Hypopharyngeal procedures and jaw advancement surgery are some of the surgical options available for the treatment of obstructive sleep apnea (OSA). Here is everything you need to know about these surgeries for sleep apnea and how they work to help patients with OSA.
A hypopharyngeal procedure is a surgery for sleep apnea that includes five different types of treatment: tongue radiofrequency, genioglossus advancement, tongue stabilization, partial glossectomy, and hyoid suspension. Hypopharyngeal procedures are mainly used to treat obstructive sleep apnea, and can be performed alone or in combination with palate procedures. They are generally performed under general anesthesia in the operating room.
These procedures treat the blockage of breathing that can occur in the lower part of the throat, often called the hypopharyngeal (or retroglossal or retrolingual) region, through a combination of tissue repositioning, tightening, removal, or shrinkage. Here are each of the surgeries for sleep apnea broken down into more detail.
Tongue radiofrequency involves a controlled cauterization of the tongue muscle. This creates small areas of damage in the tongue, leading to formation of a scar that shrinks the tongue slightly and makes the tongue less likely to fall back to block breathing during sleep. Most patients undergoing this treatment for sleep apnea should expect a total of 2-3 treatment sessions.
Genioglossus advancement takes advantage of the fact that the tongue is mainly muscle, with the largest being the genioglossus muscle that attaches over a relatively small area on the inside of the lower jaw. This surgery for sleep apnea involves cutting the portion of the lower jaw where the muscle attaches and pulling the small piece of bone forward to bring the anchor point of the tongue forward. This creates more room for the tongue to relax during sleep without blocking breathing.
Tongue stabilization holds the tongue in a different way. Through a skin incision on the neck, a screw is placed on the inside of the central part of the lower jaw. A stitch is attached to this screw and passed through the tongue on one side and brought back through the other side. As the stitch is tied down, it reduces the ability of the tongue to move around, especially to fall back and block breathing during sleep. There are two devices that can be used in this surgery for sleep apnea: Medtronic’s AIRvance and Siesta Medical’s Encore System that is part of the AirLift procedure.
Partial glossectomy refers to a number of surgeries for sleep apnea that involve removal of a portion of the tongue. These surgeries for sleep apnea include: midline glossectomy, submucosal lingualplasty, submucosal minimally invasive lingual excision (SMILE), and lingual tonsillectomy (often with extension of the tissue removal to include part of the tongue). These procedures for partial glossectomy are somewhat different. They involve physical removal of a portion of the tongue and are based on the observation that many patients with sleep apnea appear to have enlarged tongues, likely due not only to having more muscle mass, but also to deposition of fat within the tongue. Partial glossectomy procedures all differ in their techniques. One of the most advanced techniques is performed using a surgical robot.
Hyoid suspension is based on the fact that the hyoid bone, a U-shaped bone located in the neck above the thyroid cartilage (Adam’s apple), has attachments to muscles of the tongue, as well as other muscles and soft tissues around the throat. The hyoid bone is mobile in humans, perhaps allowing the structures that attach to it to collapse and cause airway blockage more easily during sleep. Through a neck incision, the hyoid suspension procedure secures the hyoid bone either slightly downwards to the thyroid cartilage or upwards to the lower jaw.
Jaw advancement surgery (called maxillomandibular advancement or bimaxillary advancement) involves moving the upper and lower jaws forward. It enlarges the space for breathing in the throat because the structures that surround the throat are effectively attached to the jaws. Advancing the jaws moves these structures forward, reducing their ability to produce blockage in the throat.
Jaw advancement surgery has demonstrated better results than the procedures listed above, but this treatment for sleep apnea has more substantial risks and a harder recovery. Because it is more involved than other surgeries for sleep apnea, jaw advancement surgery is usually performed only in patients who have not responded to other procedures. However, in some patients with jaw abnormalities, it can be a first-line surgical treatment for sleep apnea.
In patients with obstructive sleep apnea, this procedure is more complicated because it requires greater movement of the jaws and is technically more difficult for the surgeon. Patients considering jaw advancement surgery should consider its greater risks and more difficult recovery.
If alternative treatments for sleep apnea aren’t working for you, consult your doctor and discuss which surgeries for sleep apnea may work best for you and your symptoms. As you decide, remember to consider the intensity of each option and how that will affect the recovery process.
Author: Dr. Eric Kezirian
© 2020 American Sleep Association.