•The key to surgical success is patient selection

The most important role for the sleep surgeon is to:

  1. Select the correct patient
  2. For the correct surgery, and
  3. Be able to perform this surgery

Surgery is divided into surgery for the Nose, Palate and Tongue.

•NOSE

Nose surgery is important for a few reasons:

  1. The nose represents 50% of the airway (the other 50% is the mouth), hence, having a clear nasal passage is important.

  2. A clear nose is important for a patient who is using the CPAP machine, helps usage and improves compliance

  3. Nose surgery also helps reduce snoring and obstructive sleep apnea to a good extent (if done together with other procedures, like palate or tongue)

  4. Nose surgery alone (performed alone) is at best 20% to 40% effective in treating obstructive sleep apnea (should be done with other procedures, like palate or tongue, if the patient has moderate or severe obstructive sleep apnea)

Picture showing a patient with a nose mass
blocking the nasal passage.		 Endoscopic picture of a patient with nose polyps,
blocking the entire nose.

Types of nose surgery

  1. Nasal Turbinate Reduction - Laser, Radiofrequency, Micro-debrider, Coblation
  2. Nasal Turbinectomy – cutting of the turbinate
  3. Endoscopic Sinus Surgery – involves scopes through the nose to reduce nasal swellings and enlarge sinus openings

Nasal Turbinate Reduction with the Radiofrequency is effective

  1. 10 minute procedure
  2. Local anaesthesia
  3. PAINLESS procedure
  4. Done in the clinic / office
  5. Outpatient basis
  6. Good Results

Radiofrequency of the Nose, done under local anaesthesia (painless procedure).
•PALATE

Palate surgery is important for many reasons:

  1. 70% to 80% of most snoring arise from the palate.

  2. Surgery to the palate will reduce snoring and obstructive sleep apnea effectively.

  3. Correct type of surgery to the palate is important to prevent complications (stenosis of the palate).

  4. Reconstruction of the palate is now the LATEST method of surgery to the palate.

  5. The Expansion Sphincter Pharyngoplasty technique has been shown to be 86.2% effective in patients with sleep apnea (Invented by Dr Kenny Pang, 2006)

Surgery Invented by Dr Kenny Pang on the Expansion Sphincter Pharyngoplasty for Sleep Apnea,
Published in the Prestigious American Journal of ENT 2007

Types of Palate Surgery – For Snoring and Mild Sleep Apnea

  1. Radiofrequency of the Palate
  2. Pillar Implant Palate Procedure - MultiCenter Trial in United States done by Dr Kenny Pang
  3. Laser Palate Surgery
  4. Cautery Assisted Palate Surgery - Invented by Dr Kenny Pang
  5. Coblator Palate Surgery

Pillar Implants for the Palate (Multi-center Trial in USA conducted by Dr Kenny Pang

Palate Surgery For Snoring and Mild Sleep Apnea is effective

  1. 10 minute procedure
  2. Local anaesthesia
  3. PAINLESS procedure
  4. Done in the clinic / office
  5. Outpatient basis
  6. Good Results

A patient with huge obstructing tonsils,
causing narrowing
of the airway and severe obstructive sleep apnea		 The same patient after surgery of the Palate,
notice the large space created after surgery,
the patient breathes better now.

Types of Palate Surgery - For Moderate and Severe Sleep Apnea
Traditional UvuloPalatoPharyngoPlasty (UPPP) - for selected group of patients, average results from 3,000 over patients showed UPPP at best results were 59% after very careful and prudent selection of patients.

Z-PharyngoPlasty (ZPP) - good for patients with narrow palate and absent tonsils.

Expansion Sphincter Pharyngoplasty (ESP) - very useful technique, have shown to be 86% successful in a controlled trial (Invented by Dr Kenny Pang)

TYPES OF SLEEP APNEA PATIENTS
60% OF PATIENTS WITH SLEEP APNEA HAVE PALATE OBSTRUCTION AS THE MAIN CAUSE (WILL NEED PALATE SURGERY)
40% OF PATIENTS WITH SLEEP APNEA HAVE BOTH PALATE AND TONGUE OBSTRUCTION AS THE MAIN CAUSE (WILL NEED PALATE AND TONGUE SURGERY)

Patients with palate and tongue obstruction who only have palate surgery done alone, will not be cured of their sleep apnea (will not have good result).

Patients with palate and tongue obstruction will NEED both palate and tongue surgery done together for a good result.

•TONGUE

Tongue surgery is important for a few reasons:

  1. The tongue contributes a lot in sleep apnea during an obstruction
  2. The tongue needs to be treated if the patient wants a good result
  3. The tongue is the culprit in at least 40% of patients with sleep apnea
  4. Not treating the tongue, will lead to FAILURE on surgery

A patient with a BIG tongue causing small air passage and obstructive sleep apnea at night.

Types of Tongue Surgery

  1. Tongue Reduction Surgery / Excision
  2. Minimally Invasive Tongue Suspension Suture (Introduced by Dr Kenny Pang into Asia, 2005)
  3. Tongue Radiofrequency of Tongue Base
  4. Minimally Invasive Midline Submucosal Tongue Excision (SMILE technique)

The Tongue Suspension Suture to hold the tie forward, so that it does not fall back and
block the airway at night. Introduced into Asia by Dr Kenny Pang in 2004.
 
 

TYPES OF SLEEP APNEA PATIENTS
60% OF PATIENTS WITH SLEEP APNEA HAVE PALATE OBSTRUCTION AS THE MAIN CAUSE (WILL NEED PALATE SURGERY)
40% OF PATIENTS WITH SLEEP APNEA HAVE BOTH PALATE AND TONGUE OBSTRUCTION AS THE MAIN CAUSE (WILL NEED PALATE AND TONGUE SURGERY)

Patients with palate and tongue obstruction who only have palate surgery done alone, will not be cured of their sleep apnea (will not have good result).

Patients with palate and tongue obstruction will NEED both palate and tongue surgery done together for a good result.

THE TONGUE NEEDS TO BE TREATED AND OPERATED ON IF IT IS LARGE OR OBSTRUCTING THE AIRWAY, IF NOT, SURGICAL FAILURE IS LIKELY.