Surgery for Sleep Apnea in Children

For children who have more severe sleep apnea that’s caused by a blockage in the airway or other problems with the structure of the face, nose, or jaw, doctors may recommend surgery. At Hassenfeld Children’s Hospital at NYU Langone, pediatric otolaryngologists and craniofacial surgeons work together to determine the least invasive and most effective surgical treatment for your child.

In many instances, our surgeons can offer innovative solutions to improve a child’s breathing without the need for a tracheostomy, in which a breathing tube is inserted into the trachea, or windpipe, in the neck. If a tracheostomy has already been performed, our physicians work together to design a treatment plan aimed at removing the breathing tube as soon as possible.

For babies with severe sleep apnea, surgery is often recommended as soon as possible after diagnosis to prevent complications such as developmental delays and growth problems. Surgery may also be recommended for children with less severe sleep apnea who don’t respond to more conservative treatment.

Our craniofacial surgeons have developed revolutionary techniques, such as distraction osteogenesis, to treat children with severe sleep apnea that is caused by having a tiny jaw or other unusual facial features.

Your doctor uses general anesthesia for each of these procedures.

Tonsillectomy and Adenoidectomy

Children with sleep apnea caused by chronically enlarged tonsils or adenoid tissue may have a surgical procedure to remove either or both of these infection-fighting structures. Our otolaryngologists remove most of the adenoid and tonsil tissue but leave the part that is embedded in muscle to reduce the risk of bleeding.

This procedure is performed at an outpatient center. The surgeon may prescribe a mild pain reliever, such as acetaminophen or ibuprofen, to relieve pain afterward. The doctor may also suggest that your child eat soft foods that are easy to swallow, such as soups and puréed vegetables and fruits, for a few days.

A follow-up visit is usually scheduled for a week after the surgery.

Tongue Base Suspension

Some children who have neuromuscular conditions, such as cerebral palsy or muscular dystrophy, may have moderate-to-severe sleep apnea, because the tongue blocks the airway during sleep.

These children may benefit from tongue base suspension. In this minimally invasive procedure, the surgeon anchors the base of the tongue to the jawbone with a stitch or a screw, preventing the tongue from relaxing into the back of the throat.

Although your child may have difficulty talking and swallowing for about a week after this procedure, there are no long-term effects on tongue movement.

Palate Reconstruction

Palate reconstruction, also known as uvulopalatopharyngoplasty, is sometimes recommended for children with sleep apnea caused by neuromuscular conditions or a cleft lip or palate.

Palate reconstruction involves removing excess tissue from the back of the throat. This includes removing part of the roof of the mouth, or the uvula, which is the small, fleshy lobe of tissue that hangs down in the back of the mouth.

Choanal Atresia Repair

Infants with choanal atresia may need an operation to open up one or both nasal passages. In this condition, cartilage that separates the nasal passages isn’t formed properly during the baby’s development.

The surgeon usually performs the repair through the nose, using an endoscope, which is a thin tube with a light on it. This helps the surgeon obtain a better view of the area. The surgeon then shaves away excess soft and bony tissue.

Sometimes, the surgeon may instead need to make an incision in the roof of the mouth. Both approaches require the use of general anesthesia.

The surgeon examines the opening with a nasal endoscope every month for the first three months after choanal atresia repair. He or she then does so again six months later to ensure that the nasal passage remains open. The nasal passage heals completely within one year.

Distraction Osteogenesis

Distraction osteogenesis, or jaw distraction, is a surgical procedure that was developed at NYU Langone to increase the size of the lower jaw, also known as the mandible, without the use of bone grafts. Your child's doctor may recommend jaw distraction if the child was born with a tiny jaw, which pushes the tongue into the back of the throat during sleep.

In this procedure, the surgeon makes a cut on each side of the lower jawbone and attaches a device known as a “distractor” to the jawbone with special pins. The screws are turned about a millimeter each day, providing room for new bone growth.

Distraction is usually a painless process. Our care team demonstrates how to turn the screws, so you can do it at home. The doctor usually monitors your child’s progress each week.

The same technique can be used to make room in the airway in children who are born with a small upper jaw, called the maxilla, or when the middle portion of the face is pushed too far back.

This procedure takes up to two hours and can be performed in children as young as a few days old. The length of your child’s stay in the hospital after surgery may depend on the severity of the problem.

The device can be removed in about two to three months, after the jaw has grown and the bone has healed.

Tracheostomy

Tracheostomy is a surgical procedure that temporarily opens up the trachea, ensuring that your child receives enough oxygen. Tracheostomy is only used for children with severe sleep apnea who do not improve with other treatments and are too young or ill to have other types of surgery.

In this procedure, the surgeon makes an incision into the cartilage of the trachea. The doctor carefully inserts a metal or plastic tube, called a tracheostomy tube, through the opening. He or she carefully avoids other structures, such as the esophagus, which carries food to the stomach, and the larynx, or voice box.

An oxygen tank may be connected to the tube, so that oxygen can be delivered into the lungs. The tracheostomy tube is held in place with surgical tape or sutures.

Children who have tracheostomy surgery usually need to stay in the hospital for three to five days and may recover at home within two weeks. The doctor’s office can provide instructions on how to care for the tracheostomy tube and may refer your child to a speech therapist at NYU Langone’s Rusk Rehabilitation, so that your child can learn to talk while the tube is in place.

For babies who cannot eat normally because of the tracheostomy tube, nutrition may be delivered through a feeding tube, which is a thin plastic tube inserted through the nose or mouth into the stomach. Insertion of a feeding tube is a nonsurgical procedure that can be done quickly and painlessly by a nurse.