Surgery for Sleep Apnea in Children

For children who have severe sleep apnea 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 developmental delays, growth problems, and other complications. Surgery may also be recommended for children with less severe sleep apnea who do not respond to more conservative treatment.

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

Your doctor uses general anesthesia for these procedures.

Tonsillectomy and Adenoidectomy

Children with sleep apnea caused by chronically enlarged tonsils or adenoids 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 the next few days after the procedure.

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

Septoplasty

Our surgeons may perform a septoplasty if your child has a deviated septum. This procedure centers the septum, creating two nasal passages of equal size and correcting the airflow problems that are causing sleep apnea.
 
Our otolaryngologists use small surgical instruments to make an incision in the tissue lining the septum. They straighten or reposition the deviated section of the septum to maximize airflow through the nasal passages. Doctors may also remove small pieces of cartilage or bone.

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. A doctor may recommend jaw distraction to treat a child 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.

Our care team demonstrates how to turn the screws, so you can do it at home. The doctor typically 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 a maxilla, or who have a middle portion of the face that 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 who 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 through the opening.

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 at least three to five days and may need rehabilitation before returning home. 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 Pediatric Rehabilitation Services, 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.