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.
Is sleep surgery right for me?
There are several factors that Dr. Phillips will use to determine whether someone is a good candidate for sleep apnea surgery. In a comprehensive clinic visit, Dr. Phillips will obtain a full medical and sleep history, and perform a full head and neck exam. He will look at all prior sleep testing, including sleep studies, prior treatments, CPAP reports, and other surgical reports. A patient’s unique upper airway anatomy, personal preferences, sleep history, goals of therapy, and severity of sleep apnea are all taken into account in determining whether surgery will be useful.
Dr. Phillips utilizes a non-invasive diagnostic procedure called sleep endoscopy, or drug-induced sleep endoscopy, to help carefully evaluate the anatomy of the upper airway during sleep. This procedure allows Dr. Phillips to identify the areas of greatest obstruction during sleep to help determine which surgeries would best address these areas of collapse. For more information on this procedure please see the page on sleep endoscopy.
What are the different types of sleep surgeries?
There are many different types of sleep surgeries that Dr. Phillips can perform to treat obstructive sleep apnea and snoring. Each of these procedures can also be specifically tailored to each patient’s unique anatomy to optimize the upper airway for sleep. In most patients with sleep apnea, obstruction of the airway occurs at multiple levels, and correcting this obstruction at each site is essential to a successful outcome.
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.
Palate & Pharyngeal 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
- 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.
Tongue Base 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.
Upper Airway Stimulation Therapy
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.
Lower Airway Surgery
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.
How can I know which sleep surgery is right for me?
Through a careful medical and sleep history, physical examination, and evaluation of all prior and current sleep testing records, Dr. Phillips will guide each person through the various options for surgical treatment of sleep apnea. He will discuss your goals and wishes for treatment of snoring or sleep apnea, and consider the severity of your sleep apnea in making the decision.
A critical step in helping to determine which procedures would be most effective for a particular patient, Dr. Phillips often will perform a simple diagnostic procedure called a “sleep endoscopy” to further assess a person’s upper airway while they are sleeping. This is a simple, very short, non-painful procedure that allows for close evaluation of the exact sites of airway collapse during sleep. For more information about sleep endoscopy, see the page on drug-induced sleep endoscopy.
Dr. Jeffrey Phillips | Accent Sleep Solutions | 4340 West Newberry Road, Suite 301 | Gainesville, FL 32607 | (352) 271-5375