Sleep Surgery & Sleep Apnea

Serving Albany, Saratoga Springs, Schenectady, and Troy, New York

Overview

If you or someone you know has a problem with snoring, then you can appreciate just how troubling a condition this can be. The nuisance aspect of snoring can disturb an entire households’ sleep routines and put tremendous strain on relationships. Snoring can also be the first sign of sleep apnea, a serious sleep condition characterized by frank sleep pauses or apneic episodes. The public is becoming increasingly more aware of the health risks associated with untreated sleep apnea including fatigue, heart attack and stroke. Sleep Apnea Surgeon, Dr Falk’s interest in the treatments of snoring and sleep apnea is an outgrowth of the integration of his training in Otolaryngology and Craniofacial surgery. This combination provides an in-depth appreciation of the anatomy and physiology of the upper airway, and the surgical skills necessary to treat minor snoring through to advanced jaw surgery.

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Sleep Apnea Diagnosis

Our approach to the workup of sleep related disorders includes a thorough history taking, comprehensive head and neck exam, and utilization of overnight sleep studies. The overnight sleep study is performed at a sleep lab. During an overnight study, many aspects of sleep physiology are monitored to give a comprehensive profile of your sleep related health risks and to inform treatment.

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Sleep Apnea Treatment

Obstructive breathing disorders are the result of transient collapse or narrowing of the breathing space anywhere along the path from the nose to the throat. When the passage becomes narrowed you snore, and if they become blocked completely you have sleep apnea. In any individual, there can be more than one area of obstruction. The principal sites of obstruction are the nasal cavity, soft palate and base of tongue.

Treatment for obstructive sleep disorders are varied and included both medical devices such as positive pressure devices (CPAP), dental appliances, and surgical interventions. Surgical treatments are generally reserved for individuals who have failed other methods of management or because of lifestyle preferences they would like to be less dependent on external devices. The surgical approach is dictated by the severity of the condition and the specific location of the obstruction.

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Nasal Surgery

Anatomic problems in the nose can obstruct air flow and contribute to sleep disorders. The nasal septum is the anatomic structure that divides the nose in half. A crooked septum (deviated) contributes to nasal airflow obstruction. Septoplasty is the technical name for surgery to correct this problem. Nasal turbinates are specialized fins on the side of the nose that contribute to the humidification of air and regulation of nasal air flow. Swollen turbinates are another common problem that can result in obstructed nasal breathing. Turbinate hypertrophy can be treated in a variety of ways including office based radiofrequency volume reduction (somnoplasty) or operative turbinate resection.

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Soft Palate Surgery

The goal of most surgical procedures for the treatment of sleep apnea is to widen the upper airway. This is accomplished by removing or reducing redundant soft tissue at the site where the mouth meets the throat. Structures in this area that may be modified or removed include the soft palate, uvula and tonsils. There are many procedures that can be performed on the soft palate, and the decision as to which method to choose is dependent on the degree of obstruction.

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Uvulopharyngopalatoplasty (UPPP)

UPPP is the most common procedure performed for the treatment of obstructive sleep apnea. This is a procedure that is done in the operating room, and involves removal of a portion of the uvula and trimming back the soft palate to expand the oral airway. The tonsils are commonly removed during this procedure as well.

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LAUP (laser assisted uvulopalatoplasty)

LAUP is an office-based procedure where the doctor uses a laser to remove a portion of the soft palate and part of the uvula. This is to be done over a series of session in the doctor office.

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RFT (radiofrequency treatment of the palate)/Somnoplasty

An excessively floppy or redundant soft palate can contribute to snoring. There are several procedures currently used to stiffen the palate without needing to remove or resect tissue. Radiofrequency soft palate reduction (Somnoplasty) is an office based treatment, performed with local anesthesia, whereby a small needle is inserted into the musculature of the soft palate to cause a controlled injury that heals in a manner to create soft palate tightening.

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Pillar Procedure

The pillar procedure involves insertion of small woven cords of suture like material under the surface lining of the palate. Over time, scar tissue forms around the implant resulting in stiffening of the palate which reduces the vibration that give rise to snoring. This is an office base procedure done with local anesthesia.

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Base of Tongue Reduction

The area at the base of the tongue is another common region of obstruction in sleep apnea. The tongue base can crowd the airway and fall backwards when sleeping to create blockage. Volumetric reduction of the base of tongue is accomplished in several ways. Radiofrequency reduction using a needle inserted into the deep muscles of the tongue is one option. Additionally, direct removal of a portion of the tongue and associated tissue can be done with either a laser or cutary device.

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Jaw Surgery

Conventional surgery for sleep apnea consists of soft palate reduction (uvulopharyngopalatoplasty), straightening of a deviated nasal septum (septoplasty) and shrinking of enlarged nasal turbinates. However, there is considerable frustration with these approaches, because for many moderate to severe apneics, these procedures are not curative. Individuals whose condition is not improved by these methods, and for whom positive airway pressure masks are not tolerated, are left with few options. One possibility is a permanent surgical airway, or tracheotomy, but most find this unacceptable. Alternatively, facial skeletal surgery to increase the size of the upper airway space may be a solution.

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Genioglossal Advancement

Genioglossal advancement is a procedure whereby a small bone window is made in the front of the mandible at the point of attachment of the tongue musculature (genioglossal muscle). The small bone segment is advanced which accomplishes the goal of suspending the tongue in a more forward position. This results in widening of the space behind the tongue, addressing this very important area for obstruction.

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Thyrohyoid Suspension

Thyrohyoid suspension is a procedure whereby the hyoid bone, which is a key anatomic structure in the neck that aids in supporting and elevating structures of the throat, is brought forward and secured to the thyroid cartilage. The effect of this maneuver is to enlarge the upper airway space. This procedure is often done in combination with genioglossal advancement surgery.

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Maxillomandibular Advancement

Maxillomandibular advancement surgery is the most aggressive procedure performed to treat the most severe cases of obstructive sleep apnea. In this operation, the upper and lower jaw segments are mobilized and advanced as a unit to create a substantial increase in size of the upper airway space. This procedure effects multiple levels of the airway including the soft palate and tongue base. In most instances, the alignment of the teeth is unchanged.

More information is available on these procedures through our office. The appropriateness of these interventions for your specific condition is reviewed at the time of consultation.

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If you want to learn more about what The Center for Facial Plastic Surgery and Laser Skin Care of North Eastern New York can offer you, please take a look at our website and contact our Albany sleep surgery office today to schedule a consultation.