Surgical Solutions for Snoring & Sleep Apnea

Surgery for correction of snoring and obstructive sleep apnea may be performed for a variety of reasons. Many people who come to Dr. Phillips have been placed on CPAP (Positive Airway Pressure) therapy, often several times, and cannot tolerate this treatment. They are looking for an alternative that reduces or eliminates their sleep apnea. Other patients may have focal areas of airway obstruction that can be treated with surgery alone. Still other patients are simply looking for a way to reduce the air pressure required or reliance on CPAP therapy.

In all cases, Dr. Phillips has expertise in providing an individualized surgical solution for snoring and sleep apnea. Many surgeons treating sleep apnea rely on a single surgery to treat every patient with sleep apnea, regardless of their anatomy, physiology or other sleep issues. Unfortunately, research has repeatedly shown that a “one-size-fits-all” approach to surgical treatment of sleep apnea is often not successful. Dr. Phillips uses several factors to determine whether a surgical option will be helpful for a person’s sleep apnea or snoring, and which surgery or procedures will be most successful.

Obstruction of the nasal cavity, due to a deviated septum, enlarged turbinates, nasal valve collapse or nasal polyps all can contribute to poor sleep and mouthbreathing, which makes sleep apnea and snoring worse. Septoplasty, reduction of the inferior turbinates, nasal valve stabilization and sinus surgery are all surgeries that can improve airway obstruction at this level.

For more detailed information about nasal surgery and sleep apnea, see the page discussing Nasal Surgery.

The soft palate, or the arch of tissue in the back of the throat, just in front of the back wall of the throat, is one of the most common areas of obstruction in snoring and sleep apnea. The lateral pharyngeal walls (or side walls of the throat), are also often involved in obstruction, as are the tonsils. There are many surgeries that can be performed at this level, and each is custom tailored to a patient’s unique anatomy. These surgeries include:

• Expansion Sphincter Pharyngoplasty
• Uvulopalatoplasty
• Transpalatal Advancement Pharyngoplasty
• Lateral Pharyngoplasty
• Radiofrequency Ablation of the Palate
• Pillar Implants

For more detailed information about palate and pharyngeal surgery for sleep apnea, see the page discussing Palate & Pharyngeal Surgery.

Another very common site for upper airway obstruction is at the middle or back of the tongue. Due to the structure of the jaw, the physiology of the muscles of the tongue and throat, and the size of the tissue at the back of the tongue, many people have collapse of the airway at this level during sleep. Depending on a patient’s anatomy at this site, there are many surgeries that can be performed.

• Lingual Tonsillectomy
• Partial Midline Glossectomy and Tongue Reduction
• Radiofrequency Ablation of the Tongue Base

For more detailed information about tongue base surgery for sleep apnea, see the page discussing Tongue Base Surgery.

Dr. Phillips is proud to be one of very few physicians in Florida to offer this exciting and groundbreaking new therapy for sleep apnea. Inspire ® upper airway stimulation is a minimally invasive procedure that is the only therapy that addresses both the anatomy AND physiology of sleep apnea. The therapy works by gently stimulating select muscles of the tongue at night to allow the tongue base to move forward, widening the airway. This is achieved by implantation of a small electrode on a nerve branch that controls select tongue muscles.For more information on Inspire ® Upper airway stimulation therapy, and to learn more about this highly effective therapy for sleep apnea, see the page discussing Upper Airway Stimulation.

In many patients, significant airway collapse is seen at the level of the airway just above the vocal cords, including the back of the tongue, the epiglottis (a normal structure that helps to protect the airway when swallowing foods and liquids, and the lower side walls of the throat. There are very effective surgeries that can address these areas of collapse, and Dr. Phillips can provide the appropriate surgery to address the airway obstruction at this level. These surgeries include:

• Hyomandibular Advancement (AirLift ® procedure)
• Tongue Base Suspension
• Genioglossus Advancement
• Tracheostomy (in very rare cases only)

For more detailed information about lower airway surgery for sleep apnea, see the page discussing Lower Airway Surgery.

In some patients, the best correction of sleep apnea, due to obstruction at multiple levels, is to correct abnormalities in the skeletal framework of the face. A narrow or set-back jaw, or small, narrow mid-face can lead to crowding of the tongue, soft palate, and side walls of the throat. Advancement and reconstruction of the facial skeleton is very effective at allowing a wider, more open airway at all of these levels.These surgeries, which include maxillomandibular advancement, mandibular advancement, or bi-maxillary advancement, are not performed by Dr. Phillips. However, if Dr. Phillips determines that this may be the best therapy to address a person’s anatomy and sleep apnea, referral to an oral and maxillofacial surgeon will be considered.