Snoring may seem like a relatively innocuous annoyance, but the consequences can be deadly. People with sleep apnea are at triple the risk of sudden death during sleep when compared to the general population. While there are devices that can help lower this risk, they are generally uncomfortable and inconvenient to use. For this reason, a lot of people seek a more permanent, surgical alternative.
What is sleep apnea?
“Apnea” comes from the Ancient Greek words for “the absence of” and “breathing.” It refers to periods where a person stops breathing. In sleep apnea, this occurs during sleep, when the person may be completely unaware that they’re experiencing breathing problems unless a spouse or someone else points out snoring or other irregularities.
What causes sleep apnea?
Central sleep apnea occurs when the brain stops telling the muscles responsible for breathing to do their job for brief periods of time. People with this type of apnea may wake up gasping for air and have problems falling or staying asleep. Obstructive sleep apnea, which is far more common, occurs when muscles at the back of the throat relax and allow the airway to partially close. People with this type of apnea may wake up with headaches or feel tired during the day. Physical factors like neck circumference, narrow airways, or obesity are generally the primary culprits. Some medications, like sedatives, can trigger obstructive sleep apnea.
How is sleep apnea treated?
People with obstructive sleep apnea may need a device called a CPAP machine. This machine maintains positive air pressure in the airway all night, to prevent it from collapsing. A surgical procedure called a UPPP (short for uvulopalatopharyngoplasty) can help some patients by removing excess tissue around the airway to keep it from blocking breathing, but many patients still require a CPAP afterward. In a lot of cases, surgery to reposition the jaw (orthognathic surgery) and increase the size of the airway is the best option.
Can liposuction of the neck help?
Obesity is a contributing factor to sleep apnea, and fatty deposits around the neck can sometimes make proper breathing difficult while sleeping. That said, liposuction doesn’t touch the soft tissues that are actually responsible for obstructing the airway during sleep. For this reason, liposuction of the neck is unlikely to stop a patient’s snoring.
Who is a candidate for orthognathic surgery?
Jaw surgery involves general anesthesia and a pretty significant recovery time when compared to other treatments, including UPPP. For this reason it is often reserved for either people who have tried other measures to correct their sleep apnea and not experienced any improvement, or those who have jaw deformities that can also be corrected during surgery.
What does orthognathic surgery involve?
When being assessed for sleep apnea, patients generally have x-rays taken of the skull to determine if its conformation is a contributing factor to their breathing problems. In orthognathic surgery to correct breathing problems, the upper and lower jaws are moved forward to increase the size of the airway. This procedure is performed under general anesthesia, and takes about three to four hours to complete. All incisions are made inside of the mouth, so there are no external scars, and allow surgeons to free the upper and lower jaws and bring them forward. They are held in place with titanium plates and bone screws, while the patient’s bite is kept stable with the use of braces and other dental appliances. The jaw does not have to be wired shut afterwards.
What are the healing process and aftercare like?
It’s important for patients to avoid chewing while they heal, typically for up to six weeks. Most patients are able to return to work after four weeks. In some cases, a temporary tracheostomy may be placed to help prevent breathing problems due to swelling. It’s necessary to follow a liquid diet for the period immediately following surgery, then gradually transition to a diet of soft foods for the six week recovery period. Patients will also need to sleep with the head elevated to reduce swelling and assist breathing for the first week after surgery.
What risks are involved?
As with any surgery, orthognathic procedures carry some risks. Swelling may cause problems with breathing or swallowing, patients may experience bleeding, incisions can become infected if they are not properly cared for, and some areas of the face may feel numb or tingly for up to a year following surgery. Many patients notice minor changes in their appearance, but these are generally positive.
There’s no need to struggle through the daily exhaustion and headaches of untreated sleep apnea. If you are currently suffering, don’t put off relief. What may seem like a little bit of snoring may actually become deadly, and orthognathic surgery can end up saving your life. Dr. Jamali is an award-winning surgeon with decades of medical experience and a passion for facial reconstructive surgery. Contact him at Oral & Maxillofacial Surgery of New York today for a consultation, and see how orthognathic surgery can help improve your life.