World Renowned ENT & Snoring Specialist

Surgery

The key to surgical success is patient selection

The most important role for the ENT 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. Minimal pain procedure
  4. Done in the clinic / office
  5. Outpatient basis
  6. Good Results
Radiofrequency of the Nose, done under local anaesthesia (minimal pain 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 80% effective in patients with sleep apnea (Invented by Dr Kenny Pang, 2006)
expansion sphincter pharynoplasty
Surgery Invented by Dr Kenny Pang on the Expansion Sphincter Pharyngoplasty for Sleep Apnea, Published in the Prestigious American Journal of ENT 2007
expansion sphincter pharynoplasty in the treatment of osa

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. Minimal pain 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

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 80% 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.

Palate with wide open airway

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.
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Orchard Paragon Medical Center 290 Orchard Road, #18-04 Paragon Singapore 238859
Tel: (65) 6836 0060 | Fax: (65) 6836 0030
@Email: drpang@asiasleepcentre.com | Website: www.DrKennyPang.com
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