Surgical Alternatives to CPAP

Surgical treatments can eliminate or improve sleep apnea so that continuous positive airway pressure (CPAP) or other appliances are no longer needed. The Michigan Medicine Alternatives to Sleep Apnea Clinic offers several options depending on your specific preferences, sleep study findings, oral and throat anatomy and likelihood of success.

Surgery for OSA at Michigan Medicine includes options performed by an ear, nose and throat (ENT) surgeon or an oral and maxillofacial specialist. To learn about non-surgical options for CPAP visit our Non-Surgical or Dental Options to CPAP.

Surgeries Performed by an ENT Surgeon

Trans Oral Robotic Surgery (TORS) enables a 3-D image that gives the surgeon a clear view of the operative field and the ability to safely remove obstructive tissue from behind the tongue. As part of the TORS procedure, the epiglottis may be trimmed, as some patients will experience obstruction due to the epiglottis falling into the airway during sleep.

Inspire Hypoglossal Nerve Stimulator: A backward collapse of the tongue, diagnosed via a nasal endoscopy, can be treated using the Inspire Hypoglossal Nerve Stimulator. This consists of a breathing sensor and a stimulation lead, powered by a small battery. Implanted during a short outpatient procedure, Inspire therapy continuously monitors breathing while the patient sleeps. The system delivers mild stimulation to key airway muscles, and gently moves the tongue and other soft tissues out of the airway to enable breathing during sleep.

Illustration showing patient with nerve stimulator implanted and text explaining how it works

Inspire Hypoglossal Nerve Stimulator

Uvulopalatopharyngoplasty or UP3 (UPPP) is a procedure designed to open the throat to allow improved breathing in patients with OSA. During this procedure, excess tissue in the throat is removed to widen the airway and allow air to move through the throat more easily. This reduces snoring and may be effective in select mild to moderate cases of OSA. The procedure is often combined with tonsillectomy and requires a one-hour general anesthesia and an overnight stay in the hospital.

Illustration showing open mouth and throat before and after UP3 procedure

Lateral pharyngoplasty, also called expansion sphincteroplasty, is a variation of the UP3 procedure. It is often performed in patients who have narrowing of the throat or webbing of the posterior arch of the palate. If the tonsils are present they are removed at the time of the procedure. Excessive tissue that forms the web is then reconfigured to expand the back of the throat. If the uvula is present it is removed or re-shaped.

Lingual tonsillectomy is performed on patients with moderate to severe OSA. Patients may present with an obstruction at the base of the tongue. The tissue that typically causes this obstruction is called the lingual tonsil. The lingual tonsils sit on top of the base of tongue muscle and create excess volume in a tight space. The lingual tonsils are removed using the Da Vinci robot. In some cases, a portion of the tongue muscle will also be removed. See the video of a robotic lingual tonsillectomy below.

A palatal z-plasty is performed in patients with an elongated soft palate and uvula. The procedure shortens the palate and eliminates the vibration of the uvula and palate. The procedure also prevents narrowing of the soft palate as it heals. It is similar in many ways to the traditional UP3 and is often performed in conjunction with a tonsillectomy.

Tongue reduction surgery may be helpful when the tongue is abnormally enlarged. A reduction in the size of the tongue may cause less collapse into the airway, thus improving airflow and breathing.

Thyrohyoidopexy is a procedure that is performed in patients with mild to moderate OSA and significant obstruction behind the tongue. This procedure pulls the tongue forward by repositioning the hyoid bone and pulling the tongue and epiglottis down and forward. The procedure is performed through an incision through the neck and can be done without operating in the throat. As a result, recovery can be achieved in days rather than weeks. However, if this procedure is combined with a tonsillectomy and UP3, recovery will take 2 to 3 weeks.

In some cases procedures can be performed in different stages. For example, the thyrohyoidopexy can be done first followed by a sleep study in three months. If there is residual sleep apnea, palate work can be performed later, if necessary.

Surgeries Performed by an Oral and Maxillofacial Specialist

Genioglossus muscle advancement is a surgical option for patients with mild to moderate OSA. The genioglossus muscle attaches to the underside of the chin and moves the tongue forward during contraction. This surgery involves advancement of the chin bone with the genioglossus muscle to prevent collapse of the tongue onto the throat.

Maxillomandibular advancement (MMA) surgery advances the upper and lower jaw. The soft tissues of the airway are also advanced through their attachments to the jawbones, and this leads to a significant expansion of the airway. This surgery may be an option for individuals with moderate to severe OSA.

Maxillomandibular expansion (MME) surgery is another option to expand the upper airway and requires a combination of surgery and orthodontic treatment. The objective is to expand or widen the upper and lower jaw to create more room for the tongue and expand the airway.

MMA or MME surgery may not be right for you if you use tobacco, are morbidly obese, have facial pain, gum disease or are unwilling to have any alterations in facial appearance. Central sleep apnea and uncontrolled systemic medical conditions may also prevent you from having this type of surgery. An oral and maxillofacial specialist will assess your individual needs to determine which option may benefit you.

Other procedures may be offered separately or together with these procedures.

Make an Appointment

To schedule an appointment at the multi-disciplinary Alternatives to CPAP Clinic, please call 734-936-9158. To find out what a visit to the clinic involves, visit the Alternatives to CPAP Clinic page. A physician referral is required prior to your appointment date.