What are the surgical options available?

The range of surgical procedures is wide. The choice depends on the level of airway obstruction as well as on the severity of airway problem:

1. Nasal surgery
Nasal disorders causing obstructive sleep apnea are often under-diagnosed. Allergic rhinitis, sinusitis and nasal polyposis are commonly encountered conditions that fall within this group. They are the easiest and most satisfying to treat. The procedures that can be undertaken include:

• Nasal turbinate reduction (soft tissue reduction), septoplasty (correction of nasal septum cartilage deformity) or nasal valve surgery
• Radiofrequency reduction of the nasal turbinates

2. Soft palate surgery
The soft palate, because of its extreme laxity, is the most important generator of sound during snoring. The following treatment options are available to help reduce the size and laxity of the soft palate. It must be highlighted that we often make patients snore less after patient's soft palate surgery without making their OSA better. These patients tend to have obstruction in the tongue level or the lower portion of the throat. Used with other treatment modalities, such as weight reduction for example, this surgery is an excellent and simple way to solve one's snoring and OSA problem.

a) The Pillar Procedure
This innovative 10 minute procedure involves the insertion of 3 Polyester Implants into the soft palate. Done under local anesthesia, this surgery helps to stiffen the soft palate and reduces airway collapse caused by execessive floppiness of the palate tissue. [ www.restoremedical.com ]

b) Uvulopalatopharyngoplasty (UPPP) / Tonsillectomy

This 30-45 minutes procedure which is done under general anesthesia involves the removal of the tonsils and trimming of the excess soft palate tissue. The surgery is done orally and shows no external incision marks. Patients are usually warded overnight in the hospital for monitoring after surgery.

c) Radiofrequency tissue ablation of the palate

This procedure that takes about 15 minutes is done under local anesthesia. May require multiple treatments, each about 2 months apart.

d) Laser Assisted Uvulopalatoplasty (LAUP)
With the introduction of radiofrequency techniques, LAUP has taken a back seat in recent years. It is widely recognised that LAUP tends to cause more post-operative pain than radiofrequency techniques.

3. Jaw advancement surgery

This highly effective surgery aims to widen the posterior airway space by pulling the tongue forwards through the advancement of the maxilla and mandible.

This surgery was pioneered by Professors Powell and Riley of Stanford University Medical Centre in the mid 1980's. Drs Goh Yau Hong and Lim Kheng Ann successfully undertook Southeast Asia's first Jaw Advancement Surgery for the treatment of OSA in 2000.

In late 2000, both Drs Goh and Lim pioneered the new Modified Jaw Advancement Technique for the treatment of OSA, a world's first for Singapore. This was presented in the American Academy of Otolaryngology-Head and Neck Meeting and subsequently published in Laryngoscope, one of the top ENT journals in world. The new technique pioneered by Drs Goh and Lim was shown to be highly effective in treating patients with OSA without the problem of significant facial change, a problem encountered in the traditional method. Currently this surgery is only reserved for patients with severe OSA.

4. Tracheostomy

This surgery involves the creation of a breathing hole at the front of the neck. Air enters directly into the windpipe and bypasses the nose and the back of the tongue. Currently this technique is reserved for patients with significant OSA who cannot be treated with conservative means or conventional surgery.

Aim of treating obstructive sleep apnea
The aim of treating obstructive sleep apnea is two folds. Firstly, the eradication of abnormal sleep symptoms will result in increased daytime well-being from improved sleep for both patients and sleep partners. Secondly, to minimize the potential risk of medical (cardiovascular) complications with the successful treatment of sleep apnea.

Over the years, we encountered patients who suffered needlessly due to their lack of awareness or of fear of the clinical problem. Seeing a patient breathe well again is one of the most rewarding experiences a surgeon can have in his clinical practice.