Each of these surgery classes can address both soft palate and tongue-based obstruction. Choosing amongst the 4 options requires consideration of each patient’s OSA severity, throat anatomy, body weight, medical problems and personal preference.
Of note, it may take more than 1 procedure to satisfactorily address OSA; thus, the above surgery classes may be performed in a staged manner.
Soft tissue surgeries involved direct manipulation of the soft palate and tongue musculature. The most common type of soft tissue surgery for OSA is uvulopalatopharyngoplasty (UPPP). A modified version of UPPP, known as expansion sphincter pharyngoplasty, has become increasingly popular (this procedure is particularly effective in patients with lateral pharyngeal wall obstruction).
If the physician/surgeon finds that there are more than one anatomical site that is obstructing, the surgeon might recommend multilevel surgery for the OSA patient (e.g. nose, palate and/or tongue surgery).
List of available soft tissue surgeries:
There exist several skeletal surgeries, each designed to address single obstruction (palate or tongue) or double-obstruction. Most commonly, maxillomandibular advancement (MMA), also known as double-jaw surgery is performed to treat double-obstruction. MMA has been shown to be effective in treating OSA. Given the significant recovery time, however, MMA is reserved for motivated patients with limited health problems.
Other skeletal surgeries:
Nerve stimulation therapy represents the most recent advancement in sleep surgery. This therapy works by delivering electrical stimulation to the nerve which controls tongue movement (hypoglossal nerve). In essence, electrical stimulation of the tongue prevents falling back of the tongue and soft palate into the airway. Thus, this treatment is designed to treat double-obstruction.
Inspire® is a type of nerve stimulator which is synchronized to the respiratory cycle via a respiratory sensor lead. Currently, Inspire® is commercially available in both the United States and Europe. ImThera® is another nerve stimulator but does not include a respiratory sensing lead. It is commercially available in several European countries as well as Colombia.
Tracheostomy can be performed as a means of bypassing the upper airway. Tracheostomy is generally highly effective in treating OSA. The main drawbacks of the surgery are aesthetic concerns, maintenance of the stoma (neck opening) and lifestyle change (not able to participate in activities involving submersion in water such as swimming).