The following information and photographs explain most aspects of the new non-surgical procedure for snoring treatment known as Injection Snoreplasty. There is also some discussion of patient experiences with Snoreplasty in the discussion forum on this site. As always, you should consult your doctor as the first step in your snoring treatment.
Injection Snoreplasty is a newly introduced non-surgical procedure to correct snoring due to the flutter of the soft palate. With Injection Snoreplasty, the soft palate (the soft tissue in the roof of the mouth ) is injected with a suitable material to create stiffening of the soft palate. Snoring is reduced by minimising the flutter or vibration of the soft palate.
The injection agents currently used for snoreplasty are known as sclerosants. These agents are traditionally used for closing superficial varicose veins. Investigators of the Injection Snoreplasty procedure have used a variety of agents including sodium tetradecyl sulphate (Sotrodecol) and more recently alcohol. Other sclerosant agents are being investigated for their relative benefits to the reduction of snoring in the Snoreplasty patient.
Following injection, an inflammatory reaction is created in the tissues of the patient’s soft palate. During the healing process, fibrosis of the injected region occurs in which stiffening fibres of collagen are laid down within the palate. It is this fibrosis process which stiffens the soft palate and in turn reduces snoring. The healing changes may take up to two months to finalise.
The very long-term results of the fibrosis are not known at this stage, as Injection Snoreplasty has been under investigation for only the last two years. Repeat injections may be helpful if a useful result has not occurred within the first couple of months of the Snoreplasty procedure or possibly one to two years after the initial Snoreplasty procedure should the initial benefits wear off and snoring symptoms recur.
As Injection Snoreplasty is a newly introduced technique, the best combination of injection agent, pattern of injection of the soft palate or the need for repeat injections have yet to be fully established.
Who Is The Ideal Candidate For Injection Snoreplasty?
Injection Snoreplasty appears to suit many snorers.
Some 40 to 45% of adults snore of occasion. Some 25% of the adult population are chronic or habitual snorers. Most snoring is due to palatal vibration.
Injection Snoreplasty only treats snoring where the snoring is due to the soft palate. Ideally the best candidate has soft palate flutter and no other cause. Injection Snoreplasty appears to be a good technique for women with early snoring and also in men who have minimum distortion of the soft palate and no additional causes in other parts of the airway that contribute to their snoring.
Can Injection Snoreplasty Help Sleep Apnoea Sufferers?
Injection Snoreplasty at this time has no established role in the treatment of sleep apnoea or snoring related to tongue size or position. Other surgical techniques or the use of a dental appliance, known as a mandibular advancement splint or CPAP, an air pressure device, will be required in such cases.
Can Injection Snoreplasty Be Used For Children Who Snore?
Injection Snoreplasty at this time does not appear to have any role in the treatment of children or young infants who snore. In these patients the most common cause is adenoid enlargement, with or without enlarged tonsils and in some cases nasal obstruction, typically associated with nasal allergy. Surgery to remove the adenoids and tonsils usually cures the snoring problem. Nasal blockage may require anti-allergy treatment.
How Is Injection Snoreplasty Performed?
Injection Snoreplasty is a relatively comfortable through the mouth injection procedure. It mostly causes minimal or short lasting discomfort.
Injection Snoreplasty requires full ENT specialist clinical evaluation of the patient beforehand. To determine the suitability of the procedure and causes of snoring, an assessment of all contributory causes to snoring must be made.
To improve comfort, two tablets of Paracetemol (Panadol total 1000 mg) should be taken 30 minutes prior to Injection Snoreplasty.
The roof of the mouth is initially sprayed with Lignocaine (Xylocaine 10%) anaesthetic spray. Supplementary Benzocaine gel to the soft palate may also be applied.
An initial injection of 0.1 cc of anaesthetic Sotradecol 3% is placed into the soft palate as a test dose for allergic reactions. The patient is then observed from 15 to 20 minutes. If there is no allergic response by way of excess swelling, the completion of the Injection Snoreplasty procedure is then carried out.
The patient generally waits 10 to 15 minutes after injection to ensure that they are without problem and can then leave the surgery. The Injection Snoreplasty procedure is generally very well tolerated.
Pictures of Snoreplasty Procedure
How Long Does The Injection Snoreplasty Procedure Take To Perform?
The actual injection takes seconds only. However, the preliminary preparation of the patient including establishing a "pain-free" anaesthetising of the soft palate, allowing an adequate time for the observation of allergic difficulty and recovery from the procedure itself requires approximately 45 minutes.
Is Injection Snoreplasty A Painful Procedure?
No medical procedure is completely comfortable. Injection Snoreplasty is usually comfortably tolerated by most patients provided the initial paracetamol tablets and local anaesthetic technique for Injection Snoreplasty are used.
In the next few days, some discomfort may be noted which is in almost all cases relieved by a mild pain reliever e.g. two tablets of paracetamol from time to time. Discomfort beyond two days is rare. Some altered sensation of the roof of the mouth due to the volume of fluid injected and the subsequent tissue reaction may be noted for up to a couple of weeks. This is mainly noticed when swallowing.
Is Injection Snoreplasty A Safe Procedure?
Injection Snoreplasty is a new technique and as such should still be regarded as "under investigation". The preliminary experience of colleagues around the world has not demonstrated significant complications or hazards. Few surgeons at this stage have had more than some dozens of patients. A more extensive experience will be gathered over the next few years. However, the general consensus is that the technique of Injection Snoreplasty using Sotradecol has been well accepted without significant complications emerging.
Sotradecol has been used for many years as a sclerosant agent for varicose veins in the legs. It has however been used in other parts of the body and complications appear to be low.
Allergic responses to Sotradecol when used in the leg have been reported. In discussions with colleagues around the world, such allergic reactions have not been noted in the soft palate. However, Sotradecol has been reported as causing a severe allergic reaction known as anaphylaxis from which death has been reported. This outcome has not been reported for patients undergoing Sotradecol injection into the soft palate or Injection Snoreplasty. It is for this reason that a preliminary test injection is given to all patients to exclude any allergic reaction. Full resuscitation equipment is kept on hand for any such adverse outcome. Thus far the initial case load has not revealed any patients with an allergic response.
What Are The Complications Of Injection Snoreplasty?
Significant complications from the use of Sotradecol in the soft palate have not been reported. A direct communication between various surgeons commencing the use of Injection Snoreplasty technique around the world has not indicated any patients that have had major problems. Nevertheless, as in all new procedures, doctors carefully watch the results and over time complications, if any, are reported from the experience of increasing number of cases as procedures become more popular.
Injection Snoreplasty should not be used in pregnant women, or in any patients who have had previous allergic responses to Sotradecol used in other parts of the body.
What Are The Early Changes After Injection Snoreplasty?
The shared experience of this new procedure now extends in some hundreds of cases and in discussions with other doctors using this treatment there do not appear to have been any significant long term complications or reports of significant allergic reaction thus far.
Some patients may get a white healing area of the soft palate. The surface lining may be shed or sloughed. This is uncommon and seems to always heal, without permanent difficulty.
In the early stages after surgery, the consequences of swelling of the soft palate area may worsen snoring in the initial after treatment period. Swallowing may be affected. There may be the sensation of a lump in the soft palate or a sense of mucus adhering to the surface of the palate and throat, which is rarely a significant inconvenience and such symptoms are of short duration, settling within weeks.
In the initial period voice changes may be noted due to swelling of the palate. This problem does not persist.
Whilst the earlier results of this treatment are promising from the point of view of minimum complications, no procedure carried out by a doctor is totally free of the potential of permanent complications even though in this procedure such a risk would seem to be extremely rare. Such complications would be the consequence of the healing tissue changes in the soft palate or reactions to the injected sclerosant agent.
How Long Do The Benefits Of The Injection Snoreplasty Procedure Last?
This is a new procedure, with the earliest international experience being from the year 2000. A number of the earlier patients continue to show good benefits and satisfactory reduction in snoring, and this is certainly noticed in the majority of treated patients properly selected. However, until a five and ten year experience with the procedure has emerged, it is not possible to at this stage indicate what the longer term results and their effects on patient snoring will be.
There can be no guarantee that Injection Snoreplasty will work in any particular patient. Whilst the majority of patients get a good outcome, as in all other procedures, a certain number of patients will be unsuccessful. Some of these patients may be assisted by a repeat injection but not necessarily all patients.
What Are The Benefits Of Injection Snoreplasty?
In mild selected cases, this new procedure appears to be generally safe, is relatively painless and quick to perform. The after procedure experience is very tolerable, with most patients going back to work the following day. The initial results have been promising and seen in many cases to equal the results from more complex procedures such as a laser palatoplasty and radiowave palatoplasty (Somnoplasty).
The procedure may well be unsuccessful where the causes of snoring are elsewhere in the nose or deeper in the throat, such as at the back of the tongue. Proper diagnosis following a full history and examination is essential to the recommendation to performing this procedure. However even where problems exist in other locations of the airway, the relative simplicity of Injection Snoreplasty may make this an intermediate step for temporary partial relief of snoring whilst awaiting the opportunity for a more extended procedure which may require time away from work.
What Is The Cost Of Injection Snoreplasty?
The cost of this procedure will vary according to medical costs in different countries. For example, in Australia at Dr Lewkovitz’s Sydney practice, the costs of the Snoreplasty procedure are approximately $A500, per injection plus relevant consultation fees. A follow up injection may be required at a later time ranging from two to three months to one year after the procedure.
The cost of Injection Snoreplasty is not rebated by insurance funds within Australia at this time.
What Follow Up Appointments Are Required After Injection Snoreplasty?
In Dr Lewkovitz’s practice, patients are seen one week after the procedure. If all is going well at this stage, further follow up is arranged at two months, six months and one year.
In the initial period after treatment, the patient attends to most basic care.
What Can I Do About Throat Discomfort post-Snoreplasty?
After Injection Snoreplasty the throat may continue to be anaesthetised for up to one to two hours. Care should be taken with any drinking in this period. The patient can usually return to work or home unescorted.
Typically mild discomfort of the roof of the mouth may occur. Some patients do report a more severe discomfort It is uncommon for this to be for more than one to two days after the procedure and will be generally assisted by paracetamol tablets (Panadol or Tylenol). As with all surgical procedures, any pain killing tablets containing aspirin or a acetylsalicylic acid should be avoided for a two week period after a surgical procedure because aspirin increases the risk of post surgical bleeding. Anaesthetic lozenges may be taken if discomfort persists, but this is usually not necessary. Sucking on ice blocks may be of assistance. This should be continued until the discomfort is relieved. Cool drinks may also be of assistance.
Are There Any Special Precautions With Meals And Fluids?
Most meals will be tolerated but a preference should be given to softer foods with minimum fibre material that may scratch the healing throat tissues after Injection Snoreplasty. Hot fluids should be avoided until the throat settles
When Can I Return To Work?
Most patients can resume work duties the following day. Some patients feel well enough to return to work that day. Voice rest is probably useful over the first one to two days but general conversational voice use is permitted. A change in voice may be noted in some patients but these changes are rarely persistent for more than a few days.
What Do I Do If There Is Any Swelling Or Infection?
Swelling of the roof of the mouth is a common experience in the first day or two after Injection Snoreplasty. It usually settles after this time. Minor changes or awareness of a lump in the throat or in the roof of the mouth may be noted with swallowing but this rarely persists. A useful precaution is to elevate the head of the bed with an extra pillow. This is probably best placed as a cushion underneath the mattress or the head of the bed can otherwise be tilted upwards.
If there is excessive swelling causing extreme discomfort or distress relief may be obtained with 10mg per day of Prednisone or Prednisolone. This medication may be taken for two days if needed. These tablets should be taken after meals and strictly on your doctor’s instructions.
Infections are extremely uncommon but should increasing pain be noted there may be a risk of such a problem, in which case your doctor should be alerted.
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