Sleep Apnea and Snoring in Syracuse and Ithaca, NY
Double board-certified Facial Plastic Surgeon Dr. Sang W. Kim and Dr. Douglas Halliday of the Natural Face™ Clinics provide treatment for sleep apnea and snoring for patients residing in the Syracuse metropolitan area and Central New York area including Ithaca, and Rochester.
What is the connection between nasal obstruction and obstructive sleep apnea (OSA)?
Think about how the air gets into the lungs with each breath. The air goes through a continuous pipe from the nose down to its destination – the lungs. There are several segments to this air pipe, starting with the nasal valve (entry point of the nasal passage), the nasal passage, the soft palate, and back of the tongue before it enters the lower airway. Normally, the nasal valve area accounts for more than 50% of upper airway resistance.
In people with an obstructive nasal airway, the effect of obstruction is amplified beyond their problematic nasal airway. Obviously these people experience trouble moving air at their nasal valve regions. Beyond that, the increasing effort to breathe through the narrow nasal valve results in increased negative pressure further downstream at the soft palate and back of the tongue, resulting in the collapse of these structures. This is where the snoring happens as well.
To overcome this challenge, these people will start breathing through their mouths during sleep. So how much difficult is it to breath through the mouth? During sleep, it is about 250% more difficult (higher resistance) to breathe through the mouth than through the nose, and further compromising the quality of sleep.
What is the data behind nasal surgery and obstructive sleep apnea (OSA)?
Within the published studies on nasal surgery and OSA, there are some controversies as to the extent the nasal surgeries improve OSA directly. Nasal surgery to correct the structural nasal airway problem has been shown to help OSA patients who could not previously tolerate the continuous positive airway pressure device. Many patients who rely on nasal medications (such as a nasal steroid, antihistamine, or other “allergy medicines”) may need less or no further medications after the surgery compared to before the surgery.
Some studies, however, have shown that the nasal surgeries do not always result in improvement of the sleep study score. This is counter-intuitive and controversial because it seems that if one’s obstructive nasal airway is improved, then one’s OSA score should improve also. While this is an active area of future research, growing consensus is that inadequate nasal surgery played a part in some of the old studies that fail to show significant improvement in the OSA score following nasal surgery.
Recent studies in which specific anatomic problems were identified and repaired through modern functional septorhinoplasty techniques show that patients experienced improvement both in qualitative measures as well as in quantitative sleep study scores. These are patients of whom the nasal airway was the primary cause of OSA.
What are the surgical options for nasal obstruction in patients with obstructive sleep apnea (OSA)?
Traditional basic nasal airway procedures consisted of septoplasty and turbinate reduction. In fact, correction of deviated nasal septum – also called septoplasty – continues to be the most common surgery performed by the otolaryngologists for structural nasal airway obstruction. The overall success rate or the satisfactory outcome reported by patients with nasal airway obstruction after the surgery ranges from 65-80% among published studies.
More recently, the modern functional rhinoplasty and the concept of repairing the nasal valve became the main focus in nasal airway surgery. In a select few patients, the functional rhinoplasty procedure has shown to actually improve or even cure OSA.
Why do the traditional basic nasal procedures like septoplasty/turbinate reduction fail to help in some patients? Would these patients benefit from functional rhinoplasty?
In 51% of the patients who require revision surgery for nasal obstruction, the nasal valve area was the persistent problem. Below are the specific nasal structures that the traditional septoplasty technique most often fails.
Persistent obstruction of internal nasal valve:
- Dorsal cartilaginous septum – 65-92%
- Dorsal bony septum (perpendicular plate of ethmoid) – 79%
- Narrowed middle vault – 40%
Persistent obstruction of external nasal valve:
- Caudal septum – 72%
- Domal cartilage deformity – 38%
Why are these problematic nasal structures often missed by the traditional nasal surgery (septoplasty) performed by the general otolaryngologists?
Foremost, the techniques employed by general otolaryngologists, in which the septoplasty is almost exclusively performed, are through incisions inside the nose (Killian or transfixion incisions). This greatly limits the visibility of the missed nasal valve structures described above. This also makes correction or manipulation of these structures technically challenging. Secondly, these structures described above are parts of the critical supporting mechanisms of the nose. Due to the concern related to destabilizing the nose, these structures are traditionally not disturbed when the traditional technique is employed.
Facial plastic surgeons with an otolaryngology background approach the nose from a different perspective (with the lessons learned through the cosmetic rhinoplasty surgeons and their patients of the previous generation).
A functional septorhinoplasty may be performed either through intranasal incisions only (endonasal approach), or through a small incision below the nose (open approach), depending on which structures need to be corrected. This allows access and ability to correct the entire nasal structure that is causing the obstructive problem, and at the same time, re-establishing and restoring the support mechanism of the nose.
Double board-certified Facial Plastic Surgeon Dr. Sang W. Kim and Dr. Douglas Halliday at Natural Face Clinics specialize in aesthetic enhancement of the face, head, and neck, exclusively. Patients come to see us from the Syracuse metropolitan area and Central New York area including Ithaca, and Rochester. At Natural Face Clinics, we specialize in restoring the youthful neck contour, tired appearance of the brows and eyes, and skin laxity. We offer customized treatment, both surgical and non-surgical, including facelift, eyelid surgery (blepharoplasty), nose surgery (rhinoplasty), brow lift, neck lift, and skin resurfacing. Find out more by scheduling your personal consultation today.