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Treatment for Snoring and Sleep Apnea

One of the major players in snoring and obstructive sleep apnea is the soft palate, uvula and tonsils. At Canadian Sleep Surgery Clinic, Dr. Chau can help you choose the right surgery or procedure to combat your snoring and sleep issues. Treatments can range from minimally invasive procedures like the Pillar procedure and palate radio-frequency can be performed in the office under local anesthesia, and these can be very helpful in snoring and mild obstructive sleep apnea. More invasive procedures including uvulopalatopharyngoplasty (also known as UPPP or UP3), expansion sphincter pharyngoplasty, and lateral pharyngoplasty are performed for the treatment of obstructive sleep apnea in the operating room under general anesthesia.

Palate Procedures

LOCAL ANESTHETIC OPTIONS:

Uvulopalatopharyngoplasty (Radio-frequency)
This procedure is reserved for patients with snoring, mild OSA or upper airway resistance syndrome (UARS). It is performed as an outpatient without general anaesthesia or sedation. It involves two to three sessions of delivering energy with a probe in 1-3 locations of the sofa palate to heat the soft tissue in a controlled manner and create a specific amount of damage. This will initiate healing and form scar tissue which will tighten and reduce the size of the treated area.

Pillar Procedure
This procedure treats patients with snoring and can be combined with radio-frequency procedures for patient with mild to moderate obstructive sleep apnea. Pillar procedure is performed in the outpatient clinic without general anaesthesia, however, they can be placed under general anesthesia if a patient is already scheduled for additional surgical procedures. Although the Pillar Procedure has many attractive features, not every patient is an ideal candidate for the procedure, your candidacy will be discussed in consultation. The procedure involves placing three or more woven implants in the soft palate and takes approximately 30 minutes. Their presence along with the body natural response to them will stiffen the soft palate over the following 2-3 months. The implants are made of a material (trademarked as Dacron®) that has been used for decades in medical uses without any known adverse consequences.

GENERAL ANEASTHETIC OPTIONS:

Uvulopalatopharyngoplasty (Commonly known as UP3)
With local anaesthesia without sedation in the outpatient clinic, laser- or cautery-assisted surgery treats snoring and mild sleep apnea. The procedure combines tissue removal and tightening to increase the size of the airway. **Uvulopalatopharyngoplasty uses multiple techniques which are tailored to the unique characteristics of each patient. Laser removal gained popularity due to the fact that it can be done as an outpatient. There is excessive pain involved with the laser procedure as well as the possibility of recurring treatments. It has, for the most part, been replaced by radiofrequency.

Tonsillectomy and Lateral Pharyngoplasty
Performed under general anaesthesia in the operating room, lateral pharyngoplasty is performed in combination with tonsillectomy. This procedure removes and repositions lateral pharyngeal tissue (side of the throat) and tonsil tissue. Tonsillectomy was once a common procedure to treat infection and inflammation of the tonsils (tonsillitis) only, however, today, it is also performed for sleep-disordered breathing.

Palate Surgery (UP3, uvular flap rotation and tonsillectomy)
This surgery is for patient with obstructive sleep apnea. Surgery on the palate is performed along with a tonsillectomy. It’s performed under general anaesthesia in the operating room and involves a combination of tissue removal and repositioning that increases the size of the airway. This procedures is used to improve the upper airway at the possible obstruction areas (tonsils, palate & base of tongue). California Sleep Institute surgeons Drs. Robert Riley and Nelson Powell previously developed a modified UPPP procedure that creates a tissue flap of the uvula and free edge of the soft palate. This approach reduces pain and allows the procedure to be reversed in the early stages of healing. Powell N, Riley R, Guilleminault C, Troell R: A reversible uvulopalatal flap for snoring and sleep apnea syndrome. Sleep 1996;19(7):593-599

Typically this procedure will be performed with a tongue base reduction as well as we thrive to treat all potential areas of obstruction.

If a patients has been diagnosed with Obstructive Sleep Apnea and would like to proceed with surgical treatment under general anaesthetic, Dr. Chau will typically suggest multiple procedures be performed in order to treat as much of the area in the upper airway that may be causing the obstruction during sleep. Your physical exam and severity of sleep apnea will be deciding factors of how many procedures you require. The following procedures may be performed together;

Phase 1 Sleep Surgery

This is the most invasive first stage surgery and is typically suggested for moderate-severe OSA patients. This procedure is approximately 4-5 hours of operative time and requires patients to stay in hospital for 3-5 days post operatively. Patients are suggested to take a minimum of 2 weeks off work, however, if you have a physically demanding job you may require up to 4 weeks off.

  1. Uvulopalatopharyngoplasty (UP3) with Uvular flap rotation

  2. Tonsillectomy and possible lateral pharyngoplasty

  3. Partial Midline Glossectomy

  4.  Genioglossus Advancement

  5. Hyoid Suspension

Partial Phase 1 Sleep Surgery

This procedure is moderately invasive and is typically suggested for mild-moderate OSA patients or severe OSA patients that are seeking surgery to optimize their current OSA treatment, such as CPAP therapy. This procedure is approximately 2 hours of operative time and requires patients to stay in hospital for 24 hours post operatively. Patients are suggested to take a minimum of 2 weeks off work.

  1. Uvulopalatopharyngoplasty (UP3) with Uvular flap rotation

  2. Tonsillectomy and possible lateral pharyngoplasty

  3. Partial Midline Glossectomy with Radio-frequency

Phase 2 Sleep Surgery - Maxillomandibular Advancement

What is Maxillomandibular Advancement (MMA) surgery and who is a candidate?
Maxillomandibular advancement provides a great improvement in treating obstructive sleep apnea compared to other single procedures, however, because recovery is more prolonged than other sleep surgery procedures and has a different set of potential risks, the procedure is generally reserved for patients who have not obtained sufficient improvement in obstructive sleep apnea after other procedures. For some patient’s this can be a first-line surgical treatment, for example if there are jaw abnormalities. Maxillomandibular advancement (sometimes called bimaxillary advancement or double jaw advancement) is a procedure offered by Dr. Chau at Canadian Sleep Surgery Clinic.

How Is Maxillomandibular Advancement Performed?
This procedure moves the upper and lower jaws forward to enlarge the airway in both the palate and tongue region. Dr Chau performs this procedure with an Oral & Maxillofacial Surgeon and it is performed in an operating room under general anaesthesia . Incisions are made inside the mouth, except (if needed) for one small incision on the cheeks. Both the upper and lower jaws are freed with thins saws and chisels and advanced together with placement of titanium plates which are screwed to hold the jaws in place.

Recovering from the Surgery
Maxillomandibular advancement involves placing large braces (arch bars) on the teeth. These braces remain in place for about six weeks. The jaws are not wired together, but rubber bands are used to assist maintain a stable bite during the healing. Patients should eat a soft diet avoid chewing for about four to six weeks after the surgery. A temporary tracheostomy may be required by some patients in order to avoid issues with swelling after surgery.

Post-Operative Information

Please view the following PDFs for more information.

Phase 1 Sleep Surgery

Need Information?

If you have any questions or concerns about our procedures, please email or call us.

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