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Pillar procedureBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/pillar-procedure/MY00516
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The pillar procedure is minor surgery intended to relieve habitual snoring and treat mild to moderate obstructive sleep apnea, a potentially serious disorder in which breathing is interrupted repeatedly during sleep. Both snoring and obstructive sleep apnea may result from a relaxation of muscles at the back of your throat.
The pillar procedure involves surgically placing small polyester rods in the soft palate. Each implant measures 18 millimeters (mm) in length — slightly less than an inch — and 1.5 mm in diameter. The subsequent healing of tissue around the implants stiffens the soft palate, thereby reducing relaxation and vibration of the tissue. The pillar procedure is usually done in your doctor's office with local anesthesia.
Why it's done
The pillar procedure is designed to:
- Relieve snoring
- Relieve symptoms of mild to moderate obstructive sleep apnea
If you have mild to moderate sleep apnea, you may be advised to try a less invasive, nonsurgical treatment first, such as continuous positive airway pressure (CPAP). A CPAP machine uses a face mask to deliver just enough air pressure into your airway to prevent the blockage of airflow. Some people may need to use CPAP even after undergoing a pillar procedure.
It's not recommended for people who:
- Have severe obstructive sleep apnea
- Are significantly overweight or obese
Snoring and obstructive sleep apnea
As you sleep, muscles relax in the fleshy area at the back of your mouth (soft palate), as well as in your tongue and throat. These tissues can relax enough that they vibrate, causing snoring. Snoring can be a nuisance and interfere with your sleep or your bed partner's sleep. Snoring can also be an indication of obstructive sleep apnea, which is a more serious disorder.
When you have obstructive sleep apnea, the muscles in your mouth, tongue and throat may relax so much that they block your airway, causing you to stop breathing or to breathe shallowly, many times a night. This process can cause sudden drops in the amount of oxygen in your blood, and has been linked to serious health problems, such as high blood pressure and heart disease.
Other signs and symptoms of obstructive sleep apnea include restless sleep, frequent awakening, morning headache, choking or gasping after a pause in nighttime breathing, and daytime sleepiness.
If you snore or have other signs or symptoms of obstructive sleep apnea, see your doctor. You'll likely be referred to a sleep specialist or a specialist in ear, nose and throat disorders (ENT or otolaryngologist).
Studies have reported few complications associated with the pillar procedure. The most commonly reported complication is a tip of an implant protruding through the soft palate tissue (partial extrusion). In that case, the implant can be either removed or replaced.
Other potential complications are usually temporary and resolve on their own, often within a few weeks after surgery. They include:
- Sore throat
- Feeling of having a foreign body in the soft palate
- Difficulty swallowing
As with any surgical procedure, infection is a possible risk. If you develop a fever after the procedure, contact your doctor.
How you prepare
You don't need to prepare for your pillar procedure unless your doctor requests that you start taking antibiotics before your appointment.
What you can expect
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During the procedure
The pillar procedure is performed in the surgeon's office, where you'll likely be seated leaning backward, similarly to how you're seated when your teeth are cleaned. During the procedure, which takes less than 30 minutes, the surgeon:
- Applies a topical anesthetic to your soft palate to numb the area for the injection
- Injects the area with a local anesthetic, which may sting
- Positions the first implant
- Inserts the first implant, which has its own disposable insertion device
- Repeats the last two steps two more times
After the procedure
Your doctor may ask you to sit for a few minutes to be sure you're not experiencing significant bleeding or swelling. You should be able to resume normal activities and eat normally that same day.
Your doctor may prescribe an anti-inflammatory pain medication to keep down swelling and help with any pain you feel after the anesthetic wears off. He or she may also ask you to use an antiseptic rinse for several days and take an antibiotic to prevent infection.
Research has shown that, in some people, the pillar procedure can effectively treat snoring and mild sleep apnea. However, it doesn't work for everyone, and further study is needed to determine who the best candidates are.
You or your bed partner may notice a decrease in snoring or episodes of breathing cessation from sleep apnea as soon as the day after the procedure. However, because your soft palate may become more rigid over time as the tissue hardens around the implants, it may take a few months to get the full effect of the implants.
Once implanted, the rods generally aren't removed. Because the pillar procedure is relatively new, it's unknown how long the effects of the implants will last after implantation.
- Friedman M, et al. Palatal implants for the treatment of snoring and obstructive sleep apnea/hypopnea syndrome. Otolaryngology — Head and Neck Surgery. 2008;138:209.
- Gillespie MB, et al. Effectiveness of Pillar palatal implants for snoring management. Otolaryngology — Head and Neck Surgery. 2009;140:363.
- Saylam G, et al. Do palatal implants really reduce snoring in long-term follow-up? The Laryngoscope. 2009;119:1000.
- Nordgard S, et al. Palatal implants: A new method for the treatment of snoring. Acta Oto-laryngologica. 2004;124:970.
- Obstructive sleep apnea. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/sec05/ch061/ch061b.html. Accessed Jan. 4, 2011.
- Sleep apnea. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_WhatIs.html. Accessed Jan. 4, 2011.
- Steward DL, et al. Palate implants for obstructive sleep apnea: Multi-institution, randomized, placebo-controlled study. Otolaryngology — Head and Neck Surgery. 2008;139:506.