Orthognathic Surgery for Sleep Apnea
what is Sleep Apnea?
When obstructive sleep apnea (OSA) occurs, the tongue is sucked against the back of the throat during sleep. This blocks the upper airway, and airflow stops. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears, and the flow of air starts again, usually with a loud gasp.
Repeated cycles of decreased oxygenation lead to very serious cardiovascular problems. Additionally, these individuals suffer from excessive daytime sleepiness, depression, and loss of concentration.
Some patients have obstructions that are less severe, called Upper Airway Resistance Syndrome (UARS). In either case, the individuals suffer many of the same symptoms.
The first step in treatment resides in recognition of the symptoms and seeking appropriate consultation.
The doctors will assess as detailed history as well as the anatomic relationships in the maxillofacial region. With cephalometric (skull x-ray) analysis, the doctors can ascertain the level of obstruction. Sometimes a naso-pharyngeal exam is done with a flexible fiber-optic camera. To confirm the amount of cardiovascular compromise and decreased oxygenation levels, a sleep study may be recommended to monitor an individual overnight.
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Treatment Options for sleep apnea:
- An initial treatment may consist of using a nasal CPAP machine that delivers pressurized oxygen through a nasal mask at night.
- A device may be placed in the mouth to position the lower jaw and tongue forward to releive the airway obstruction.
- Uvulo-palato-pharyngo-plasty is a surgical option performed in the back of the soft palate and throat.
- Laser assisted uvulo-palato-plasty is a similar procedure performed with the assistance of a laser.
- A radio-frequency probe can be utilized to tighten the soft palate. These procedures are usually performed under light IV sedation in the office.
- Orthognathic surgery repositions the upper and lower jaw bones to increase the size of the airway. This procedure is done in the hospital under general anesthesia and requires a one to two day overnight stay in the hospital.
OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment.