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The Sleep Apnea Surgical Option: An effective and viable alternative to CPAP and MADs

If you’ve been diagnosed with Obstructive Sleep Apnea (OSA), you’re likely familiar with the CPAP machine, which is widely considered to be the first line of defense for OSA.  However, for many, CPAP is uncomfortable, awkward and even claustrophobic.  As a result, there are many CPAP machines that are just sitting and collecting dust.

A second option for OSA treatment, commonly recommended as an alternative when CPAP is not tolerated, is a custom-made oral appliance. Also known as a Mandibular Advancement Device (MAD), the appliance opens the airway by moving your mandible (lower jaw) forward, which in turn also brings your tongue forward.  However, as with CPAP, there are many who can’t tolerate an oral appliance – especially those who also suffer from TMJ problems.  Even for those with mild TMJ problems, an oral device can exacerbate the problem.

Sleep Apnea and Snoring

A common symptom and possible indicator of OSA is loud snoring. However, most people don’t know that you can still have sleep apnea without snoring.   And that can lead to serious health issues.  In other words, an oral appliance could very well eliminate your snoring, which leads you to think that your OSA is resolved.  However, the MAD could actually be masking the symptoms – without treating the disease.  This is sometimes referred to as silent sleep apnea.

Benefits of Surgery for OSA

When neither CPAP nor an oral appliance works for you, what else can you do to help prevent the disruptive and potentially severe and life threatening effects of OSA?  For many, that’s the surgical option.  The benefits of the surgical option include:

  • Permanence: For patients with mild and even severe sleep apnea, surgery can be a permanent solution. Although it’s always a possibility that OSA may return, the surgical option is geared at providing a permanent anatomical fix to the issue causing your OSA.
  • Effectiveness: Even if the surgical option doesn’t completely resolve your OSA, it can still be very effective in reducing the severity of your OSA. In fact, it’s not unusual for surgery to result in a 50% drop in the Apnea-Hyopnea Index (AHI), the measure used to indicate the severity of OSA.  For example, if your AHI pre-surgery level is at 40 (severe apnea) and then drops to 9 (mild apnea) post-surgery, that’s a significant improvement.
  • Convenience: If surgery does reduce the level of your OSA, you’ll no longer have to deal with the inconvenience of a CPAP or MAD if you have been using them for treatment.  A surgical solution means no more devices at home or when you travel.
  • Peace-of-mind: Most of all, a surgical solution, when successful, will let you literally and figuratively breathe easier, knowing that the risk of serious side effects of OSA has been significantly diminished.  It means better sleep, increased energy – and a reduced risk of cardiac problems associated with OSA.

Surgical Options for OSA

There are three surgical options that are typically the most effective when treating OSA.  It’s essential to keep in mind that no matter what option you choose, the surgery should be performed only by a Board Certified Oral and Maxillofacial Surgeon with extensive experience in OSA surgical procedures and protocol.  The three surgical options are:

  • Genioglossus Advancement

Genioglossus Advancement prevents upper airway blockage by preventing the tongue to collapse toward the back of the throat during sleep. The genioglossus is the primary muscle of the tongue and is attached to a small bony projection on the interior of the lower jaw. During this surgery, this small bone projection is moved forward and the tongue attachment is repositioned anteriorly so that it is less likely to collapse posteriorly and block the airway during sleep.

  • Hyoid Advancement:

The hyoid bone is a small bone under your chin, which is advanced to treat tongue-based obstructions by expanding the airway. This surgery is often done in combination with a Genioglossus Advancement, as it has been shown that this combined approach increases the overall success of the treatment of sleep apnea.

  • Maxillomandibular Advancement:

Maxillomandibular Advancement is the most effective and reliable treatment for patients with severe obstructive sleep apnea. This sleep apnea surgery involves moving the upper and lower jaws forward, thereby enlarging the entire airway. The treatment procedure is performed on patients with moderate to severe OSA as the only treatment, or when other procedures have failed.  It is also sometimes combined with a chin advancement to maximize the enlargement of the airway space.

Maxillomandibular advancement has been shown to significantly increase airway dimensions in both lateral and anterioposterior directions. Maxillomandibular advancement surgery has been shown to have a success rate as high as 90% in the treatment of sleep apnea.

Determining if surgery is right for you

If you’re suffering from the symptoms of OSA –- including daytime fatigue and nighttime snoring –- it’s important to schedule a sleep study at your earliest convenience.  A sleep study will help determine if you do have apnea, and if so, the level of its severity.

When considering surgical options to treat your OSA, it is important to note that surgery is not considered the first line of treatment.  If diagnosed with OSA, it’s likely that your physician will recommend that you first try CPAP or an oral appliance.  Both of these options do work for many patients.  However, if they don’t work for you, surgical options should be explored with your physician.   In order to determine if you are a candidate for surgical treatment, your physician may order a CT scan and/or a sleep endoscopy.

Don’t give up…see your physician today!

If you’ve already been diagnosed with OSA and neither CPAP nor a MAD have worked for you, it’s critical that you don’t give up – because OSA can cause serious health issues, even heart failure if left untreated.


Ruben Cohen, D.D.S. is a Diplomate of the American Board of Oral and Maxillofacial Surgery. Dr. Cohen is the founder of Park Avenue Oral & Facial Surgery, P.C., located in the Upper East Side of New York City.

For more information on Dr. Cohen’s sleep apnea treatment options, including surgery and custom oral appliances, please visit his website at www.ParkAvenueFaces.com.


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