Snoring surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Surgery

Surgery is also available to correct social snoring. Some procedures, such as uvulopalatopharyngoplasty attempt to widen the airway by removing tissues in the back of the throat including the uvula and pharynx. These surgeries are quite invasive, and there are risks of adverse side effects. The most dangerous risk is that enough scar tissue could form within the throat as a result of the incisions to make the airway more narrow than it was prior to surgery, diminishing the airspace in the velopharnyx. Scarring is an individual trait. It is difficult for a surgeon to predict how much a person might be predisposed to scarring. Some patients have reported that they developed severe sleep apnea as a result of damage to their airway caused by pharnygeal surgeries. At the present time, the American Medical Association does not approve of the use of lasers to perform operations on the pharnyx or uvula.

Radiofrequency ablation (RFA) is a relatively new surgical treatment for snoring. This treatment applies radiofrequency energy and heat (between 77ºC to 85ºC) to the soft tissue at the back of the throat, such as the soft palate and uvula, causing scarring of the tissue beneath the skin. After healing, this results in stiffening of the treated area. The procedure takes less than one hour, is usually performed on an outpatient basis, and usually requires several treatment sessions. Discomfort and pain is usually minimal. Radiofrequency ablation is frequently effective in reducing the severity of snoring, but, often does not completely eliminate snoring.

Device Based Therapy

Dental appliances

Specially made dental appliances such as a mandibular advancement splint, which advance the lower jaw slightly, and thereby pull the tongue forward, are a preferred mode of treatment for social snoring. Typically, a dentist specializing in sleep apnea dentistry is consulted. Such appliances have been proven to be effective in reducing snoring and sleep apnea, however side effects include the possibility that a patient's bite could be altered. Typical costs for such appliances would be between USD1000 to USD3000.

"Do it yourself" (DIY) dental appliances are also available, which cost around $50 to $200. These provide the same benefits if fitted correctly. They are usually made from an EVA polymer, and are similar in appearance to protective mouth-guards worn for sports. One disadvantage of the cheaper devices compared to the professionally fitted devices is the difficulty in setting up the correct jaw position. An over-advanced jaw results in jaw joint pain, whilst an under-advanced jaw produces no therapeutic effect. The professionally fitted devices generally incorporate an adjustment mechanism so that jaw advancement can be easily increased or decreased after fitting. To adjust the DIY appliances it is necessary to reheat them and mold them again in the desired new position. Alternatively, given the low cost, a new appliance can be used to hold the jaw in the new position.

DIY devices can be purchased at pharmacies in most countries (except the U.S.), or online (anywhere - though not legally in U.S.). In the U.S., the devices are considered class 2 medical devices and cannot be legally sold without a prescription. The FDA (Food and Drug Administration) has never made their reasons for this decision clear. Americans are, however, allowed to purchase these devices outside the US and import them for personal use. In Australia, manufacturers can obtain approval from the TGA (Therapeutic Goods Administration) allowing the devices to be sold via normal retail channels, without the involvement of a doctor.

Possible side effects of dental appliances include Temporomandibular joint disorder (TMJD). TMJD is an inflammation of the temperomandibular joint (jaw joint) which can be very painful and is sometimes, although very rarely, irreversible. There is no reliable way of knowing whether a person is at risk for TMJ before they start using a dental appliance.

Positive airway pressure

A Continuous Positive Airway Pressure (CPAP) machine is often used to control sleep apnea and the snoring associated with it. To keep the airway open, a shoebox-sized device pumps a controlled stream of air through a flexible hose to a mask worn over the nose, mouth, or both.[1]

References

  1. "Continuous Positive Airway Pressure (CPAP)". American Academy of Otolaryngology−Head and Neck Surgery. Retrieved 2007-07-02.



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