What are the possible complications of surgical interventions for the treatment of obstructive sleep apnea (OSA)?

Updated: Feb 25, 2021
  • Author: Charles E Morgan, DMD, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

Postobstructive pulmonary edema occasionally occurs after relief of clinically significant airway obstruction. This condition manifests as airway edema and respiratory distress, and it results from the dramatic alteration in pulmonary physiology that follows obstruction removal.

Complications from septoplasty include nasal bleeding, septal hematoma, injury to the skull base that results in an altered sense of smell or cerebrospinal leak, and septal perforation.

Nasal crusting and bleeding can occur after turbinoplasty, regardless of the method used to reduce the turbinates’ size. Rhinoplasty may leave the patient with an unappealing cosmetic result that may require further surgery.

The palatal Pillar system has been used for only the past few years. To date, complications include superficial mucosal ulcerations and dislodgement of the pillar implants. The complication rate seems to be about 3%, based on the studies currently available.

Minor bleeding is the only common complication of uvulopalatoplasty; UPPP may provoke more significant bleeding when the tonsils are removed. Airway obstruction, velopharyngeal insufficiency, and nasopharyngeal stenosis are less common complications of UPPP. Most advocate inpatient care in a closely monitored unit.

The most common (10-12%) complication of transpalatal advancement pharyngoplasty is an oronasal fistula, which seems to be temporary in most cases.

Tongue-base surgery is sometimes associated with bleeding, dysphagia, odynophagia, and airway edema. Superficial ulcer formation, hypoglossal nerve injury, and abscess are less common complications. Taste may also be altered after tongue-base surgery and, in rare cases, following standard tonsillectomy.

Radiofrequency ablation of the tongue base and soft palate is associated with rare, minor complications. These include mild pain, swelling, and mucosal ulceration that generally resolves unaided within 1-2 months.

Genioglossal advancement with hyoid suspension may be complicated by bleeding or infection in the floor of the mouth, Warthin duct injury, dental trauma, neck hematoma, pharyngocutaneous fistula, and wound infection.

Maxillary-mandibular advancement procedures may result in injury to the lingular neurovascular bundle. Most sensory impairments resolve over time. Cosmesis is generally not a problem.

A study by Friedman et al found a higher incidence of complications in patients with OSA who underwent multilevel surgery that included UPPP than in those who were treated with UPPP alone (4.63% vs 1.6%, respectively), although values for fatal complications were too small to compare. [13]

The complications of tracheotomy include bleeding, pneumothorax, subcutaneous emphysema, and formation of peristomal scar tissue. Early tube dislodgment can occur and may result in hypoxia and death if the tube is not promptly replaced.


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