RE: Tracheostomy anyone?
I cannot stress enough that having a tracheotomy is no trivial matter and should only be entered into after a long and concentrated effort for CPAP compliance has failed and no other non surgical techniques have proven successful.
When done correctly, a tracheotomy will bypass the area of collapse, if that is indeed the problem, but it opens itself up to any manner of other problems down the road and is open to infections and a variety of other problems. And, should the reason for your Apnoea not be based in the upper throat, as in CSA, it will have no effect at all.
This isn't a quick fix, and if the only reason for it is because you find the CPAP onerous, let me assure you that maintaining the opening after a tracheotomy will be far more onerous, and can be medically dangerous if you slack on the maintenance of it, unlike slacking on cleaning your CPAP.
Before you consider this, read up on all the side effects and the care and maintenance post-op, something you will have to do every day for the rest of your life. Twice daily, actually. I really would think long and hard about any form of surgical treatment for Apnoea, and even then only after it has proven impossible for you to get benefit from conservative therapies, like CPAP, either due to physical problems or to non compliance issues. And once you are old, it will lead to far more problems and infections than if you stuck with a PAP device.
But if it is simply because you hate the mask, trust me you will hate this even more. As for advancements in T-section techniques and post operative care, no, there is little advance to in now from my days in med school back when dinosaurs ruled the earth. We have better knives and some neat emergency T-section devices, but that is the extent of if. The basic technique is the same as 100 years ago.
About the "button" - that is probably a voder you are referring to, which is used when the vocal chords are damaged - to speak after a T-section, you have to close the hole, either by slipping a flap of skin over it by hand, or having a plug in the hole during the day. Some people can speak without need of closing the hole, depending on where the hole is made and other factors. The hole is prone to infection, and must be kept rigorously clean. Because the air intake bypasses much of the nose and throat, the air taken in is less humid and this can cause throat problems and lung infections, which can be even worse due to the fact that you are bypassing the body's first line of cleansing the air taken in, the mucous and hairs in the nose.
The operation itself isn't complicated, but easy enough to screw up in the wrong hands, and we have an emergency "punch" kit when doing it in the field, but that is a quick and dirty method for a temporary solution. The type of method used for longer term solutions, like you are looking at, requires considerably greater surgery, and sometimes painful post operative recovery, if the surgeon elects to create a skin flap to close the hole when speaking is needed.
Risks include the development of an oesophageal fistula, where a hole opens between your breathing tube and your eating tube, allowing fluids and foods to enter into your trachea and lungs, tracheoinnominate fistula, the generation of a a passage between the trachea and the innominate artery which can create life threatening bleeding, bacterial colonisation of the wound and tube insert, which can lead to pneumonia and other lung infections, some of them fatal, and a myriad of other types of infections, not to mention blockage of the tube itself due to excess mucous coughed up from the lungs because of the drier air you will be breathing.
Do this only if there is no other choice. If you can tolerate a PAP device and it works to alleviate your symptoms, then it is a far better, safer and more comfortable solution than ANY surgical solution. Period.
The only upside is that a tracheostomy can be closed up and healed, unlike a messed up MMA, so if you don't like it, or it threatens your life, you have an out, but you will have spent a great deal of money and have assaulted your body in a very non trivial way, and that will not give you good odds at prolonging your life.