What is septal surgery?

The septum is a thin piece of cartilage and bone inside the nose between the right and left sides. It is about 7 cms long in adults. In some people this septum is bent into one or both sides of the nose, blocking it. Sometimes this is because of an injury to the nose, but sometimes it just grows that way. We can operate to straighten the septum.

Why have septal surgery?

If you have a blocked nose because of the bend in the septum, an operation will help.

Sometimes we need to straighten out a bent septum to give us room to do other things, such as sinus surgery. The operation is not meant to change the way your nose looks.

In some cases a bent septum may occur with a twist in the outside shape of the nose. In these cases septal surgery may be combined with nose reshaping surgery (septorhinoplasty) to straighten the nose.

Do I have to have septal surgery?

A bent septum will not do you any harm, so you can just leave it alone if you want to. Only you can decide if it is causing you so much bother that you want an operation.

How is the operation done?

The operation takes about 30-45 minutes. You might be asleep after anaesthesia. The operation is usually all done inside your nose - there will be no scars or bruises on your face. We make a cut inside your nose and straighten out the septum by taking away some of the cartilage and bone and moving the rest of the septum back to the middle of the nose. Then we hold it all in place with some stitches. Complex cases may require a cut across the skin between the noses and may be combined with rhinoplasty procedures.

Packs and splints

We may need to put a dressing in each side of your nose to keep things in place and prevent bleeding. The dressings are called ‘packs’, and they will block your nose up so that you have to breathe through your mouth. We will take them out the morning after your operation.

You may get a little bit of bleeding when the packs come out - this will settle quickly.

Sometimes we put small pieces of plastic in your nose to prevent scar tissue from forming. They are called ‘splints’ and we will take them out after about a week.

Does it hurt?

Not really, but sometimes the front of your nose can be a bit tender for a few weeks.

After the operation

We may give you some drops or spray to help this. It may take up to three months for your nose to settle down and for your breathing to be clear again. Try to stay away from dusty or smoky places.

There will be some stitches inside your nose - these will dissolve and usually fall out by themselves.

Do not blow your nose for about a week, or it might start bleeding.

If you are going to sneeze, sneeze with your mouth open to protect your nose.

You may get some blood colored watery fluid from your nose for the first two weeks or so - this is normal.

Your nose will be blocked both sides like a heavy cold for 10-14 days after the operation.

How long will I be off work?

You can expect to go home the day after your operation. Sometimes it is possible to go home the same day. You will need to rest at home for at least a week

If you do heavy lifting and carrying at work, you should take two weeks off. You should not play sports where there is a risk of your nose being knocked for about a month.

Possible complications

Septal surgery is safe, but there are some risks. Sometimes your nose can bleed after this operation, and we may have to put packs into your nose to stop it. This can happen within the first 6 – 8 hours after surgery or up to 5 – 10 days after surgery. Rarely you may need to return to the operating theatre with another general anaesthetic to stop the bleeding.

Infection in your nose is rare after this operation but if it happens it can be serious, so you should see a doctor if your nose is getting more and more blocked and sore.

Rarely, the operation may leave you with a hole in your septum inside the nose going from one side of your nose to the other. This can cause a whistling noise when you breathe, crusting with blockage or nosebleeds. Most of the time it causes no problems at all and needs no treatment. Further surgery can be carried out if necessary to repair a hole in the septum.

Very rarely you may find that the shape of your nose has changed slightly, with a dip in the bridge of your nose. Most people do not notice any change, but if you are not happy with it, it can be fixed with surgery. Very rarely though, but you can have some numbness of your teeth, which usually settles with time.

Is there any alternative treatment?

Only an operation can fix a bent septum, but nose spray or drops can help treat swelling in the nose which might be making your nose feel blocked.

If septal deformity is the cause of your nasal blockage there is no treatment other than surgery to correct the shape of the septum.

What are sinuses?

Sinuses are air-filled spaces in the bones of the face and head. They are connected to the inside of the nose through small openings. The sinuses are important in the way we breathe through the nose and in the flow of mucus in the nose and throat. When the sinuses are working properly we are not aware of them but they often are involved in infections and inflammations which cause symptoms. These infections and inflammations are called sinusitis.

What is sinusitis?

Sinusitis is caused by blocked, inflamed or infected sinuses. Patients will often complain of a blocked nose, pressure or congestion in the face, runny nose or mucus problems. Other symptoms include headache and loss of sense of smell. Sinusitis can be difficult to diagnose and your specialist will want to examine your nose with a telescope in order to help find out what is wrong. Most patients with sinusitis get better without treatment or respond to treatment with antibiotics or nose drops, sprays or tablets. In a very small number of patients with severe sinusitis an operation may be needed. In rare cases if sinusitis is left untreated it can lead to complications with infection spreading into the nearby eye socket or into the fluid around the brain. These very rare complications are just some of the reasons that a sinus operation may become necessary.

What is endoscopic sinus surgery or FESS?

Endoscopic Sinus Surgery is the name given to operations used for severe or difficult to treat sinus problems. In the past sinus operations were done through incisions (cuts) in the face and mouth but endoscopic sinus surgery allows the operation to be performed without the need for these cuts. Before any operation patients will be treated using drops, tablets or sprays for a period of weeks if not months. Only if these treatments are unsuccessful will an operation become necessary. After an examination of your nose with a telescope your surgeon will discuss whether or not you will need to have a CT scan to help decide about the need for an operation.

Do I have to have the operation?

Endoscopic sinus surgery is only one approach to the treatment of sinusitis. Endoscopic sinus surgery is as safe, and possibly safer, than other methods of operating on the sinuses. The other methods of operating on the sinuses involve cuts in the face or mouth and if you feel that this may be more appropriate in your case you should discuss this with your surgeon.

In some patients an operation can be avoided by use of antibiotics and steroid medicines, again this should be discussed with your surgeon.

How is the operation done?

Usually the operation is done with you asleep (General Anaesthetic) but it can also be done with just your nose anaesthetised (Local Anaesthetic). The operation is all done inside your nose. The surgeon will use special telescopes and instruments to unblock your sinuses. Small amounts of bone and swollen lining blocking your sinuses are removed. Once the sinuses are unblocked, the inflammation usually settles and your symptoms should start to get better. Rarely there may be some bruising around the eye but this is very uncommon. There should be no need for incisions (cuts) unless the operation is a complicated one in which case this will have been discussed with you before the operation.

After the operation

Immediately after the operation you may feel your nose blocked. This may be because of some dressing inside your nose or some special plastic sheets called splints. These are not used in every case but your surgeon will explain if they have been necessary in your case. Dressings, if used, will usually be removed from your nose within 24 hours but plastic splints may have to stay longer.

It is common to have a stuffy blocked up nose even after removing the dressing or splints and this does not mean that the operation has not worked.

Does it hurt?

It is common for the nose to be quite blocked and to have some mild pain for a few weeks after the operation. This usually responds to simple painkillers.

Can I blow my nose?

It is important that you do not blow you nose for the first 48 hours following your operation. Your surgeon will advise you on when you can start to gently blow your nose. Some doctors recommend the use of drops, ointments and salt water sprays after the operation. You will be given specific instructions by the ward staff before your discharge from hospital. Some mucus and blood stained fluid may drain from your nose for the first week or two following the operation and this is normal. It is important to stay away from dusty and smoky environments while you are recovering.

How long will I be off work?

You can expect to go home on the day of your surgery or the day after your operation depending on the size of your operation. You will need to rest at home for at least a week. If you do heavy lifting and carrying at work you should be off work for at least 2 weeks. You will be given instructions on when to return to the hospital for your follow-up visit.

Possible complications

All operations carry some element of risk in the form of possible side effects. There are some risks that you must know about before giving consent to this treatment. These potential complications are very uncommon. You should discuss with your surgeon about the likelihood of problems in your case before you decide to go ahead with the operation.

How often do complications happen?

In general, complications are very rare. If you are particularly worried you should ask your surgeon about his or her experience of these complications.

What is allergy?

Our bodies have an in-built and complex system to defend against microbes such as viruses and bacteria etc but when our immune system kicks up an overly heightened response on getting exposed to certain foreign substances, it is called allergy.

What symptoms show onset of nasal allergy?

Runny nose, stuffy nose, multiple recurring bouts of sneezing, itching in throat and/or nose – a patient with nasal allergy can show all these and some of these symptoms.

How is nasal allergy treated?

Unfortunately, the medical science still hasn’t found any permanent cure for allergies. Most medicines prescribed – such as antihistamines, with or without decongestants; steroid nasal sprays, or antihistamine-delivering nasal sprays or cromolyn sodium - can only offer symptomatic relief. For those suffering from chronic allergy, allergy testing and allergy shots (also called immunotherapy) can help to an extent. The ENT doctor can also prescribe antihistamine and steroid sprays for long term usage but these must be used correctly.

What is a blocked nose?

The sensation of a blocked nose is often referred to as nasal obstruction, a stuffy nose and nasal congestion. The severity of the nasal obstruction varies from one patient to the next. Some people find even mild nasal blockage quite troublesome, whereas others, with quite severe nasal obstruction, find it does not have a significant impact on their daily activities. Your specialist will take this into account when developing a plan for your treatment.

What causes a blocked nose?

Nasal obstruction can be due to problems with the shape of the inside of the nose, or swelling of the lining of the inside of the nose. Problems with the shape of the inside of the nose can be due to twisting of the middle partition of the nose (the nasal septum), or to weakness of the outside of the nose. Either of these may be associated with abnormalities of the shape of the outside of the nose. Occasionally other structures, such as the adenoids, can be enlarged leading to nasal obstruction.

The nose is lined by a thin mucous membrane which can swell to cause blockage. Folds of the mucous membrane called turbinates are particularly prone to swelling. We all experience this swelling in response to the common cold, in which case the lining swells in response to a viral infection. Doctors often refer to swelling of the lining of the nose as “rhinitis” and it can have many other causes. Apart from viral infections, rhinitis may be due to bacterial infection in the nose and sinuses, allergy, or overuse of nasal decongestant medication. Occasionally the mucous membrane swells enough to cause the formation of polyps in the nose.

What are the symptoms?

Nasal obstruction is a symptom in itself. In certain conditions it may be accompanied by other symptoms such as rhinorrhoea (nasal discharge, which can drip from the front of the nose, or into the back of the throat - catarrh), facial pain, anosmia (loss of sense of smell), sneezing, itching and crusting. Your specialist will consider these other symptoms when making a diagnosis and developing a plan for your treatment.

What can I do to help myself?

Mild nasal obstruction may not require any treatment. If your symptoms are short lived, lasting only a few days to a couple of weeks, you may want to treat it yourself using over the counter medication such as a decongestant nasal spray. Decongestant sprays should not to be used in the long term. Sometimes people find it soothing to breathe in steam, or vapours such as menthol and eucalyptus. Saline drops or sprays, or other nasal douching preparations from your pharmacist may also be used to help wash away any thick sticky mucus in your nose.

If your symptoms are caused by a seasonal allergy and are mild and intermittent an antihistamine tablet may help. Alternatively, your doctor may prescribe a steroid nasal spray. It is important to follow the instructions provided with this treatment. If the cause of your nasal obstruction is collapse of the outside of the nasal tip, you may find it useful to wear an adhesive dilating strip, particularly at night. If you find your symptoms troublesome and persistent, or if they are caused by an injury to your nose, you should contact your doctor for advice.

How is the condition diagnosed?

The first thing your specialist will do to diagnose your condition is ask some questions about your symptoms. Asking about your symptoms is very important to help narrow down the possible causes of your condition. To help clarify the cause of your symptoms your specialist will then examine your nose often with the help of a headlight or an endoscope (a thin telescope with a camera). This examination is not painful but some people find it slightly uncomfortable.

Occasionally your doctor may want to do some other tests to help clarify the cause of your symptoms. Common tests include blood tests, skin tests for allergy, and imaging studies such as a CT scan of the nose and sinuses. It is important to remember that not all conditions causing nasal obstruction need investigations. Your specialist will decide which investigations are necessary.

Treatment options

The treatment options for your blocked nose depend on the underlying cause and severity of your symptoms; they include medication and surgery. If the cause of your nasal obstruction is rhinitis your specialist may prescribe a course of medication such as an intranasal steroid spray, antihistamines or decongestants. It is important to follow your specialist’s instructions closely.

What is the correct manner of using steroid spray?

• Wash your hands thoroughly.
• Use a nasal decongestant or blow your nose gently to clear your nasal passages.
• Shake the steroidal spray container a few times.
• Close one nostril using index finger.
• Put the nozzle into the open nostril away from the nose’s midline (nasal septum) and spray straight back. Never spray up towards the tip of the nose. This becomes easy if you spray into the right nostril using the left hand and into the left nostril using the right hand.
• Sniff in gently and deeply to activate the spray and exhale through the mouth.
• Now repeat these steps for the other nostril.

Caution: Spray only one nostril at one time. Spray into alternate nostrils each time. Never give two sprays in one nostril. One spray per nostril is sufficient.

What causes nosebleeds?

Think about the human face. You will see that the nose protrudes out from the face and is actually rather vulnerable to injuries. A trauma on the face can cause injury to the nose and result in nosebleed (medically called epistaxis). Depending on the site and the extent of injury, this bleeding can be minor or major. Nosebleeds can occur on their own as well without an outside injury. It can also happen if the nasal membrane becomes overly dry and cracks open letting out blood.

As a matter of fact, such nosebleeds are extremely common in very dry climates whether summer or winter. Plus, if a person is on anticoagulant or blood thinning medicine such as warfarin or aspirin or anti-inflammatory drugs, even minor traumas can result in heavy nosebleeds.

Who are more prone to nosebleeds?

Nosebleeds can happen more among people with:

• Infection i.e. rhinosinusitis
• Allergic and nonallergic rhinitis
• Use of blood thinning drugs
• Trauma that can also be self-inflicted through actions such as nose picking. This is commoner in children.
• Hypertension (high blood pressure)
• Alcohol abuse
• Pregnant women undergoing hormonal changes
• In rare cases, nosebleeds can be due to tumours or inherited bleeding disorders

What is the recommended first-aid for stopping a common nosebleed?

Actually tackling a common nosebleed is easy and does not require help from a doctor. Of course, you should know the correct first-aid steps which we are outlining below:

• Use your index finger and thumb to pinch together the soft part of the nose.
• Compress the pinched part of the nose towards the face bones.
• Lean forward a bit and tilt the head forward as well. This will stop blood from running back into sinuses and throat which can lead to gagging or inhalation of blood
• Keep on holding the pinched nose for minimum 5 minutes. Repeat the entire process until nosebleed stops.
• Keep the head higher than the level of the heart. Do not lie down. Do not put your head between your legs. Just sit quietly.
• Wrap some ice in towel and place it on cheeks and nose.
• If the problem recurs, visit your ENT physician for a checkup.

When should I rush to a hospital’s emergency section over a nosebleed?

While most nosebleeds are the common type and can be handled at home, you need to watch out for the following symptoms and rush to the hospital immediately:

• If the bleeding is unstoppable or keeps happening again and again.
• If the bleeding is heavy and the blood loss seems considerable.
• If the patient is feeling faint or weak.
• If the nosebleed is happening due to facial trauma, or is accompanied by loss of consciousness or blurred vision.
• If the nosebleed is occurring with fever or headache.
• Last but not the least, if your infant or toddler gets a nosebleed, visit your pediatrician.

Rhinoplasty Gallery

What gives the nose its shape?

The shape of the nose on the outside is due to the shape of the bone and cartilage and the overlying skin. The top of the nose is made of bone shaped like a roof, which is hard. The middle and tip of the nose are made of cartilage, which is softer. The skin varies in thickness from person to person, and this also affects the shape.

What is Rhinoplasty?

Rhinoplasty is an operation to change the shape of the nose. The type of rhinoplasty depends on which particular area of the nose needs correction.

The nose can be straightened, made smaller or bigger, and bumps may be removed.

The shape of the tip of the nose can be changed.

Pieces of cartilage or bone may be removed from or added to the nose to change its shape.

Sometimes the wall that separates the nose into right and left (nasal septum) is twisted. We may need to correct it at the same time. The combined operation is called septorhinoplasty.

How successful is the operation?

Everybody�s nose and face is different, so it may not be possible to make your nose look exactly like your perfect nose.

The thickness of the skin is important in how much better the nose will look after rhinoplasty and in what can be done. If the skin is thin, it makes bumps or hollows in the nose difficult to hide. If it is thick not all changes that can be made on the inside will show up on the outside.

Your surgeon will aim to produce a nose that looks natural. However, your surgeon may not be able to say exactly how your nose will look after your operation. It is important that you discuss your expectations with your surgeon. 90-95% of patients are happy with the results of their operation but some people request more surgery.

How is the operation done?

Photographs will be taken to allow a record to be kept in your notes of how your nose looked before surgery, and to allow the surgeon to plan your operation.

Rhinoplasty and septorhinoplasty are usually performed with you asleep. Cuts are made inside your nose. Occasionally a small cut on the skin between the nostrils or at the base of the nostrils may be necessary. The skin of your nose is gently lifted off the bone and cartilage underneath. A hairline fracture may be made in the nasal bones to allow the surgeon to change the shape of the nose. Pieces of bone and cartilage can be removed from or added to the nose to smooth out any bumps or dips.

After the operation packs and splints

We may need to put a dressing in each side of your nose to keep things in place and prevent bleeding. The dressings are called �packs�, and they will block your nose up so that you have to breathe through your mouth.

We may take them out the morning after your operation. You may get a little bit of bleeding when the packs come out � this will settle quickly.

Sometimes we put small pieces of plastic in your nose to prevent scar tissue from forming. These are called �splints� and we will take them out after a week.

You will have a temporary splint on the outside of the nose for a week. This should be kept dry.

Does it hurt?

Not really, but sometimes the front of your nose can be a bit tender for a few weeks.

What happens after the operation?

• Do not blow your nose for about a week, or it might start bleeding.
• If you are going to sneeze, sneeze with your mouth open to protect your nose.
• You may get some blood-coloured watery fluid from your nose for the first two weeks or so � this is normal.
• Your nose will be blocked both sides like a heavy cold for 10-14 days after the operation.
• We may give you some drops or spray to help this.
• It may take up to three months for your nose to settle down and for your breathing to be clear again.
• Try to stay away from dusty or smoky places.
• There will be some stitches inside your nose � these will dissolve and fall out by themselves.
• You may have some bruising and swelling around your nose and eyes for one to two weeks
• Sleeping upright with extra pillows for a few days helps.
• Following rhinoplasty or septorhinoplasty, the skin of the nose is very sensitive to the sun. It is important to wear strong sunscreen and a hat for at least six months.
• The nose may feel a little stiff and numb for up to three months, particularly around the tip. Fine swelling may take up to a year to settle at which time the final results of surgery may be judged.

How long will I be off work?

You can expect to go home the day after your operation. You should rest at home for at least a week. Most people need one to two weeks off work, especially if their work involves heavy lifting or strenuous activity.

You should not play sports where there is a risk of your nose being knocked for six weeks

Possible complications

Sometimes your nose can bleed after the operation, and we may have to put packs into your nose to stop it. This can happen within the first 6 � 8 hours after surgery or up to 5 � 10 days after surgery. Very occasionally patients need to have another operation to stop the bleeding.

Infection in your nose is rare after this operation but if it happens it can be serious, so you should see a doctor if your nose is getting more and more blocked and sore.

Rarely, the operation may leave a hole in your septum inside the nose going from one side of your nose to the other. This can cause a whistling noise when you breathe, crusting with blockage or nosebleeds. Most of the time it causes no problems at all and needs no treatment. If necessary, further surgery can be carried out to repair a hole in the septum. Very rarely, you can have some numbness of your teeth, which usually settles with time.

About 5-10% patients need further operations in the future to further adjust the shape of the nose.

Is there any alternative treatment?

There are no pills or tablets that can be used to change the shape of the nose. Very rarely an injectable skin filler might be helpful for small refinements in the shape of the nose.In some cases a patient�s wish for rhinoplasty may be related to a disorder of body image (body dysmorphic disorder). These patients should not have surgery and should be offered a referral to a psychiatrist.

Is snoring a common problem?

Yes, at least 20% of the adult population snore regularly and loud enough to disturb those around them.

Why do some people snore and others do not?

The following 5 things are most likely to make you snore:

Being overweight- People who are overweight are much more likely to snore than those who are the correct weight for their height. Gaining weight makes existing snoring worse and losing it makes snoring better.

Getting older -Snoring gets worse with age.

Gender -Men are three times more likely to snore than women, but of course women are also afflicted. After the menopause women tend to catch men up.

Drinking alcohol- Alcohol makes snoring worse. This is a direct effect because alcohol relaxes the muscles of the throat and this causes airway collapse � the cause of snoring.

Smoking -Smoking makes snoring worse.

Some other factors that influence whether people snore

Families who snore

Snoring may run in families. Snoring is related to the shape of your throat, and in the same way that families look alike, they may snore alike!

A blocked nose

If you have a blocked nose at night, this may cause snoring. Correcting the nasal abnormality may reduce the snoring.

Sleeping position

Often lying on your side reduces snoring, particularly if it is not very severe. This is because when lying on your back, your tongue tends to fall backwards and block the airway.

In children

Large tonsils and adenoids can cause severe snoring and sleep apnoea in children. This may be so severe as to require urgent treatment.

What is sleep apnoea and is it related to snoring?

Sleep apnoea is when you stop breathing during sleep. The sleep apnoea which occurs in snorers is called obstructive sleep apnoea because the throat actually blocks while you are sleeping. Sufferers can be seen to be struggling for air and tend to wake with a loud grunt or snort. Sometimes they actually hear their own snoring and if a snorer is waking himself up at night, it is often because of sleep apnoea.

Apart from causing restless sleep, the sufferer may be very tired in the daytime because of the disturbed sleep. Such people may find it difficult to stay awake even when doing important tasks such as driving a vehicle. Sleep apnoea and snoring are part of the same condition. Bad snorers tend to develop sleep apnoea. The 5 important factors in snoring also apply to sleep apnoea. However, occasional stopping of breathing during sleep is not unusual. This can happen up to four times an hour and not be important, but if it is happening regularly and causing sleep disturbance and tiredness, it may well be significant.

When you visit our doctors

• You will be asked about the problem.
• You will be examined, including your weight and height to calculate your Body Mass Index (BMI).
• You will be advised about weight loss if appropriate.
• You may have some form of �sleep study� recommended and arranged. This essentially involves measuring your blood oxygen level, breathing and pulse rate. It can be done in the hospital overnight.
• If the �sleep study� reveals you have sleep apnoea specific treatment will be recommended: �Continuous Positive Airway Pressure� (CPAP) treatment. This involves wearing a mask over your nose at night. The mask gently blows air into you all the time, holding the airway open during breathing. This treatment is effective but needs careful supervision, particularly at first and not all patients find it tolerable or useful.
• If your nose is blocked and the surgeon thinks this is contributing significantly towards the snoring, you may be offered an operation to clear your nose.
• If you are slim and have a narrow throat, you may be offered surgery to your palate to shorten or stiffen it so that the snoring stops. There are a range of operations done for this and you need to discuss the benefits and risks of what you are being offered.
• In children who snore badly or have obstructive sleep apnoea, tonsillectomy and adenoidectomy can be very effective in curing the problem.

What are the different surgical options to improve snoring and obstructive sleep apnoea?

The surgeon will first examine and investigate to identify the sites of airflow obstruction. Then as per the diagnosis, he may decide to undertake single or multiple procedures in one stage or in multiple stages to minimize these obstructions and bring relief from snoring and sleep apnoea.

Surgical treatments for obstructive sleep apnoea available in our hospital include:

Septoplasty and Turbinate Reduction:

The septum is a bony partition that divides the nose into two nostrils. A bent septum can block the air passage and cause airflow obstructions. Septoplasty is a surgical procedure for straightening the bent septum and clearing the airway. Turbinates are curved bones along the walls of the nasal passage. Enlarged turbinates can also block the airflow and worsen the sleep apnoea. Reducing their size makes the airway bigger and brings relief.

Uvulopalatopharyngoplasty (UPPP):

In this surgery, the soft palate (at the back of the roof of your mouth) is trimmed or adjusted forward. In addition, your tonsils and uvula may also be removed. While this is a common surgical treatment for sleep apnoea, its effectiveness varies from patient to patient, depending on the size of the tonsils, palate, jaw, and tongue.

Barbed stitch Palatoplasty:

is a form of repositioning the palate to widen the airway at the level of nasopharynx and oropharynx. A barbed suture is a type of knotless surgical suture that has barbs on its surface. While suturing tissue, these barbs penetrate inside the tissue and lock them into place, eliminating the need for knots to tie the suture.

Midline Glossectomy and Base of Tongue Reduction:

These two procedures enlarge the airway by removing a section of the back half of the tongue. Latest surgical techniques such as coblation are making these surgeries more common and easier as well. In severe cases, the surgeon can opt for more aggressive procedures as detailed below:

Hyoid Suspension:

If the airway is getting blocked at the base of your tongue, the surgeon can seek to connect your hyoid bone (a U-shaped bone in the front of your neck that supports the tongue) to the bony projection in the front part of the throat known as "Adams apple" or suspend it from your jaw to keep the airway open and check sleep apnoea.

Genioglossus Advancement (GGA):

GGA is a specialized procedure to open the airway in order to treat sleep apnoea. The surgeon tightens a tendon in the front section of the tongue so that it can�t slide back and close off the breathing passage. In most cases, GGA is combined with UPPP or hyoid suspension.

Maxillomandibular Osteotomy (MMO) and maxillomandibular advancement (MMA):

These surgeries are probably the best treatments for severe sleep apnoea. In it, the airway is enlarged by making cuts into the jawbones to pull the jaws forward. However, these are complex surgeries that require overnight hospital stay. Plus, the surgeon may choose to shut your jaw using wires for a few weeks to ensure optimal healing.