Multilevel Upper Airway Surgery for OSA
Obstructive sleep apnea (OSA) is the intermittent obstruction of the upper airway during sleep. OSA can result from a nasal obstruction, oropharyngeal obstruction, hypopharyngeal obstruction or obstruction in a combination of these areas. The most common treatment for OSA is continuous positive airway pressure (CPAP) in which lightly pressurized air is blown into the airway by way of a mask that covers the nose or nose and mouth. The force of the air pressure pushes against upper airway tissues to maintain an open airway.
Many people with OSA are unwilling to use CPAP or are unable to tolerate CPAP treatment and may seek surgical alternatives. The most common surgical treatment for OSA is uvulopalatopharyngoplasty (UPPP), which involves the removal of a person’s tonsils, adenoids, uvula and excess tissues in the oropharynx (i.e., the area from the soft palate to the upper edge of the epiglottis). The removal of these tissues increases airflow through the oropharynx. However, if an obstruction occurs elsewhere in the upper airway (e.g., the hypopharynx [i.e., the area between the upper edge of the epiglottis and the opening of the larynx and esophagus]), UPPP may not fully relieve OSA episodes. Some research indicates that multilevel surgery is more effective than single level surgery in reducing the severity of OSA.
Upper airway obstruction in OSA may result from upper airway muscles relaxing excessively during sleep, which allows tissues supported by these muscles such as the tonsils and adenoids to collapse into the airway and block airflow fully or partially. Surgeries for OSA involve modifying the nasal passage (e.g., septoplasty, turbinate reduction), the oropharynx (e.g., UPPP, adenotonsillectomy) and/or hypopharynx (e.g. tongue base reduction, hyoid suspension).
In septoplasty, the nasal septum (i.e., the wall of tissue that divides the nose in left and right halves) is straightened or repaired. A deviated septum can reduce or block airflow through the nasal passages.
The turbinates consist of three thin, curled, bony mucous membrane-covered plates (i.e., superior, middle and inferior) that extend from the lateral walls of the nasal cavity. They normally slow the speed of incoming air so that it becomes heated, humidified and filtered. In some people, the turbinates are enlarged, which narrows the amount of space within the nasal cavity, thereby reducing airflow. Turbinate reduction surgery reduces the size of turbinates to allow air to flow more readily through the nasal passage.
As mentioned earlier, in UPPP, the uvula, soft palate (i.e., the soft portion of the roof of the mouth), tonsils, adenoids and excess throat tissues (e.g., fatty tissue) are removed to widen the oropharynx.
To learn more about the application of multilevel surgical procedures of OSA treatment, view the full article in the 2020 Q4 issue of A2Zzz.