Snoring surgery

Surgical treatment of ronchopathy, that is, surgery for snoring, can solve some problems of reduced patency of the upper respiratory tract - a decrease in their lumen due to the existing anatomical structures of the nasopharynx, oropharynx and laryngopharynx.

The localization and nature of surgical intervention in each case depend on the specific structures causing the obstruction of the upper respiratory tract and their condition. [ 1 ]

Indications for the procedure

Given the underlying causes of snoring with or without sleep apnea, indications for surgical intervention include:

• narrowing of the nasal passages due to a deviated nasal septum or the presence of fibrous bridges (synechiae) between the nasal septum and the turbinates of the nasal cavity;
• nasal polyps;
• cyst of the maxillary paranasal sinus (maxillary);
• hypertrophy or hyperplasia of the palatine tonsils (glands);
• enlargement of the pharyngeal tonsil, i.e. adenoids;
• hypertrophy of the uvula and/or soft palate with liposis of the mucous membrane and weakening of the muscles (tensor, levator and palatoglossus);
• hypertrophy of the pharyngeal mucosa;
• pharyngeal recess cyst (Thornwaldt's cyst).

Preparation

In preparation for any type of surgery to eliminate the causes of snoring, it is necessary to take a general blood and urine test, a blood test for its clotting rate (coagulogram), for hepatitis C and the immunodeficiency virus.

Depending on the site of intervention and the ENT organs affected, the following is performed:

• examination of the pharynx with radiography of the larynx and pharynx;
• rhinoscopy and x-ray of the nasal cavity and paranasal sinuses;
• Rhinomanometry is a study of the respiratory function of the nose.

If the operation is performed under general anesthesia, an ECG is done.

All patients should stop smoking and taking Aspirin and drugs containing acetylsalicylic acid, as well as non-steroidal anti-inflammatory drugs (Ibuprofen, Nurofen, etc.) 12-14 days before the upcoming surgery. A week before surgery on the nasal cavity or paranasal sinuses, stop using vasodilator drops for a stuffy nose (Naphthyzinum, Galazolin, etc.). And stop eating 8-10 hours before the surgery.

Technique snoring operations

What surgeries are currently being performed to treat snoring? These include surgical procedures such as:

• uvulotomy for hypertrophied uvula (uvula palatina);
• uvulopatoplasty, designed to reduce the volume of tissue in the uvula and soft palate;
• uvulopalatopharyngoplasty uvulopatoplasty with tonsillectomy (removal of the tonsils) and suturing of the bases of the vertical folds of the mucous membrane (palatine arches) on the sides of the pharynx;
• tonsillectomy;
• radiofrequency ablation (somnoplasty) of the soft palate.

In case of nasal obstruction and chronic nasal congestion, depending on the identified pathology, the following is performed:

• septoplasty - correction of the curvature of the nasal septum, that is, straightening the bone and cartilage that form the nasal septum;
• removal of hypertrophied tissues of the mucous membrane of the nasal cavity, conchotomy (regular, laser, ultrasonic with liquid nitrogen);
• dissection of nasal adhesions;
• removal of nasal polyps;
• removal of a maxillary sinus cyst (maxillary sinusotomy).

Adenoidectomy is also performed to remove adenoid vegetations, that is, hypertrophied pharyngeal tonsils. [ 2 ]

The technique of performing tonsillectomy, adenoidectomy and removal of nasal polyps (as well as possible complications of these operations) are discussed in detail in the articles:

• Tonsil removal surgery, also known as tonsillectomy
• Removal of adenoids in children
• Laser adenoid removal surgery
• Methods of removing nasal polyps

How laser uvulopalatoplasty is performed, an operation against snoring with a laser (carbon dioxide, neodymium or erbium), which reduces the volume of soft tissues of the structures of the oropharyngeal region, read in a separate article Treatment of snoring with a laser.

One of the most common procedures is a radiofrequency ablation surgery on the palate for snoring, which reduces excess soft palate tissue (submucous supratonsillar fat layer of the medial or lateral palatine space) and increases its rigidity. The procedure is performed under local anesthesia using an RF probe, which is supplied with high-frequency radio waves. When tissues are heated (to a temperature of +45-85°C), their volume decreases due to protein coagulation. [ 3 ]

The technique for performing surgery to remove a maxillary sinus cyst for large-sized formations involves antrotomy with an approach through the upper gum and the nasal wall of the sinus maxillaris. For a small cyst, an endoscopic method with access through the nasal passage is used.

Removal of adhesions that obstruct nasal breathing is usually performed under local anesthesia. Endoscopic methods, conventional surgical scissors, laser, or a special microdebrider instrument (with a rotating tip) can be used. [ 4 ]

The main types of operations (with a description of some surgical manipulations) for anomalies of the structures of the nasal cavity, including septoplasty, are covered in the publications:

• Defects of the nasal septum
• Atresia and stenosis of the nasal passages

Contraindications to the procedure

Surgeries for snoring are contraindicated if the BMI (body mass index) is ˃ 30.

General contraindications for the procedure include:

• inflammatory processes in the nasopharynx or exacerbation of chronic ENT diseases;
• poor blood clotting;
• severe failure of the respiratory and/or cardiovascular system;
• severe diabetes mellitus;
• tuberculosis, hepatitis C, AIDS;
• oncological diseases of any localization;
• mental disorders;
• pregnancy.

Laser uvulopalatoplasty is contraindicated in patients with sleep apnea and in patients under 18 years of age.

Consequences after the procedure

The negative consequences of laser snoring surgery include:

Formation of scars and fibrosis of the palatal tissues, development of pharyngeal stenosis and worsening of apnea. In addition, laser uvulopalatopharyngoplasty can cause nasopharyngeal regurgitation, long-term change in the timbre of the voice and partial loss of taste.

The consequences of conchotomy may include the formation of fibrous adhesions to the nose and deformation of its shape; antrotomy may lead to trigeminal neuralgia; after removal of the maxillary sinus cyst, a bone-cartilaginous scar forms on its nasal wall.

Also read Tonsillectomy (Tonsillectomy) Consequences and Complications.

Complications after the procedure

The most common complications after the procedure, common to the listed operations, are:

• pain of varying intensity;
• bleeding;
• the addition of infection and the development of inflammation;
• swelling of the mucous membranes of the nose, mouth and throat;
• dryness of the mucous membranes of the mouth and oropharynx.

Septoplasty may cause temporary numbness of the upper gum,

Dryness and congestion in the nose, formation of blood clots in the nasal cavity, and decreased sense of smell.

Possible complications of conchotomy include inflammation and dryness in the nose.

Complications of the radiofrequency ablation procedure include erosion and ulceration of the palatal mucosa.

Care after the procedure

Care and rehabilitation after the septoplasty procedure consists of regularly cleaning the nasal cavity from crusts and mucus with a nasal shower. In addition, to reduce the likelihood of nosebleeds and swelling, it is recommended: for one to one and a half months, do not blow your nose, minimize physical activity and sleep with the head of the bed raised high.

By the way, the last two recommendations apply to all the above procedures for getting rid of snoring. You should also drink more liquid.

After a maxillary sinusectomy, a saline solution is instilled into the nose, after a conchotomy, the nose is washed with a saline solution, and after the removal of nasal adhesions, ointments (Bacitracin, Polymyxin, etc.) are used to treat the nasal mucosa.

In general, each patient is given clear instructions for the postoperative period, and the doctor's recommendations must be followed.

How to get rid of snoring without surgery?

Surgical intervention is necessary only in the cases discussed above. And not always such operations for snoring give a positive result, and the person stops snoring. For example, as clinical experience shows, removal of adenoids does not reduce the likelihood of snoring, but for solving the problem of airway obstruction this measure is 100% effective. [ 5 ]

Therefore, you can try to get rid of snoring without surgery by losing excess weight, using tablets, drops or aerosols. Read more about them:

• Anti-snoring pills
• Anti-snoring drops
• Treating snoring with sprays