This pamphlet has been designed as an educational resource for patients with Obstructive Sleep Apnea (OSA). The successful use of CPAP requires no further intervention; however, not every patient is able, interested or motivated to use CPAP as prescribed. Certain patients find the side effects of CPAP therapy to be intolerable. For others, the thought of wearing CPAP is not ideal. The treatment concept is to relieve the obstruction to breathing that can occur from the tip of the nose down to the entrance of the voice box. Surgery can successfully conclude the symptoms of Obstructive Sleep Apnea and produce freedom from CPAP, especially for mild to moderate disease severity. This overview is designed to help you and your physician to make a more informed decision about the role that surgery might play in the treatment of your Obstructive Sleep Apnea. Wayne B. Colin, DMD, MD Otolaryngology/ENT 1
Tonsillectomy and UPPP The tonsillectomy and uvulo-palatopharyngoplasty (UPPP) are often performed to relieve airway blockage in the throat. The tonsillectomy can be an important component of surgery for OSA, especially if the tonsils are enlarged. before Before Narrow Breathing Passage AIR FLOW The removal of redundant tissue by tonsillectomy increases the caliber of throat, thereby reducing blockage to breathing. Partial removal of the uvula with forward repositioning, tightening and shortening the soft palate makes for a larger breathing passage. Most patients who snore, but do not have OSA should enjoy a reduction in snoring intensity after UPPP. Nasal, Septal and Adenoid Surgery are performed in order to open the nasal breathing passage. Unfavorable tissue quality around the nostrils or deeper in the nose can cause restricted breathing. Weak or malpositioned cartilage 2
around the nostrils, deviation of the nasal septum, swelling of the turbinates (natural ridges in the nose) or enlargement of the adenoid can impede nasal airflow and are surgically correctable. after After Widely Open Breathing Passage AIR FLOW Dr. Wayne Colin performs corrective surgery. For more information or to watch an informational video on surgical treatment for obstructive sleep apnea, please visit osasurgery.com. 3
Genio-Glossus Advancement The Genio-Glossus Advancement (GGA) is a procedure that was developed for the treatment of Obstructive Sleep Apnea. This operation is designed to open the upper breathing passage at the tongue base. The procedure is done through the mouth by an incision below the gum tissue in front of the lower teeth. After creating a small rectangular bone window, the tendons that BEFORE Before AIR FLOW Narrow airway at base of tongue Tongue tendon attachment to inner surface lower jaw 4
attach the front of the tongue to the jaw are pulled forward on a small bone fragment. This produces a larger space between the back of the tongue and the throat to create a wider airway. There is no alteration in facial appearance. This procedure is often performed with at least one other procedure. After After AIR FLOW Wider airway at base of tongue Bone fragment with attached tongue tendon pulled through lower jaw 5
Hyoid Suspension The Hyoid Suspension is a procedure specific for the treatment of Obstructive Sleep Apnea. The operation advances the tongue base and epiglottis forward by repositioning the hyoid bone to open the breathing passage at this level. The procedure is done through a before Before AIR FLOW Narrow airway at base of tongue Epiglottis Trachea (Windpipe) 2008 Hyoid Bone Thyroid Cartilage (Adam s Apple) 6
small horizontal incision in a convenient skin crease in the upper neck. The hyoid bone, above the Adam s apple, (called the thyroid cartilage) can be advanced and secured over the thyroid cartilage. Since the vocal cords are not manipulated, the voice should remain unimpaired. after After AIR FLOW Wider airway at base of tongue and Epiglottis 2008 Hyoid Bone repositioned and sutured over Thyroid Cartilage 7
MaxilloMandibular Advancement Maxillomandibular Advancement (MMA), or double jaw advancement is a procedure whereby the upper and lower jaws are surgically moved forward (Lefort 1 osteotomy of the maxilla and sagittal split advancement of the mandible). The concept is that as the bones are surgically advanced the soft tissues of the palate and tongue are also moved forward. The usual movement is about a half an inch. Since the upper and lower teeth are moved the same amount, the bite would be similar before and after the operation. BEFORE Before Narrow airway at base of tongue prior to jaw surgery 2008 8
The MMA will always alter and often enhance appearance but is not disfiguring. The operation is accomplished through the mouth. The jaws may be briefly wired closed following the operation. The procedure is technically involved with the potential for complications as in any surgical procedure, but most patients recover remarkably well. For some individuals, MMA is the only technique that can adequately create the necessary air passageway to resolve OSA with finality. AFTER After Airway enlarged after jaw advancement 2008 9
Tracheotomy A Tracheotomy is one of the oldest, most shunned, and least understood procedures for Obstructive Sleep Apnea. The concept with this procedure is that any area of blockage to breathing, from the nose to the voice box is bypassed by a hole placed into the windpipe. The hole in the trachea is maintained by insertion of a tube. The tracheotomy tube must be kept exquisitely clean; otherwise painful infections of the hole will occur, or the tube and/or windpipe could become blocked with secretions. Typically a tracheotomy for OSA does not prevent a patient from being able to talk or eat. tracheotomy Blockage of airway 2008 Tracheotomy tube 10
Conclusion Surgery or CPAP can treat Obstructive Sleep Apnea equally well. Indeed a successful surgical outcome will show relatively normalized sleep cycles, control of respiratory obstructions and a rise in oxygen levels, equivalent to the results obtained by CPAP. Patients who complete a full course of surgical therapy can anticipate a greater than 95% chance of success and bypass the need for long-term CPAP therapy. The surgical plan is designed to relieve the obstruction to breathing typically seen within the nose, behind the palate or behind the tongue. The type of surgery that is recommended is specifically tailored to each patient s situation. Hopefully this information will allow a more educated decision about treatment options for Obstructive Sleep Apnea. 11
Red Mile Road Lexington Clinic South Broadway 1221 South Broadway Lexington, KY 40504 Gay Brewer, Jr. Golf Course Gibson Avenue South Broadway Mason Headley Road Parkway Drive Lexington Clinic American Avenue Burley Avenue Campbell House Legion Drive Bob-O-Link Drive Shaker Drive Harrodsburg Road Saint Joseph Office Park Bob-O-Link Drive Saint Joseph Hospital Waller Avenue Elaine Drive Man O War Place Lexington Clinic Otolaryngology/ENT Department 1221 South Broadway, 3rd Floor Lexington, KY 40504 859.258.4000 If you d like further information about OSA, Obstructive Sleep Apnea or would like to schedule an appointment, please contact Lexington Clinic Otolaryngology/ENT at: 859.258.4000 or toll-free at 800.565.6841. 12
Lexington Clinic Otolaryngology/ENT 1221 South Broadway Lexington, KY 40504 859.258.4DOC (4362) osasurgery.com