Sleep & Airway Surgery

Obstructive Sleep Apnoea

Obstructive sleep apnoea (OSA) is a common sleep disorder that affects millions of people. It occurs when the muscles in the back of your throat relax too much during sleep, causing the airway to become blocked or narrowed. This blockage leads to pauses in breathing, known as apnoeas, or shallow breaths, known as hypopnoeas. These interruptions in breathing can happen repeatedly throughout the night, disrupting your sleep and leading to a range of health problems.  

How OSA Can Present:

OSA can manifest in several ways, and symptoms may vary from person to person. Common signs and symptoms include:  

  • Loud snoring: Often the most noticeable symptom, especially to a sleeping partner.

  • Gasping or choking during sleep: You might wake up suddenly feeling like you can't breathe.  

  • Excessive daytime sleepiness: Feeling tired even after a full night's sleep.  

  • Morning headaches: Due to reduced oxygen levels during the night.  

  • Difficulty concentrating: Problems with memory and focus.  

  • Irritability or mood changes: Sleep deprivation can affect your emotions.  

  • Frequent nighttime urination: Waking up multiple times to go to the bathroom.  

  • Dry mouth or sore throat upon waking: Due to mouth breathing.  

Potential Health Effects of Untreated OSA:

If left untreated, OSA can have significant negative impacts on your health, increasing your risk of:  

  • High blood pressure: Repeated drops in oxygen levels strain the cardiovascular system.  

  • Heart disease: Including heart attack, stroke, and heart failure.  

  • Type 2 diabetes: OSA can affect insulin resistance.  

  • Depression: Chronic sleep deprivation can contribute to mental health issues.  

  • Liver problems: Such as non-alcoholic fatty liver disease.  

  • Increased risk of accidents: Daytime sleepiness can impair driving and other activities.  

  • Complications with surgery and medications: OSA can interfere with anaesthesia and other medical treatments.  

This information aims to give you a basic understanding of OSA, its symptoms, and potential treatment options. If you suspect you may have OSA, it's crucial to consult with a healthcare professional for proper diagnosis and treatment.

Surgery for OSA

If you've been diagnosed with obstructive sleep apnoea (OSA), and non-surgical treatments like CPAP are not suitable or effective, surgical options may be considered.

Soft Tissue Surgeries:

Several soft tissue procedures aim to open the airway by removing or reshaping tissues in the throat. These include:

  • Tonsillectomy and Adenoidectomy: Removal of the tonsils and adenoids.

  • Soft Palate Surgery (Uvulopalatopharyngoplasty - UPPP): Reshaping the soft palate and uvula.

  • Tongue Reduction Surgery: Reducing the size of the tongue.

While these surgeries might offer some relief, they often have limited long-term success rates, as they don't address the underlying skeletal causes of OSA in many patients.

Bimaxillary Osteotomy: A More Effective Approach:

For many patients, especially those with moderate to severe OSA, a bimaxillary osteotomy offers a more comprehensive and effective solution. This procedure involves surgically moving both the upper and lower jaws forward, significantly expanding the airway at all levels:

  • Nasal Airway: The space behind the nose.

  • Oral Airway: The space in the mouth.

  • Pharyngeal Airway: The space in the throat.

Benefits of Bimaxillary Osteotomy:

  • Significant Improvement in OSA Scores: Many patients experience a substantial reduction in their apnoea-hypopnoea index (AHI), which measures the severity of OSA.

  • Reduced Snoring: Snoring is often dramatically reduced or eliminated.

  • Improved Quality of Life: Patients report better sleep, increased energy, and improved overall well-being.

  • Reduced or Eliminated CPAP Use: Studies have shown that greater than 50% of patients are able to discontinue their CPAP machines after bimaxillary advancement.

Minimising Risks Through Expertise:

Surgical management of OSA, particularly bimaxillary osteotomy, requires a high level of surgical skill and expertise. The risks associated with these procedures are significantly minimised when performed by highly trained oral and maxillofacial surgeons, such as Mr Saha and A/Prof Delpachitra. Their extensive experience and specialised training ensure optimal outcomes and reduce the potential for complications.

By addressing the skeletal structure, bimaxillary osteotomy provides a more stable and long-lasting solution for OSA compared to soft tissue surgeries. It is important to note that every patient is different, and a thorough assessment with an oral and maxillofacial surgeon is needed to determine the best course of treatment.

Risks

While bimaxillary osteotomy is a highly effective treatment for obstructive sleep apnoea (OSA), it's essential to be aware of the potential risks and complications. As with any surgical procedure, there are inherent risks involved, although these are generally low and can be further minimised by choosing an experienced surgeon.

Here's a breakdown of the potential risks:

General Surgical Risks:

  • Bleeding: Some bleeding is expected during and after surgery. Excessive bleeding is rare.

  • Infection: There's a small risk of infection, which can usually be managed with antibiotics.

  • Swelling and Bruising: You will experience swelling and bruising around your face and jaw, which will gradually subside over a few weeks.

  • Pain: You can expect some pain after surgery, which can be managed with medication.

  • Adverse Reaction to Anaesthesia: Although rare, there's always a slight risk associated with general anaesthesia.

Specific Risks of Bimaxillary Osteotomy:

  • Nerve Injury: The nerves that supply sensation to your lips, chin, teeth, and gums can be affected during surgery. This can lead to temporary or, in rare cases, permanent numbness or tingling.

    • The risk of nerve injury is higher with bimaxillary surgery compared to single-jaw surgery.

    • However, the majority of patients experience full recovery of sensation within 12 months.

  • Malocclusion or Bite Changes: There's a small risk that your bite may not align perfectly after surgery, requiring further orthodontic treatment.

  • Jaw Joint Problems (TMJ): Some patients may experience temporary or, rarely, permanent discomfort or clicking in the jaw joint (TMJ).

  • Relapse: Although uncommon, there's a slight chance that the jaws may shift slightly back towards their original position over time, especially if post-operative instructions are not followed carefully.

  • Need for Revision Surgery: In some cases, a second surgery may be necessary to achieve the desired results or to address complications.

Minimising Risks Through Expertise:

The risks associated with bimaxillary osteotomy are significantly reduced when the procedure is performed by highly trained and experienced oral and maxillofacial surgeons. Mr Saha and A/Prof Delpachitra have extensive experience in this field, having performed hundreds of bimaxillary osteotomies. Their expertise and knowledge translate to a lower risk of complications and a higher likelihood of a successful outcome.

Following Post-Operative Instructions: It's crucial to follow your surgeon's instructions carefully after surgery to promote healing and reduce the risk of complications.

Important Note: This information is intended to provide a general overview of the risks associated with bimaxillary osteotomy for OSA. Your surgeon will discuss these risks in detail with you and answer any questions you may have before your surgery.

Fees

The fees for your orthognathic surgery will vary depending on the complexity of the procedure and the specific treatment required.

Surgical Fee Range:

  • Single Jaw Surgery or Genioplasty: For less complex cases, such as a lower jaw advancement (BSSO) or a genioplasty, the surgical fee can be approximately $5,000.

  • Double Jaw Surgery (Bimaxillary Osteotomy): More complex cases, such as a double jaw advancement with or without a genioplasty, can range up to $15,000.

  • Complex Cases: For complex cases involving segmental osteotomies or additional procedures, the fees may be higher.

Additional Costs:

Please note that the surgical fee is only one component of the overall cost. You will also incur:

  • Hospital Fees: These cover the cost of your hospital stay, operating theatre, and nursing care.

  • Anaesthetic Fees: These cover the cost of the anaesthetist's services.

Private Health Insurance:

If you have private health insurance with appropriate cover (Silver or above), a significant portion of these additional costs will likely be covered. However, it's essential to confirm the details of your coverage with your health fund before proceeding.

Post-Operative Care:

In some cases, a post-operative stay in an Intensive Care Unit (ICU) or High Dependency Unit (HDU) may be necessary to monitor your airway. This will incur additional costs. Your surgeon will discuss this with you if it applies to your situation.

Item Codes for Reference:

Here are the item codes for common orthognathic procedures. These codes can be helpful when discussing your treatment and fees with your health fund:

  • Surgically-Assisted Maxillary Expansion (SAME): 46154

  • Genioplasty: 45761

  • Bilateral Sagittal Split Osteotomy (BSSO): 46150

  • Bimaxillary Osteotomy (Bimax): 46158

  • Bimaxillary Segmental Osteotomy (Segmental Bimax): 46158