SGH and NDC Surgeons Collaborate in Breakthrough Surgery for Sleep Apnea

In the year 2000, Dr Goh Yau Hong, then doctor at the SGH Department of Otolaryngology, together with Dr Lim Kheng Ann, then doctor at the National Dental Centre's Department of Oral and Maxillofacial Surgery performed the first maxillomandibular advancement for the treatment of Obstructive Sleep Apnea (OSA) in Singapore.

The surgery comprising of a Le Forte I osteotomy and bilateral sagittal split osteotomies, required the harvesting of a cranial bone graft to bridge the gap which arises after maxilla and mandible advancement. The procedure enlarges the posterior airway space by moving the upper and lower jaws forward, thus helping patients to breathe better during sleep.

In October 2002, both Dr Goh and Dr Lim have once again achieved a breakthrough in the treatment of OSA with a new jaw advancement surgery. The procedure, a modified version of the earlier surgery and not done anywhere in the world for the treatment of OSA, enlarges the upper airway without any resulting changes to the patient's facial profile.

Comparing the two procedures, Dr Goh said that as the first technique involved shifting the patient's upper and lower jaws forward to enlarge the posterior airway space, this has resulted in some degree of facial profile alteration. The new modified technique, while similarly advancing the lower jaw forward, involved the posterior setback of the anterior maxilla and anterior alveolar ridge of the mandible, achieved with the extraction of a bicuspid from each quadrant of the dental arch.

“The setting back of the anterior segments of the maxilla and mandible minimizes the aesthetic facial alterations associated with the traditional maxillomandibular advancement surgery. All the patients who underwent this modified and improved procedure were delighted with the cosmetic outcome of the surgery, as they actually looked younger after the surgery,” Dr Goh enthused.

Most importantly, eleven of Dr Goh’s patients who have undergone the surgery experienced significant symptomatic improvement. Unlike traditional maxillomandibular advancement surgery, the modified technique now uses bone wedges form the anterior segmental sites as grafts in Le Forte I osteotomies, which means that there is no need for calvarial bone harvesting to fill the gap created with the shift of the lower jaw.

While cautioning that the procedure may not be suitable for all patients who are suffering from sleep apnea, Dr Goh is encouraged by the good outcome of his patients who have undergone the surgery.

“The potential risk of facial alteration is one of the obstacles which deterred patients from opting for surgery to correct their sleep apnea problem. As this new technique improves the profile of the patient and is also highly effective, it holds great promise as the treatment of choice for OSA” added Dr Goh.

• Patients with tongue obstruction
• Patients with significant OSA
• Patients with small chin
• Patients who are not better with tonsillectomy or soft palate surgery
• Patients who have tried and failed or do not want CPAP treatment

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"What is two months of discomfort, compared to 20 years of pleasure?" That was Mr. Mohamed Hussein's rationale for undergoing the modified maxillomandibular advancement surgery to treat his sleep apnea problem.

Unaware that he was suffering from sleep disordered breathing until his wife complained of his “thunderous snoring followed by frightening moments of silence” each night, Mr. Hussein decided to seek treatment at SGH, as he was always feeling tired and lethargic. “I woke up every morning feeling like I did not sleep the previous night,” shared the 57 year-old inflight supervisor. “Worst of all, I was always looking for chairs and quiet corners so that I could take power naps.”

When Dr Goh discussed with him about the new surgical procedure that may provide relief, he decided to give it a go. It didn't help that his brother queried him on going through the ordeal when he saw him at the ward the day after surgery, with swollen face and unable to talk. His response to him was, "2 months of discomfort, 20 years of pleasure, and I am ready to take the challenge."

Obviously, the two months of discomfort and silence paid off. Today, Mr. Hussein is a picture of health. "Everyone noticed that I don't look that tired anymore, and of course, I no longer need my power naps in the afternoon," quipped the youthful looking man. Thanks to Dr Goh and Dr Lim, I am now looking forward to my 20 years of pleasure."