Why Surgery of the Nose, Tongue and Palate May Be Needed for OSA Treatment

by Dr. Kenny Pang
In obstructive sleep apnea, collapse of the upper airway is usually multi-level.

Obstructive sleep apnea (OSA) has been known since the 1960s. Management of obstructive sleep apnea has evolved since, and CPAP alone is no longer deemed the gold standard for every patient – CPAP therapy has huge limitations and shortcomings, especially in terms of patient compliance. 

In a large-scale study that I co-authored, we found that the compliance rate of CPAP over the last 20 years is only 35% to 40% at best (Rotenberg et al., 2016). Despite the advances in technology and the many upgrades in the CPAP machine, the compliance (usage) rate of patients are persistently at best 35% to 40% overall.  

Long-term studies have shown that in over 20,000 patients studied, after seven years of either CPAP or Uvulopalatopharyngoplasty (UPPP) surgery, mortality in CPAP patients was twice as high as that of surgery patients (Weaver et al., 2004).

A landmark scientific paper published in the New England Journal of Medicine (2016), showed that in over 2600 patients, after an 8 year period, patients who used CPAP had the same risk of heart failure, heart attacks, strokes and chest pains, as patients who did not use CPAP. 

Obstructive sleep apnea (OSA) surgery has also been found to reduce the incidence of cardiovascular complications such as heart failure, heart attacks, and strokes in OSA patients (Lee et al., 2018). 

In obstructive sleep apnea (OSA), collapse of the upper airway is usually multi-level – at the level of the nose, palate, base of tongue, and/or the lateral pharyngeal walls. 

Let’s take a closer look at the different anatomy that can cause airway obstruction.


Nose surgery is important because:

  • The nose represents 50% of the airway (the other 50% is the mouth), hence, having a clear nasal passage is fundamental. 
  • It is well known that the nose represents up to 60-70% of the entire upper airway, and its importance is in being open and allowing the patient to breathe.
  • A clear nose is important for a patient who is using the CPAP machine, as it helps in the latter’s usage and improves patient compliance. 
  • Nose surgery also helps reduce snoring and obstructive sleep apnea (OSA) to a good extent. 

Note: Nose surgery alone is at best 20% to 30% effective in treating obstructive sleep apnea (OSA). It should be done with other procedures, like palate or tongue surgery, if the patient has moderate or severe obstructive sleep apnea. 


Palate surgery is important because:

  • 70% to 80% of snoring arise from palate problems. 
  • Surgery to the palate will reduce snoring and obstructive sleep apnea (OSA) effectively. 
  • The correct type of palate surgery is important to prevent complications. 
  • Palate reconstruction is now the best method of surgery to correct palate-related issues. 
  • The recently (2007) invented Pang’s Expansion Sphincter Pharyngoplasty technique (invented by Pang KP) has been shown to be over 80% effective in helping selected patients with obstructive sleep apnea (OSA).


Tongue surgery is important because:

  • The tongue may contribute to sleep apnea during an obstruction.
  • The tongue contains fat tissue as well (a sizeable amount in fact).
  • The tongue needs to be treated if the tongue is causing an obstruction. 
  • The tongue may be the cause of airway obstruction in around 30% of patients with sleep apnea. 

For optimal surgical success rate, the correct procedure needs to be selected for the correct patient; not every patient should have surgery, and surgery can be very successful for a selected group of OSA patients.

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