Sleep Apnea Treatment in Ankara, Turkey

In the management of Obstructive Sleep Apnea Syndrome within plastic, reconstructive, and aesthetic surgery, the core principle is the anatomical repositioning of skeletal and soft tissue structures that narrow the airway. At the center of treatment, Maxillomandibular Advancement (MMA) and craniofacial airway reconstruction permanently enlarge the pharyngeal volume by advancing the lower and upper jaws forward as a single unit. By increasing tissue tension around the airway and mechanically preventing collapse during sleep, this surgical protocol both ensures functional airway patency and eliminates the problem at its root by correcting aesthetic disproportions in the facial profile.

What is Sleep Apnea Treatment?

Sleep apnea treatment includes methods aimed at controlling sleep apnea, which is characterized by repeated pauses or reductions in breathing during sleep. Treatment may include lifestyle changes, weight control, positional therapy, intraoral appliances, and the use of a continuous positive airway pressure (CPAP) device. In advanced cases, surgical options may be considered. Appropriate treatment aims to improve the patient’s quality of life and reduce possible cardiovascular risks.

Why Should Sleep Apnea Not Be Viewed as a Simple Snoring Problem?

This condition, which is often perceived by the public as merely loud sleeping or snoring, is in fact a health problem that carries vital risks. During sleep, as the muscles relax, the airway closes and breathing stops. When the brain notices this lack of oxygen, it jolts the body awake. This cycle can repeat hundreds of times throughout the night. The issue is not only that the patient cannot rest; the real danger is that the body remains under constant stress.

Some health problems that this syndrome may cause or trigger include:

• Hypertension
• Cardiac arrhythmias
• Insulin resistance
• Type 2 diabetes
• Difficulty concentrating
• Chronic fatigue
• Depression
• Decreased sexual desire

For us physicians, this picture indicates insufficiency of the skeletal structure that keeps the airway open. If we think of the airway as a tunnel, if the bones forming the walls of the tunnel are narrow or positioned posteriorly, the airflow passing through the tunnel will be obstructed with the slightest relaxation.

How is Anatomical Evaluation Performed in Plastic Surgery?

When our patients come to the clinic, the first thing we pay attention to is their facial profiles. Airway patency is directly related to the position of the jawbones. A retruded position of the lower jaw (mandible) or upper jaw (maxilla) relative to the cranial base is one of the main factors that narrows the airway. To detect this, a physical examination alone is not enough; we need to analyze the bony structure millimetrically.

The main diagnostic methods we use at this stage are:

• Lateral cephalometric analysis
• Panoramic X-ray
• Computed tomography
• Endoscopic airway examination
• Polysomnography reports

Especially in cephalometric analysis, we measure a value called the SNB angle. This angle mathematically shows us how far back the lower jaw is. If the jaw is retruded, the tongue muscles attached to the jaw are also pushed backward and obstruct the throat during sleep. Our task is to map this anatomy and clarify whether the problem originates from the bone or only from the soft tissue.

Why Is Maxillomandibular Advancement (MMA) Surgery the Most Effective Solution?

In moderate to severe sleep apnea cases, especially in patients with skeletal narrowing, the method that yields the most successful results is Maxillomandibular Advancement, or MMA surgery. This operation is considered the pinnacle of airway reconstruction in plastic surgery. The logic of the procedure is to expand the volume by moving the bony framework surrounding the airway forward.

During surgery, the upper and lower jawbones are cut in a controlled manner and advanced forward, generally by around 10 millimeters. This advancement does not only move the bones; it also tensions all soft tissues attached to these bones, including the tongue base and palate muscles. Thus, the tissues around the airway become taut and gain resistance against relaxation during sleep.

The most suitable candidate profile for MMA surgery has the following characteristics:

• Those with severe sleep apnea
• Those who cannot tolerate CPAP
• Those with a significantly retruded lower jaw
• Those with narrowing not caused by obesity
• Patients in the young and middle-age group

This surgery not only gives patients comfortable breathing but also provides a significant aesthetic improvement in the facial profile. Patients who have a “bird-like face” appearance due to a retruded chin achieve a stronger jawline and a more balanced facial profile after surgery. This reveals the “functional aesthetic” aspect of the procedure.

What Do Genioplasty and Muscle Advancement Achieve in Tongue Base Obstruction?

In some patients, instead of advancing the entire jaw, it may be sufficient to focus only on the tongue base, which is the main source of obstruction. The tongue attaches to a small bony prominence on the inner aspect of the lower jaw. If this attachment point is positioned posteriorly, the tongue falls backward under the effect of gravity during sleep and blocks the airway. To correct this, we apply the technique called “Genioglossus Advancement.”

In this procedure, a bony window in the midline of the lower jaw is pulled forward, moving the tongue’s attachment point anteriorly. However, in plastic surgery practice, we usually combine this procedure with an aesthetic refinement. When combined with chin tip surgery, namely “Sliding Genioplasty,” both the tongue base is opened and the patient’s chin tip is aesthetically enhanced.

The advantages provided by this combined approach are:

• Preventing the tongue from falling backward
• Defining the jawline
• Reducing the appearance of a double chin
• Keeping scars inside the mouth
• Faster recovery process

This method is an ideal option especially for patients with mild to moderate apnea who also have a small and retruded chin. The absence of any external incision scar also eliminates patients’ aesthetic concerns.

In Which Cases Are Soft Tissue Surgeries Preferred?

Not every patient needs bone surgery. If the patient’s jaw structure is normal and the obstruction is caused only by a drooping soft palate, enlarged tonsils, or lax pharyngeal tissues, soft tissue procedures come into play. Techniques that were frequently used in the past and were based only on cutting and removing tissues have now been replaced by methods in which tissues are repositioned and their tension is increased.

Current techniques applied within this scope include:

• Anterior palatoplasty
• Expansion sphincter pharyngoplasty
• Tonsil reduction procedures
• Radiofrequency applications
• Tongue base suspension

Especially in the “Expansion Sphincter Pharyngoplasty” technique, the muscles on the lateral wall of the throat are suspended upward and laterally with sutures, opening the airway like a curtain. In this way, tissues are preserved and airway collapse is prevented. These procedures are quite effective in reducing snoring and improving sleep quality in properly selected patients.

Is the Postoperative Recovery Process Difficult?

After surgical interventions, the issue patients are most curious about is the recovery process. Especially after extensive surgeries such as bony advancement (MMA), we follow our patients closely. Keeping them under observation in the hospital for the first few days is important to control edema in the airway and ensure comfort. Pain control is achieved with strong painkillers, and patients generally go through a more comfortable process than they expect.

During recovery, the nutrition plan plays a critical role. Since procedures are performed on the jawbones, it is necessary not to strain the jaw during the bone healing process.

Postoperative nutrition stages are:

• Clear liquids in the first week
• Thick liquids in the second week
• Pureed foods in the third week
• Soft chewable foods in the fourth week
• Normal diet after the sixth week

Patients can usually return to their daily routines and work life within 3–4 weeks. Complete resolution of facial swelling and settling of the final aesthetic result may take several months. However, improvement in breathing quality begins to be felt immediately after surgery.

How Do Weight Control and Lifestyle Affect Treatment?

Although surgical treatments anatomically enlarge the airway, obesity is still a very important variable in disease management. Excess fat accumulation around the neck puts external pressure on the airway, increasing narrowing. Therefore, weight management is essential to make surgical success permanent. In patients with a very high body mass index, we definitely recommend losing weight with dietitian support before or after surgery.

Lifestyle changes recommended to patients are:

• Regular exercise program
• Mediterranean-style diet
• Limiting alcohol consumption
• Quitting smoking
• Paying attention to sleep hygiene

When weight is lost, the fat pads in the neck region shrink and the airway opened by surgery becomes even more comfortable. This is the most important detail showing that treatment must be considered as a whole.