There are several types of nasal surgery for patients with obstructive sleep apnea. The common goal is to increase the size of the nasal passage, thereby decreasing the nose's airflow resistance. Once you are able to easily breathe through your nose, CPAP or oral appliance are generally better tolerated.
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Endoscopic Sinus Surgery
Inflammation of the nasal cavity and sinuses, known as chronic sinusitis, may contribute to obstructive sleep apnea. Endoscopic nasal surgery can be performed to treat it.
During endoscopic nasal surgery, an endoscope is inserted into the nose to view the nose and sinus cavity. The surgeon then uses specialized instruments to remove blockages and drain mucous to improve airflow and improve drainage from the sinuses to the nose.
Septoplasty
The bony structure separating your nostrils, known as the septum, can be crooked. This makes it hard to breathe through your nose and can cause a runny nose. Septoplasty can fix this problem.
During a septoplasty, your surgeon straightens the cartilages and bone causing the deviation. Any other blockages will be removed too. The procedure may be done with either local or general anesthesia.
Most patients recover from a septoplasty in about a week and notice improvements in their sleep soon after.
Turbinate Reduction
The bone structures of the nose, known as turbinates, are covered with a spongy lining that helps warm and moisturize air as it passes through your nasal cavity. Allergies and dust irritation can cause swelling in the turbinates, making it difficult to breathe. Enlarged turbinates can contribute to sleep apnea.
A turbinate reduction is a surgical procedure that opens up the blocked airways using cauterization, coblation, or radiofrequency ablation. It's often performed at the same time as a septoplasty.
Most patients recover from a turbinate reduction in about a week and notice improvements in their sleep soon after.
Nasal Valve Surgery
Weak or collapsed sidewalls in the nose can obstruct airflow and cause sleep apnea. Sidewalls can be collapsed all of the time or only when you're inhaling.
There are several surgical procedures that can be performed to widen or support your nasal valves:
- Spreader grafts widen the nasal valve
- Alar batten grafts prevent collapse in the sidewall
- Lateral nasal valve stabilization can support upper and lower lateral cartilages
Distraction Osteogenesis Maxillary Expansion (DOME)
When the upper jaw is too narrow, it also means the floor of the nose is too narrow, which restricts airflow. A treatment called distraction osteogenesis maxillary expansion (DOME) can treat nasal obstructions and other obstructions in the mouth by surgically expanding the upper jaw to improve your breathing.
DOME is a four-part procedure that requires an orthodontist and surgeon.
- First, the orthodontist installs a customized maxillary expander and four to six mini-implants in the roof of your mouth.
- Next, the surgeon performs an outpatient procedure to deepen and widen the natural suture of bone in the palate, which creates a small gap between the two sides of the upper jaw.
- After that, the patient turns the expander every day for a month. The goal is to create an expansion of 8 to 10 millimeters.
- After the expansion period, the orthodontist uses an oral appliance to return your teeth back to their normal alignment and spacing over the course of a year.
After DOME, most people sleep better, breathe more easily, and see improved blood oxygen levels.