Sleep Surgery | CPAP Alternative Treatments for Obstructive Sleep Apnea
What is Sleep Surgery?
Sleep Surgery combines soft tissue and maxillofacial surgery to improve the airway in patients with obstructive sleep apnea. Maxillofacial Sleep Surgery may involve a uvulopalatopharygoplasty (UPPP) with a single jaw advancement like a genioglossal advancement, sliding genioplasty, or bilateral sagittal split osteotomy (BSSO). It may also involve include functional rhinoplasty, septoplasty, and turbinate reduction in select patients. Other patients with tongue base enlargement may benefit from a tongue base reduction called a midline glossectomy. The most successful sleep surgery procedure we perform is a maxillomandibular advancement.
Learn more about Sleep Surgery San Antonio specialist Dr. Jose Barrera at Sleep Surgery San Antonio youtuve CPAP Alternative Treatment Options with Dr. Jose Barrera, MD.
What is the goal of sleep apnea surgery?
The goal of sleep apnea surgery is to improve the nasal, oropharyngeal, and hypopharyngeal airway and successfully treat patients with obstructive sleep apnea. Dr. Jose Barrera is fellowship trained in maxillofacial sleep surgery, having completing a two year fellowship with Stanford University Professors Drs. Nelson Powell and Robert Riley at Facial Reconstructive Surgery in Palo Alto, California. Dr. Barrera is also fellowship trained in Facial Plastic and Reconstructive Surgery and is triple board certified in Otolaryngology-Head and Neck Surgery, Sleep Medicine, and Facial Plastic and Reconstructive Surgery.
Dr. Barrera has published two monumental research papers on maxillofacial sleep surgery. The first paper is the first report detailing the feasibility and accuracy of virtual surgical planning to direct the surgical and polysomnography (PSG) outcomes of patients with obstructive sleep apnea (Barrera JE, Laryngoscope 2014 May;124(5):1259-66). Severe sleep apnea patients with a mean apnea hypopnea index (AHI) and respiratory disturbance index (RDI) of 60.1 and 69.5 events per hour significantly improved to 2.83 and 4.5 events per hour, respectively, P = .03, with maxillomandibular advancement. We define cure as achieving an AHI < 5 events per hour after surgery.
Can swallowing be affected by sleep surgery?
Our second research study aimed to show the swallowing characteristics after sleep surgery. Obstructive sleep apnea patients underwent mandibular advancement (genioglossal advancement) with a uvulopalatal flap (palate surgery). We showed that swallowing was not negatively affected by the multi-level surgery. In addition, we improved the patients sleep apnea as shown in following the apnea hypopnea index before and after surgery. The mean AHI was 48.3 ± 48.45 events per hour, with a median of 48.5 (AHI > 30 is considered severe sleep apnea). Postoperatively the mean AHI was 11.6 ± 10.7 events per hour, with a median of 10.75, achieving surgical success overall (Laryngoscope 2014 Sept 24).