Sleep Apnea: When is surgery beneficial?

Surgery is beneficial in obstructive sleep apnea when patient’s symptoms do not improve after the first line of conservative treatment. Many patients pursue non-invasive treatments for sleep apnea initially, but patients may consult with a sleep apnea surgeon if their symptoms do not improve.

Obstructive sleep apnea occurs when the soft tissues at the back of the mouth collapse during sleep and cover up the opening to the airway. This causes the patient to stop breathing repeatedly for very brief periods of time throughout the night.

Night guards reposition some of the structures of the mouth, such as the tongue or the jaw, in order to prevent this obstruction of the airway.

A sleep apnea surgeon must get involved if the night guard is ineffective due to a defect in either the size and shape of the nasal passages or the fit of the jaw, either of which may need to be corrected surgically. Some of the procedures may also target the soft tissues that interfere with breathing.

Patients with obstructive sleep apnea will notice numerous symptoms, including daytime drowsiness and a persistent pattern of morning headaches. A sleeping partner may alert the patient to the telltale pattern of apparent stops in breathing. When experiencing such symptoms, the patient can complete a sleep study to confirm the diagnosis.

This condition has been linked with serious health problems like stroke and high blood pressure, so it’s important to seek effective treatment if you have been diagnosed with obstructive sleep apnea. Additionally, you’ll get more restful sleep and enjoy a better quality of life.
Some patients may be reluctant to consider surgery, but it can have dramatic results for patients who have not found other approaches to be effective.

Sleep apnea can have significant consequences for your health and well being, so if you have tried conservative measures, like a night guard, with minimal success, consider your options for a surgical treatment that can effectively address the problem. Schedule a consultation with our sleep apnea surgeon, Dr. Larry M. Wolford, to learn more.

If you have questions or would like to schedule an appointment, please contact Dr. Larry Wolford’s office using our online contact form or call 214-828-9115.

Condylar hyperplasia (CH) is a generic term describing enlargement of the condyle.  There are a number of different condylar pathologies that enlarge the mandibular condyle, with subsequent adverse effects on the morphology and function of the TMJ and mandible.  This may result in the development or worsening of a dentofacial deformity such as; mandibular prognathism (symmetric or asymmetric), and unilateral enlargement of the condyle, ramus, and body, facial asymmetry and malocclusion. 

Wolford has developed a simple, but encompassing classification that will allow the clinician to better understand the nature of the various CH pathologies, progression, and treatment options that have proven to eliminate the pathological process and provide optimal functional and esthetic outcomes.  The classification (Table 2 and Figure 29) also begins with the most common occurring form of CH and progresses to the least common occurring form.

CH Type 1:  This condition develops during puberty, is an accelerated and prolonged growth aberration of the normal condylar growth mechanism, is self-limiting but can grow into the 20’s, and can occur bilaterally (CH Type 1A) or unilaterally (CH Type 1B).

CH Type 2:  These condylar pathologies can develop at any age (although 2/3s develop in the 2nd decade), are unilateral condylar vertical and/or horizontal over-growth deformities, and are the most common occurring mandibular condylar tumors; osteochondroma (CH Type 2A) and less common osteoma (CH Type 2B).

CH Type 3:  These are other rare benign causing condylar enlargement. 

CH Type 4:  These are malignant conditions that can cause condylar enlargement.

The more common forms of CH (Types 1 and 2) will be presented relative to the clinical and radiographic findings, growth characteristics, effects on the jaws and facial structures, histology, and treatment considerations that are highly predictable in the elimination of the pathology and provide optimal treatment outcomes. 

FIGURE 29 Description

A-C) normal TMJ with balanced joint spaces.
D-F) CH Type 1 with relatively normal condylar shape, elongated condylar head and neck, and narrow joint space related to thin articular disc or displaced disc.  In the coronal view the condylar head is more rounded.
G-I) CH Type 2Av; an osteochondroma with a vertical growth vector without significant horizontal condylar enlargement or exophytic horizontal growth. This is a “young” osteochondroma with only about 3 years of growth.
J-L) CH Type 2Ah; an osteochondroma with horizontal (as well as vertical) enlargement of the condyle and exophytic outgrowth of the tumor. This tumor has been present for 6 years. Notice the significant increased vertical height of the mandibular body and ramus.

FIGURE 29