The treatment for obstructive sleep apnea is usually medical or continuous positive airway pressure (CPAP). Surgical treatment is usually not preferred and used as the last line of treatment in this condition when all the medical treatment and other therapies fail. Although, various surgical procedures are there which could be used in its treatment like uvulopalatopharyngoplasty, hyoid myotomy, craniofacial reconstruction, maxillomandibular osteotomy, etc. but not all of them are used in children.
Is There A Surgery For Obstructive Sleep Apnea In Children?
Craniofacial Reconstruction: It is the most common mode of surgical treatment in acceptor sleep apnea in the case of a child. Children suffering from genetic disorders and chromosomal aberrations like down syndrome, Treacher Collins syndrome etc. can have facial defects like cleft palate, cleft lip, hyoid bone defects, temporomandibular joint dislocation, and other midline defects which can be the cause of obstructive sleep apnea. In such conditions, facial reconstruction can be done to readjust the alignment of the face and close the defects for the permanent treatment. Maxillomandibular osteotomy could also be combined with this surgery in which some parts or partial bone can be taken out which may be creating the narrowing of the airway.
Genioglossus Advancement With Hyoid Myotomy: It is a surgical procedure in which the genioglossus muscle is detached from the original insertion and repositioned to a new location. The muscle attachment from the hyoid is also mobilized so as to create more space in the pharynx. Narrowing of the airway can be relieved effectively but there have been no long-term studies for obstructive sleep apnea confirming the permanent treatment.
Uvulopalatopharyngoplasty: It is a common surgery to be done in adults and it is less preferred in children but can be done if required. In this surgery, many tissues of the oral cavity and pharynx are removed like uvula, tonsils, pharyngeal tissue and a part of the soft palate. It helps in reshaping the pharynx for the widening of the airway and reducing, airway resistance. The results of this surgery are variable and a 50% success rate has been found which is comparatively a poor result for a surgical treatment. There are various complications related to this surgery like silent apnea, hemorrhage etc.
Tracheostomy: It is the last line of treatment given in the surgical procedures. Although it is a 100 percent successful treatment in obstructive sleep apnea whether in children or in adults it is a considerably disfiguring treatment for life. It also greatly reduces the quality of life of the child and is reserved for the last line when all the medical and other surgical modalities fail.
Few other surgical procedures can be done but are less likely to be done in a classic case of obstructive sleep apnea in a child, like laser-assisted uvulopalatoplasty, lingual plate, laser-assisted removal of the midline of the tongue, etc. These are dependent upon the choice of the doctor and the requirements of the patient.
Sometimes nasal surgeries can also be needed like polyp removal, septal reconstruction, turbinectomy, etc. which may additionally cause the symptoms of obstructive sleep apnea.
Yes, there are many surgeries available for the treatment of obstructive sleep apnea in children as well as in adults but the drawback is that surgical treatment is limited only in the patients who do not respond to medical therapies. It is kept as a last line effort to be done to treat the condition because it can be considerably decreasing the quality of life and is associated with more complications than medical treatment. Although a benefit of the surgical treatment is that it is permanent and does not require patient compliance for a longer period of time as compared to the medical treatment which demands a persistent effort. Children are less likely to undergo a surgical treatment because this condition is not so serious in childhood and is more aggressive in adulthood.
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