The Vancouver Sleep and Breathing Centre

 

SURGERY

 

There are many different operations that can be done for the treatment of snoring. These can be categorized as follows:

All surgery is irreversible.


Surgery to Improve the Nasal Airway

Operations can be performed to straighten deviated septums, remove polyps, remove nasal cartilage, or strip the lining of the nose. It is often difficult to predict when these operations will be effective.


Surgery to Remove Enlarged Lymphoid Tissue

This is the tonsillectomy and adenoidectomy that many baby-boomers will have had as a routine when they were children. Physicians are now much more selective in choosing who will have this surgery. Enlarged lymphoid tissue is one of the more common causes of snoring and OSA in children.


Surgery to the Soft Palate Alone

The most popular operation of this kind is the LAUP or Laser-Assisted Uvulopalatoplasty. This is an operation that can be performed in the surgeon's off ice under local or general anaesthetic. Tissue is removed from the back of the throat using a laser. This is done in one or more stages depending on the specialist's training and experience.

A LAUP is not equivalent to a UPPP (see below).

WHICH TISSUES ARE REMOVED BY THE LASER?

The laser is used to trim back the uvula and the adjacent soft palate. These are the things that you see dangling in the back of your throat when you look in the mirror.  It is often said that a person's snoring is caused by the vibration of these tissues.  However, in most patients, all portions of the throat contribute to snoring.

 

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Before

After

IS THIS PROCEDURE PAINFUL?

Despite what you may have read or heard in the news media, this surgery is painful.  There will be little discomfort during the procedure because of the anaesthetic. Some discomfort may be present for weeks to months.

WILL IT WORK?

The originator of this procedure, Dr. Kammani, states that it works best on women who are not overweight, who smoke, and who snore lightly. This is because you only have to remove a small amount of tissue to achieve good results. Men who are very overweight should not have this procedure at all.

Dr. Kammani reported a success rate of more than 90%.  No other surgeon has achieved this high a success rate.  The true success rate appears to be in the range of 30-50%.  In most cases, the snoring is reduced but not eliminated.

The results are not permanent.

Laser treatment is not for everyone. Once the tissue is removed, it cannot be put back.

Click here for information on the effects of LAUP on different kinds of snorers.

WHAT ARE THE SIDE-EFFECTS?

Most people will have some discomfort on swallowing for the first while. Perhaps 5-10% will have some degree of persistent nasal regurgitation (food shooting into the nose when you swallow). The rare individual will experience changes in their voice.

However, the most serious side effect is that the surgery can cause or worsen Obstructive Sleep Apnea.  This occurs in up to 1/3 of patients who have this surgery.

CAN MY SNORING BE CURED BY LASER SURGERY?

A few individuals will have good results that last a long time. However, most of the medical literature reports that 10-15% are not improved and 30-40% of those who do improve start to snore again within one year.

WHAT IF I SNORE AND HAVE OSA?

The results are unpredictable in these circumstances. Many patients are worse off after this surgery.  No patient who has any degree of OSA should use this surgery as the only form of treatment for their snoring.

WHO IS QUALIFIED TO DO THIS PROCEDURE?

In most areas, this treatment is offered by Ear, Nose, and Throat Specialists. However, there are no regulations in place that state clearly who can do this procedure or what training they must have. Be sure to ask the surgeon about their training and experience with this procedure.  Be skeptical of claims of high success rates.

HOW MUCH WILL IT COST?

This varies a great deal from place to place and depends on who provides the treatment, the type of facility, and type of anaesthetic given. Prices can range from $500-$1,000 per procedure. This surgery is not covered by any type of insurance

For more information on the harmful effects of LAUP, click here.

 

SMART QUESTIONS TO ASK ABOUT LASER SURGERY

QUESTIONS TO ASK THE SURGEON:


More Involved Surgery - Uvulopalatopharyngoplasty (UPPP)

UPPP is a rather involved procedure that requires a general anaesthetic. The soft palate and uvula are removed, as are the tonsils if they are still present. The surgeon also sews the muscular fold found behind the tonsil to the one in front of the tonsil. In the past, this surgery was performed on patients who had Moderately Severe OSA or worse. However, recent reports on long-term follow-up of these patients suggest that this surgery should be reserved for patients with milder disease. The relapse rate may be quite high when performed in those with severe disease.

There are many complicated surgeries which involve expanding the jaw or removing portions of the tongue. These are only performed in specialized centres. They will not be described here.


 

Lifestyle changes
Body position
Nasal sprays
Nasal valve dilators
Dental appliances
Continuous Positive Airway Pressure (CPAP)
Surgery

 

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