Sleep Apnea and Orthognathic Surgery

Although people who snore loudly are often made fun of, snoring can be a serious problem and may signal a potentially life-threatening disorder – obstructive sleep apnea or OSA that requires medical and sometimes surgical attention.

During sleep, the upper airway can be obstructed by excess tissue, large tonsils and/or a large tongue. Also contributing to the problem may be the airway muscles, which relax and collapse during sleep, nasal passages, and the position of the jaw.

The cessation of breathing, or "apnea," brought about by these factors stimulates impulses from the brain to awaken the person just enough to restart the breathing process. This cycle repeats itself many times during the night and may result in sleep deprivation and a number of health-related problems. Sleep apnea is generally defined as the presence of more than 30 apneas during a seven hour sleep. In severe cases, periods of not breathing may last for as long as 60 to 90 seconds and may recur up to 500 times a night.

Symptoms of Sleep Apnea

  • Snoring with pauses in breathing (apnea)
  • Excessive daytime drowsiness
  • Gasping or choking during sleep
  • Restless sleep
  • Problem with mental function
  • Poor judgment/can't focus 
  • Memory loss
  • Quick to anger
  • High blood pressure
  • Nighttime chest pain
  • Depression
  • Problem with excess weight
  • Large neck (>17" around in men, >16" around in women)
  • Airway crowding
  • Morning headaches
  • Reduced libido
  • Frequent trips to the bathroom at night

Evaluation for Sleep Apnea

Patients are evaluated and managed for sleep disorders in our Sleep Clinic at the Sleep Health Center affiliated with Brigham and Women's Hospital in Brighton (Boston).

Treating Sleep Apnea

Obstructive sleep apnea can be treated effectively. Depending on whether your OSA is mild, moderate or severe, your doctor will select the treatment that is best for you. There are several non-surgical treatments including behavior modification, the use of oral appliances or C-PAP (Continuous Positive Airway Pressure) and Bi-PAP (Bi-level). While C-PAP and Bi-PAP devices keep the throat open and prevent snoring and interruptions in breathing, they only treat your condition and do not cure it.

Often craniofacial surgery is required to treat the most severe cases of sleep apnea. This surgery involves moving the maxilla and the upper and lower jaws

Surgery for Sleep Apnea

Surgical intervention may be a viable alternative for some OSA patients. Every patient has a different shaped nose and throat, so before surgery is considered your plastic surgeon at Brigham and Women’s Hospital will measure the airway at several points and check for any abnormal flow of air from the nose to lungs.

  • Uvulopalatopharyngoplasty (UPPP) - If the airway collapses at the soft palate, a UPPP may be helpful. UPPP is usually performed on patients who are unable to tolerate the C-PAP. The UPPP procedure shortens and stiffens the soft palate by partially removing the uvula and reducing the edge of the soft palate.
  • Hyoid Suspension - If collapse occurs at the tongue base, a hyoid suspension may be indicated. The hyoid bone is a U-shaped bone in the neck located above the level of the thyroid cartilage (Adam's apple) that has attachments to the muscles of the tongue as well as other muscles and soft tissues around the throat. The procedure secures the hyoid bone to the thyroid cartilage and helps to stabilize this region of the airway.
  • Genioglossus Advancement (GGA) - GGA was developed specifically to treat obstructive sleep apnea, and is designed to open the upper breathing passage. The procedure tightens the front tongue tendon; thereby, reducing the degree of tongue displacement into the throat. This operation is often performed in tandem with at least one other procedure such as the UPPP or hyoid suspension.
  • Maxillomandibular Advancement (MMA) - MMA is a procedure that surgically moves the upper and lower jaws forward. As the bones are surgically advanced, the soft tissues of the tongue and palate are also moved forward, again opening the upper airway. For some individuals, the MMA is the only technique that can create the necessary air passageway to resolve their OSA condition.

Corrective Jaw Surgery

Corrective jaw, or orthognathic, surgery is performed by a few of our craniofacial plastic surgeons to correct a wide range of minor and major skeletal and dental irregularities, including the misalignment of jaws and teeth, which, in turn, can improve chewing, speaking and breathing. While the patient's appearance may be dramatically enhanced as a result of their surgery, orthognathic surgery is performed to correct functional problems.

Following are some of the conditions that may indicate the need for corrective jaw surgery:

  • difficulty chewing, or biting food
  • difficulty swallowing
  • chronic jaw or jaw joint (TMJ) pain and headache
  • excessive wear of the teeth
  • open bite (space between the upper and lower teeth when the mouth is closed)
  • unbalanced facial appearance from the front or side
  • facial injury or birth defects
  • receding chin
  • protruding jaw
  • inability to make the lips meet without straining
  • chronic mouth breathing and dry mouth
  • sleep apnea (breathing problems when sleeping, including snoring)

More Information?

If you have questions, please contact us.

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