Snoring operation

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

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

Indications for the procedure

Considering the main causes  of snoring  with or without sleep apnea, indications for surgery include:

• narrowing of the nasal passages due to the  curvature of the nasal septum  or the presence of fibrous bridges (synechia) between the nasal septum and the conchas of the nasal cavity;
• nasal polyps ;
• cyst of the maxillary paranasal sinus (maxillary);
• hypertrophy or hyperplasia of the palatine tonsils (tonsils);
• an increase in the pharyngeal tonsil, that is, adenoids;
• hypertrophy of the palatine uvula and / or soft palate with lipatosis of the mucous membrane and weakening of the muscles (tensor, levator and palatoglossal);
• hypertrophy of the pharyngeal mucosa;
• pharyngeal pocket cyst (Thornwald's cyst).

Preparation

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

Depending on the place of intervention and the affected ENT organs, 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  study of the respiratory function of the nose .

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

All patients should stop smoking and take Aspirin and drugs with acetylsalicylic acid, as well as non-steroidal anti-inflammatory drugs (Ibuprofen, Nurofen, etc.) 12-14 days before the upcoming operation. A week before surgery on the nasal cavity or paranasal sinuses, the instillation of a stuffy nose with vasodilating drops (Nafthyzinum, Galazolin, etc.) is stopped. And eating stops 8-10 hours before the operation.

Technique of the snoring surgery

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

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

With obstruction of the nasal passages 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 of the bones and cartilage that form the nasal septum;
• removal of hypertrophied tissues of the mucous membrane of the shells of the nasal cavity by conchotomy (normal, laser, ultrasonic, liquid nitrogen);
• dissection of nasal synechia;
• removal of nasal polyps;
• removal of the maxillary sinus cyst (maxillary sinusectomy).

An adenoidectomy is also performed to remove adenoid vegetations, that is, a hypertrophied pharyngeal tonsil. [2]

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

• Surgery to remove the tonsils , as well as the  removal of tonsils
• Removal of adenoids in children
• Surgery to remove adenoids with a laser
• Methods for removing polyps in the nose

How laser uvulopalatoplasty is performed is 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 material  Treatment of snoring with a laser .

One of the most common procedures is palatal surgery for snoring using radiofrequency ablation, which reduces the excess tissue of the soft palate (the submucosal 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 fed 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 of performing an operation to remove a cyst of the maxillary sinus for formations of significant size involves a sinus otomy with an approach through the upper gum and the nasal wall of the sinus maxillaris. With a small cyst, an endoscopic method is used with access through the nasal passage.

Removal of synechia that makes it difficult to breathe through the nose is usually carried out with local anesthesia. An endoscopic method, conventional surgical scissors, a 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 procedures) for anomalies of the structures of the nasal cavity, including septoplasty, are covered in publications:

• Malformations of the nasal septum
• Atresia and narrowing of the nasal passages

Contraindications to the procedure

Operations against snoring are contraindicated for BMI (body mass index) ˃ 30.

General contraindications for the procedure include:

• inflammatory processes in the nasopharynx or exacerbation of ENT diseases of a chronic nature;
• poor blood clotting;
• severe insufficiency of the respiratory and / or cardiovascular system;
• severe degree of diabetes;
• tuberculosis, hepatitis C, AIDS;
• oncological diseases of any localization;
• psychical deviations;
• pregnancy.

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

Consequences after the procedure

The negative consequences after laser snoring surgery are

Scarring and fibrosis of the tissues of the palate, development of stenosis of the pharynx and worsening of apnea. In addition, laser uvulopalatopharyngoplasty can cause nasopharyngeal regurgitation, a long-term change in the timbre of the voice, and a partial loss of taste.

The consequences of conchotomy may be the formation of fibrous adhesions to the nose and deformation of its shape; maxillary sinusectomy can lead to trigeminal neuralgia; after removal of the cyst of the maxillary sinus, an osteochondral scar is formed on its nasal wall.

Also read  Removal of tonsils (tonsillectomy) Consequences and complications .

Complications after the procedure

The most common, common for these operations, are complications after the procedure in the form of:

• pain of varying intensity;
• bleeding;
• accession of infection and development of inflammation;
• swelling of the mucous membranes of the nose, oral cavity and pharynx;
• dryness of the mucous membranes of the mouth and oropharynx.

Septoplasty can lead to short-term numbness of the upper gums,

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

Possible complications of conchotomy are 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 in regular cleansing of the nasal cavity from crusts and mucus with a nasal shower. In addition, to reduce the likelihood of nosebleeds and swelling, it is recommended that you do not blow your nose for one to one and a half months, minimize physical activity and sleep with your head up high.

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

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

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

How to get rid of snoring without surgery?

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

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

• Snoring pills
• Drops from snoring
• Spray treatment for snoring