Lower airway surgery is undertaken by doctors to both increase the size of the airway to allow for proper breathing as well as to prevent the worry that the airway might suddenly collapse. It also goes a long way in preventing snoring in sleep apnea patients. As the name implies, lower airway surgery is meant to “narrow the lower part of the airway, located behind the back of the tongue.” Let’s take a look at the various types of lower airway surgery.
There is a muscle known as the genioglossus muscle that connects from the back portion of the tongue to a place on the back of the chin. A lower airway surgery known as genioglossus advancement takes place in order to move the tongue forward in the mouth to make more space behind the tongue allowing for air to circulate easily. This operation must be done in a hospital under general anesthesia and is performed by way of an incision being made inside the lower lip of the patient.
Sitting slightly above the Adam’s apple in the throat is a boned shaped like the letter “C” known as the hyoid bone. This bone connects to muscles at the edges of the lower throat as well as to the back of the tongue. Sometimes an operation known as hyoid advancement is performed on a sleep apnea patient to make the space behind the tongue more accommodating for airflow. With this surgerical procedure an incision is made in the hyoid bone and then it is brought forward and the doctor attaches it to either the jawbone or the Adam’s apple.
Sometimes the cause of air obstruction is a tongue that is too big. Doctors may decide to make the tongue smaller by taking out a small part of the center of it, in a V-shape formation. This surgery is known as midline glossectomy. When even more of the tongue is removed including side parts it is called a lingualplasty. If they are inflamed or enlarged, the lingua tonsils may be gotten rid of by way of a laser. The lingual tonsils are defined as the “tonsil-like tissue on the back part of the tongue.” Very often doctors will also perform a temporary tracheostomy because swelling from any one of these surgeries could cause breathing problems in the patient.
Some doctors choose to move both the lower and upper jawbones forward as well as the teeth of the patient. By pulling the “soft tissue structures” forward this allows more room for the tongue to rest in and can decrease air obstruction concerns. The portions of the jawbone that are brought forward must then be held where they remain by way of titanium screws and metal plates. This surgery is known as bimaxillary advancement (or the more scientific name is lafort 1 maxillary osteotomy with bilateral sagittal split mandibular osteotomy) and is usually performed on patients who have a jaw that is very small or else those who have not found relief from their sleep apnea symptoms from other forms of “soft tissue surgeries.” This surgery must take place in a hospital under general anesthesia. Often a patient will need to go to an orthodontist for realignment of their teeth after the surgery. This surgery will affect a patient’s facial appearance. How much change will be noted depends on how much work needed to be done to move the jawbone forward during surgery.