Our goal is to maximize airway effectiveness, to open obstructed airways, to minimize snoring, and to treat obstructive sleep apnea. We also perform appropriate workups to rule out underlying problems or conditions that may be associated with airway problems.
If patients have moderate to severe obstructive sleep apnea, and cannot tolerate CPAP or have daytime somnolence, mandibular advancement surgery can help. A mandibular advancement is jaw surgery that enlarges and stabilizes the entire velo-orohypopharyngeal airway (the area of the upper airway at the base of the tongue and soft palate). By moving the lower jaw forward, we can maximize airway effectiveness and treat lower jaw deformities that contribute to obstructive sleep apnea.
Mandibular distraction osteogenesis is a jaw surgery that treats sleep apnea and enhances airway function by widening the mandible (lower jaw). The basis of mandibular distraction is a surgical technique commonly associated with orthognathic surgery. Most commonly, mandibular distraction is used to treat children and adults with jaw abnormalities, especially due to cleft palate, severe asymmetry, severe mandibular hypoplasia with resulting airway compromise, facial clefts, Treacher Collins syndrome, Pierre Robin Sequence, and hemifacial microsomia.
Using 3D technology allows us to create a surgical plan with a level of accuracy not available with traditional imaging technology.
Another goal of the surgery is to avoid a tracheostomy or so that an existing tracheostomy can be removed.
If a patient has obstructive sleep apnea due to jaw deformities, maxillomandibular advancement surgery can help by enlarging the airway in the palate and tongue region by moving the upper and lower jaws forward.
Children and adults with syndromic craniosynostosis, such as Apert syndrome, Crouzon syndrome, and Pfeiffer syndrome, often experience obstructive sleep apnea and impaired nasal breathing due to midface hypoplasia. These patients can be helped with a technique called midface distraction.
In midface distraction, the upper jaw, cheeks, nose, and orbital rims are moved forward. Using external distraction devices, the midface is gradually brought forward by separating the spaces in the bone to allow new bone to form.
By using advanced 3D imaging, we can simulate the outcome of proposed surgical plans and adjust any discrepancies before surgery. The 3D technology allows us to create a surgical plan with a level of accuracy not available with traditional imaging technology.
At the Yale Airway and Sleep Disorders Program, our renowned faculty has successfully treated many children and adults with midface hypoplasia using midface distraction. Our goal is to provide the best medical treatment and supportive care before, during, and after surgery.
At the Yale Airway and Sleep Disorders Program, our team, composed of multidisciplinary specialists including maxillofacial surgeons, ENTs, dentists, and sleep disorder specialists, can provide relief from obstructive sleep apnea and snoring with surgical and non-surgical treatments.
The most common surgical procedures used to treat nasal obstruction are turbinate surgery, septoplasty, and rhinoplasty and nasal valve surgery.
- Turbinate surgery reduces the size of enlarged turbinates.
- Septoplasty attempts to straighten a deviated septum and restore its position to the midline to open the nasal airway.
- Rhinoplasty and nasal valve surgery are commonly used to treat nasal obstruction that originates at the external nose.
For more than 20 years, the airway and sleep disorders team at Yale has been helping children with craniofacial disorders by providing coordinated management and comprehensive care. All of our faculty members have a special interest in helping children and their families.
When a child is born with Pierre Robin Sequence, micrognathia, microretrognathia, glossoptosis, and other causes of micrognathia and airway obstruction, it can be difficult for the child to breathe and feed due to a cleft palate. A tongue-lip adhesion is a procedure to open the airway by temporarily sewing the tongue to the bottom lip in infants. In mild to moderate cases, a tongue-lip adhesion is a successful way to keep the tongue from falling back and blocking the airway.
Once the child’s cleft palate is repaired, which is generally around nine months old, the tongue and lip can be detached.
In situations where airway obstruction is more severe, the lower jaw might need to be brought forward, or elongated, using a procedure called distraction osteogenesis. Distraction entails placing a device that is turned to “grow” the jaw forward one millimeter per day. It is then removed within several months. Our ultimate goal is to avoid a tracheostomy; however, one might be required if the lower airway is obstructed as well.