This procedure is now approved by Health Canada for snoring and mild sleep apnea. Although this is a new procedure to Canada, worldwide over 70,000 people have received pillar implants.  It involves a one-time insertion of three polyester implants into the soft palate done in the office under local anaesthesia.  The procedure takes about 20 minutes and normal activities may be resumed at once.  The post-operative pain and swelling is very mild and much better than any other snoring procedure.  Patients can go back to work immediately after the procedure.

Patients report a noticeable, lasting reduction in snoring within 2 months.  Studies on snoring show an 80 to 90% bed partner satisfaction. Although there is often residual snoring, it should not bother patients or their bedpartners. 

The most reliable study on the procedure was reported by Dr. Friedman at the annual meeting for Ear, Nose, and Throat surgery (2006).  This study was a double-blinded placebo controlled trial (the highest level of evidence) on 62 patients.  In this study, half the people had implants inserted and the other half had a 'fake' surgery where a needle was used but no implants were inserted.  Nobody knew if they had the implants or not.  They study showed at least a 50% reduction in snoring volume if implants were inserted and no change if there was no implants. 

How the Pillar Procedure Works

The Pillar Procedure addresses the most common site responsible for snoring, the soft palate. During the Pillar Procedure, three tiny woven inserts are placed in the soft palate to help reduce the vibration that causes snoring. Once in place, the inserts add structural support to the soft palate. Over time, the body's natural tissue response stiffens the palate even more further reducing vibration (less snoring).  The implants are permanent which greatly increases the chances of a long term solution.

Pillar inserts are made of material used in implantable medical devices for more than 50 years. They are designed to be invisible and should not be felt or interfere with swallowing or speech. Most patients resume normal diet and activities the same day.

Who can have the Pillar Implants?

The pillar implants (when used by itself) is designed for patients with a relatively normal sized palate without a large uvula (that dangly thing at the back of your throat).  The distance between the back edge of the hard palate and the lowest part of the uvula should be less than 4cm.  The uvula should also be less than 1.5 cm long.  If the uvula is too long, it can be trimmed at the same time as the Pillar Implants are inserted.

Scientific Overview

The vibration or collapse of the soft palate is the main contributor to snoring. When tissue in the upper airway flutters or vibrates, it causes snoring; Sleep Apnea occurs when tissue collapses or blocks the upper airway. Studies suggest that the soft palate is involved in more than 80% of snoring and sleep apnea.  As muscles in the upper airway relax during sleep, unsupported or excess tissue in the back of the mouth and throat (i.e. palate, tonsils, uvula, pharyngeal walls, epiglottis, tongue) collapse making the airway narrow.   The air speed through the collapsed region increases (called the Venturi Effect). Whenever there is an increase in air speed, there is also a drop in pressure which creates a vacuum (called the Bernoulli effect). 

The palate vibrates as the sucking forces overwhelm the supporting force of the palate, resulting in snoring sounds.

When the negative pressure in the airway reaches a critical point, the combination of collapsible tissues and loss of muscle tone causes airway collapse, resulting in OSA - Obstructive Sleep Apnea.

The Pillar Palatal Implant System changes the soft palate structure and its response to airflow. Placing three tiny implants into the muscle of the soft palate adds support and stiffens the soft palate. Most of the lift forces are generated at the leading edge, where the soft and hard palate meet. Placing implants at the junction of the hard and soft palate stiffens the area that starts the motion. This stiffening increases the air speed required to initiate palate movement, leading to a decrease in snoring and a reduction in the ability of the soft palate to obstruct the airway.

1. Katsantonis GP, Moss K, Miyazaki S et al. Determining the site of airway collapse in obstructive sleep apnea with airway pressure monitoring. Laryngoscope 1993; 103:1126-1131
2. Quinn, SJ, Daly, N, Ellis PD, Observation of the mechanism of snoring using sleep nasoendoscopy, Clinical Otolaryngology 1995:20(4);360-6

The Procedure

Selection for the procedure begins with a complete history and physical examination including pharyngoscopy.  A small flexible camera is placed through the nose to look at the back of the throat while snoring and breathing maneuvers are performed.  This allows identification of the site of snoring determining if you are a good candidate for the pillar procedure.

You will be given a prescription for an antibiotic which should be taken two hours before the procedure and continued for 5 days after the procedure.  This lowers the chance of infection.  Your mouth is first sprayed with an anaesthetic spray.  You will than be given antibacterial mouth wash (Pyridex) to gargle and rinse your mouth out just before the procedure.  Your soft palate is then injected in 3 sites with local anaesthetic, using a very small needle (27 gauge).

The Pillar Implant System is a curved needle with the implant already loaded.  The needle is inserted into the soft palate in the midline.  Once fully inserted, the implant is released and the needle is withdrawn.  This step is repeated 2 to 4 more times, once on either side of the midline.  A total of 3 to 5 implants are used.  Once all implants are inserted, the flexible camera is passed through the nose again to check the position of the implants. 

After the procedure, tylenol should be all that is necessary for pain control. I recommend sucking on ice cubes and ice cold drinks to decrease the chance of any swelling.  Antibiotics are taken for 5 days.  You will be seen back in one week to check implant position.  You will be seen back again at 10 weeks to determine if the procedure was successful.  I recommend bringing your bedpartner to this appointment.

Replacement of displaced implants

Medtronics has agreed to replace any implants which come out or have to be re-inserted which occures about 10% of the time.