Lower Airway Surgery
In many patients, the part of the airway just above the level of the vocal cords, and near the very back of the tongue can be the main cause of airway collapse, leading to airway obstruction. Often, blockage of the airway at this level is caused by tongue base collapse, the structure of the lower airway, and collapse of a small cartilage flap, called the epiglottis, which is a normal structure that helps to protect the airway when swallowing food, preventing aspiration of liquids/foods into the lungs.
There are several surgeries that Dr. Phillips performs to help support the lower airway at this level. Evaluation with a sleep endoscopy is usually performed to help diagnose obstruction of the airway at this level.
Two small incisions are made externally in the neck, each about 1-2cm each, one just under the chin, and one near where the neck and chin meet. Permanent sutures are passed around the hyoid bone, and tethered to a very small screw that is anchored into the inside of the jaw, so it is not able to be seen. In some cases, the tongue can also be suspended forward with a small additional suture to this same area. This surgery is very well tolerated, performed under general anesthesia, and few patients report prolonged pain or difficulty swallowing.
Dr. Phillips is the only physician in Gainesville and Northern Florida that can provide this option for patients, and he is excited to offer this to patients that good candidates for the procedure.
One of the most important muscles that keeps the tongue from falling back and blocking the airway is the genioglossus muscle. This is a large tongue muscle that attaches from the back of the tongue to the central inside part of the jaw. By tightening this muscle, collapse at the back of the tongue and lower airway can be improved and stabilized, preventing airway obstruction.
Advancement of the muscle can be performed by making a small rectangular cut in the bone at the center of the jaw, and pulling this small piece of bone forward. The inside of the bone attaches to the genioglossus muscle, and pulls the muscle and tongue base forward. The bone is anchored in this forward position. Patient report minimal pain with the procedure, which is performed through the mouth.
In very rare cases, where obstructive sleep apnea is very severe, and contributing to significant issues with cardiopulmonary disease, completely bypassing all sites of upper airway blockage is recommended. This can be done by placing making a small incision in the windpipe (or trachea) through the neck skin, below the level of the vocal cords. A small plastic tube is placed in this incision to keep the hole open. A patient will be able to breathe freely through the tube, effectively bypassing all sites of upper airway blockage.
This is most often performed as a temporary procedure, sometimes along with other sleep surgeries, to allow for maximal healing before the plastic breathing tube is removed. The trachea incision will then close on its own, and heal completely.
Dr. Jeffrey Phillips | Accent Sleep Solutions | 4340 West Newberry Road, Suite 301 | Gainesville, FL 32607 | (352) 271-5375