the procedure.
The UPPP can be combined with other procedures for the treatment of sleep apnea. Because the area in which the surgery is performed is so sensitive, the patient will be under general anesthesia. Some patients may also experience sore throats, and problems with swallowing and speech. Some medicines used to relieve pain may lead to sleepiness and other side effects.
MMA
Patients with moderate-severe OSA may benefit from maxillomandibular advancement (MMA) surgery. This surgical procedure is a relatively new treatment option that is used to improve sleep quality for patients with moderate to severe OSA. It has a good safety record and results in predictable reductions in AHI and diastolic blood pressure, along with improved subjective sleepiness and quality of life. It is an ideal treatment option for patients who have failed to achieve improvement through CPAP therapy.
MMA for sleep apne surgery improves sleep quality and sleepiness, improves QOL, and lowers blood pressure. Compared to traditional surgical treatments, MMA is associated with a low rate of major complications and has low rates of adverse events. Despite these disadvantages, patients who undergo MMA often experience only minimal pain and discomfort after surgery, and are typically discharged within a few days.
Before choosing MMA for sleep apneia, patients must undergo a thorough physical exam and a sleep study. Both tests should be performed by a physician. The patient should have a baseline AHI of at least 53 events per hour (AHI) to be considered a good candidate for the procedure. MMA is an effective treatment for patients with moderate-severe OSA who have failed to respond to CPAP.
This study used a focus medical records query to identify patients who underwent MMA for sleep apne surgery and had long-term follow-up evaluations. At long-term evaluation, the mean ODI3 for these patients was 9.7 events/h. This translates to a mean reduction of 9% from preoperative to postoperative FOSQ scores. Despite this decrease, the majority of patients had an ODI3 of five events per hour or higher, and 80.8% achieved or exceeded 15 events/hour.
Patients who had undergone MMA for sleep apneoa surgery have reported fewer symptoms than patients with conventional treatment. Some reported minor pain in the chin and lips. Some also reported jaw movement or popping or clicking of the jaw joints. The patients were also asked to rate their symptoms on a 7-point Likert scale.
The results from the study are promising and confirm the safety of this surgery. Although it is highly invasive, it can improve AHI and reduce the duration of sleep apnea episodes. It is also a permanent solution for OSA patients. However, it requires skilled surgeons, multidisciplinary approaches, and frequent follow-ups.
Hypoglossal nerve stimulation (HGNS)
A recent review has examined the effects of hypoglossal nerve stimulation (HGNS), a surgical procedure that involves electrical stimulation of the hypoglossal ganglion. The therapy works by activating the tongue muscles, thereby opening the upper airway. However, questions about the effectiveness of this procedure, patient selection, and potential health benefits remain. An expert research panel reviewed the current research and the unanswered questions. In addition, they discussed individual and anatomical factors that may affect the effectiveness of hypoglossal nerve stimulation.
HGNS is an important treatment option for patients suffering from obstructive sleep apnea. It is an alternative to continuous positive airway pressure therapy. It works by electrically stimulating the hypoglossal nerve to cause timed tongue movements, which relieve upper airway obstruction during sleep. Currently, 50% of patients who have undergone this therapy report a positive effect on their health and well-being.
Despite the positive results of clinical trials, uncertainties about the technique, proper patient selection, and reporting of results continue to hamper this therapy. As of today, it is recommended for patients with moderate to severe OSA. However, there is a need for further research to determine its optimal indication. For example, better understanding of airway anatomy could increase the effectiveness of the therapy. Additionally, the understanding of obstructive sleep phenotypes could expand its indications.
One clinical trial involving 126 participants showed that HGNS is effective for treating obstructive sleep apnea. The results were positive in 83 of the 126 patients, and the average AHI reduction was 20 events per hour. However, the study’s failures involved patients who had high AHI levels or had structural collapse. Therefore, patients with elevated AHI should be counseled regarding the expected benefits of this therapy and the need for additional OSA therapy.
In this sleep apnea treatment, electrodes are implanted on the hypoglossal nerve, which provides motor control to the tongue muscles. It also helps with swallowing.
Tongue base reduction
A doctor can use a special tool called a coblation probe to reduce the base of the tongue to reduce the obstruction that is causing sleep apnea. This procedure is performed under local anesthesia. The surgeon inserts the probe into multiple points in the base of the tongue. The radiofrequency energy causes the tongue base to contract and shrink, resulting in the reduction of the obstruction. Afterward, the doctor will remove the tongue base with a catheter.
While the tongue may not be as important as the palate or the tonsils, it does play a role in obstructing the airway during sleep. The enlarged base of the tongue is the result of a lymphatic tissue lining the base of the tongue. Surgical removal of this tissue may provide additional obstruction relief. Additionally, it may increase the overall surgical success. This procedure is usually done in conjunction with other procedures to address the tonsils and palate.
The procedure has a high success rate. In a study, a single stage surgery for tongue base reduction and UPPP is successful for patients with Fujita type III collapse. The patients who had successful surgery reported an increase in total sleep time and sleep efficiency.
Another procedure to reduce the tongue base is the Transoral Robotic Surgery (TORS). This method utilizes coblation technology to remove the tongue base. This procedure is gaining popularity as an effective treatment for sleep apnea. The TORS approach may include both tongue base reduction and supraglottoplasty.
Tongue base reduction surgery can help patients who cannot tolerate CPAP due to their large tongue base. It also helps enlarge the airway and allows the tongue to relax during sleep. However, tongue base reduction surgery is not the best option for everyone. It is not recommended for people with OSA.