Sleep Apnea Surgery: Paralysis by By Analysis

One of the great advances of the internet is the boom in information available for health related topics. There's a ton of great information about sleep apnea out there, but unfortunately, much of it is the same old, recycled information that's not always accurate. I make it my job to know what patients are reading, and believe me, I try to read everything. 

There are a lot of benefits and problems associated with having all this information, but one thing that stands out is the paralysis that can occur when someone is considering surgery. Let's say that you tried everything possible with CPAP and oral appliances and wish to consider surgery. The first barrier that you'll encounter is all the negative opinions about the uvulopalatopharyngoplasty procedure, one of the more common procedures that's offered for sleep apnea. Much of the comments by patients that underwent this procedures are not very supportive of this procedure, in direct contrast to the studies that I read about in my journals. Granted, the overall success rate is about 40% at best long term, and there is a small risk for complications. 

One of the most commonly mentioned of the complications is something called velopharyngeal incompetence, where due to too much soft palate being removed, air or food can leak into the nose when you talk or swallow. It's like having a cleft palate. This was a common complication in the early 80's when this procedure was first developed, but these days, it's rare. Even when it happens, it's usually temporary. But because a small minority of people who suffer from this complication continue to voice their opinions against the uvulopalatopharyngoplasty procedure, it seems like this complication happens all the time. 

For some reason, physicians and the lay public are overly fixated on the soft palate as the source of all snoring and sleep apnea. We've known for years that sleep apnea involves multiple levels, including the nose, soft palate and tongue areas. If you definitively address all the appropriate areas with surgery, your success rates can go up to about 80% (for soft tissue procedures only). If you add bony framework surgery (maxillo-mandibular advancement), then success can go up to 95%. 

Once you get past the possible complications of sleep apnea and the fact that you'll probably need to address multiple levels of your airway, the next hurdle to overcome is: Which combination of procedures do you need?

There are multiple types of procedures for each area of the throat. Even with the same operation, all surgeons, by definition, will do it differently. Given all the different options available along with different recommendations by different surgeons, how are you to choose? 

Some people get more opinions, with even more confusion. Others just put off the decision altogether. Some just end up biting the bullet and pick a surgeon that they trust and go with it.

Are you someone that's considering surgery and can't make a decision? What's preventing you from making a choice?

Please note: I reserve the right to delete comments that are offensive or off-topic.

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