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There are a variety of surgical approaches to treating OSA, depending on the anatomical
location of the obstruction, the severity of the OSA, and the ingenuity and experience of the surgeon.. For OSA
patients with more severe disease,, several procedures or a combination of procedures may need to be performed.
It is important that sleep studies be repeated after completion of surgical procedures to confirm effectiveness.
Nasal Surgery - A variety of procedures can be useful in selected patients with
nasal obstruction, and may be used alone or in conjunction with other procedures. A specific advantage of nasal
surgery for some OSA patients may be a reduction in the required CPAP pressure.
Somnoplasty - This is a recent advancement in surgical technology for treatment
of OSA. Delivering radio frequency energy submucosally through a partially insulated electrode, Somnoplasty reduces
tissue volume with minimal, if any, crusting or bleeding. For chronic nasal obstruction, the procedure typically
takes less than 2 minutes per turbinate.
One study demonstrated that 89% of patients were no longer using medication for nasal
obstruction at the end of 8 weeks. For OSA Somnoplasty is applied to the base of tongue creating limited zones
of coagulation beneath the tissue surface. As lesions resorb, they stiffen and reduce the tissue in the base of
tongue. A study published for OSAS/UARS reported a 55% reduction in the mean respiratory disturbance index (RDI)
from baseline for all subjects with an overall mean reduction in tongue volume of 17%. When applied exclusively
to the uvula and soft palate it is also effective in curing chronic snoring, and, like UPPP, has limited efficacy
on OSA. Whether or not somnoplasty of the tongue will be effective in OSA is currently unknown.
UPPP/LAUP - During uvulopalatalpharyngoplasty (UPPP) and laser assisted uvuloplasty
(LAUP), portions of the uvula, soft palate and posterior nasophyrynx are resected to widen the oropharyngeal airway.
Although snoring may be relieved in most cases, apnea may persist since the obstruction may be at a lower level
(base of tongue). There has been great enthusiasm for this procedure in the past, but it is difficult to predict
which patients will benefit from this procedure.
Facial Reconstructive Surgery - Many OSA patients have obvious abnormal facial
structure while in others the abnormalities may not be so apparent. Correcting and improving these anatomic factors
in OSA have been found to be effective. However such surgery is expensive and not generally available. These procedures
are usually combined with nasal airway procedures, and uvulopalatoplasty. The procedures include tongue advancement,
as well as mandibular and at times maxillary procedures (requiring extensive dental work).
Tracheostomy - Although highly successful in eliminating sleep apnea, Tracheostomy
is very invasive, both physically and psychologically. It was the main method of treating severe OSA prior to the
development of CPAP. It is currently indicated only in very severe OSA when CPAP is not tolerated.It is now extremely
rare to require tracheostomy, due to newer methods of ventilation .
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