Somnoplasty

Somnoplasty is a unique surgical method for reducing habitual snoring by removing or stiffening tissues of the uvula and soft palate.

During normal breathing, air passes through the throat on its way to the lungs. The air travels past the tongue, soft palate, uvula, and tonsils. The soft palate is the back of the roof of the mouth. The uvula is the prominent anatomic structure dangling downward visibly at the back of the mouth (pharynx). When a person is awake, the muscles in the back of the throat tighten to hold these structures in place preventing them from collapsing and/or vibrating in the airway. During sleep, the uvula and soft palate frequently vibrate causing the distinctive sounds of snoring. Snoring may also originate from the walls of the throat and further down around the tongue base.

The most important aspect of snoring treatment is to first rule out the presence of obstructive sleep apnea. Obstructive sleep apnea is well known to be associated with significant medical problems such as heart disease, risk for stroke, increased somnolence, and increased risk for motor vehicle accidents. Snoring is a hallmark sign of obstructive sleep apnea for many patients. However, just because someone snores, it does not mean they have sleep apnea. To rule out obstructive sleep apnea, they require an overnight sleep study. The test is usually conducted in a lab or at home with specialized equipment and should be evaluated by a sleep medicine physician. When snoring is present without obstructive sleep apnea, it is called primary snoring.

Somnoplasty is a unique surgical method for reducing habitual snoring by removing or stiffening tissues of the uvula and soft palate. Unlike other approaches (such as the laser), somnoplasty uses very low levels of radiofrequency heat energy to create finely controlled localized burn areas beneath the lining (mucosa) of the soft tissues of the soft palate. These burn areas are eventually resorbed by the body, shrinking the tissue volume and stiffening the tissues, thereby reducing symptoms of snoring. Somnoplasty is performed under local anesthesia in an outpatient setting and takes approximately 30 minutes.

The following complications have been reported in the medical literature. This list is not meant to be inclusive of every possible complication. It is here for your information only, not to frighten you, but to make you aware and more knowledgeable concerning this procedure. Although many of these complications are rare, all have occurred, at one time or another, in the hands of experienced surgeons practicing the standards of community care. Anyone who is contemplating any type of surgery must weigh the potential risks and complications against the potential benefits of the surgery or any alternative to surgery.

1. Failure to resolve or eliminate snoring. Most surgeons feel that about 80% of patients who undergo a somnoplasty will have a significant reduction in their snoring for at least a year or more, and an additional percentage of patients will notice reduced levels of snoring such that their sleep partners will report that its level is no longer offensive.
2. Failure to cure sleep apnea or other pathological sleep disorders. Pathological sleep disorders, like sleep apnea, are medical problems that may have associated serious complications. At this time, the somnoplasty procedure has not been proven to cure these disorders.
3. Nasal regurgitation, a change in voice, or velopharyngeal insufficiency whereby liquids may flow into the nasal cavity during swallowing (rare).
4. Need for revision, or further and more aggressive surgery.
5. Prolonged pain, infection, bleeding, or impaired healing.
6. Thermal or electrical injury to the mucus membranes of the soft palate, uvula, or mouth. This may result in tissue loss by burn.
7. While not considered a complication, recurrence of snoring over time (usually greater than a year) has been noted for many snoring treatments. This is felt to occur as the tissue stretches out over time.

You should not take aspirin, or any product containing aspirin, within 10 days of the date of your procedure. If there is any question as to the contents of a medication, please call your doctor or consult your pharmacist. Acetaminophen (Tylenol and others) is an acceptable pain reliever. You should consult your doctor about whether or not ibuprofen (Advil, Nuprin, and others) or other nonsteroidal anti-inflammatory drugs are permissible.

You may eat a light meal before your procedure. Smokers should make every effort to stop smoking, or at least reduce the number of cigarettes. This will help to reduce postoperative coughing and bleeding.

You must know precisely what time you are to come to the office, and that you allow sufficient preparation time. You should wear comfortable loose-fitting clothes which will allow for a conductive pad to be placed on the lower back area.

Before the actual procedure, you will be given an oral spray to start anesthetizing the throat area. Once the throat is partially anesthetized, you will be given approximately three small injections in the roof of the mouth. Most patients find the process of anesthetizing the throat to be of only minor discomfort.

During the operation, you will be asked to sit upright and will be fully awake throughout the entire procedure. Your surgeon will explain the process and demonstrate the equipment. The Somnus "gun" device, which is connected to a radiofrequency generator, is placed into the mouth. A small electrode located at the end of the device is inserted into the soft palate (back of the roof of the mouth). Radiofrequency is applied through the electrode. Sections of the electrode are insulated to protect the delicate surface of the tissue. Through controlled delivery of radiofrequency energy, the tissue is heated in a limited area around the electrode. Most patients find the procedure to be surprisingly comfortable.

Snoring can be expected to be worse immediately after the procedure because of local swelling of the tissues treated. Improvement usually begins in one or two weeks and continues to occur for up to several months.

You will be able to go home once you feel comfortable. Most patients can safely drive themselves home from the office. It is best to sleep with your head elevated on 2-3 pillows for several nights following the procedure. A sense of fullness in the back of the throat is commonly reported for several days. By keeping your head elevated above your heart, you can minimize edema and swelling. Applying an ice pack to the neck may help relieve swelling.

You may experience a sore throat for several days for which you may take acetaminophen (Tylenol, and others) or ibuprofen (Advil, Nuprin, and others). A throat lozenge, such as Cepacol, can be soothing to the throat.

Do not eat or drink until the anesthesia has gone away. After this time, you may advance your diet as tolerated.

An appointment for a checkup should be made 7 to 10 days after the procedure. Call your doctor's office to schedule this appointment.

Notify your doctor if you have:

1. Extreme difficulty swallowing.
2. Difficulty breathing.
3. Sudden bleeding from the surgical site.