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Reduction in Orthopedic Conditions through Teledontic Treatment of Pharyngorofacial Disorders
Published in Kohlstadt Ingrid, Cintron Kenneth, Metabolic Therapies in Orthopedics, Second Edition, 2018
Joseph Yousefian, Michael N. Brown
Patient proceeded with phase II-telegnathic procedure included an 8 mm maxillary expansion and an 8 mm maxillomandibular advancement (MMA). The postsurgical teledontic treatment was completed in 12 months. A remarkable increase in the retropalatal, retroglossal, and hypoglossal airway spaces was evident cephalometrically. Clinically patient reported absence of snoring, EDS and MD and TMJ symptoms. The post treatment sleep study showed improvement of AHI to 2.5, with sleep efficiency of 94%.
The Surgical Management of Snoring and Obstructive Sleep Apnoea
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Bhik Kotecha, Mohamed Reda Elbadawey
A number of procedures were described in the literature aimed at dilating the hypopharynageal airway, including genioglossus advancement, tongue base suspension suture, hyoid suspension, maxillomandibular advancement and laser midline glossectomy. Most of the reports describing these procedures are pilot studies with no standardized comparison of other techniques used in the treatment of OSA. The reported success rate of some of these procedures approaches 60% in the short term. These procedures are associated with relatively high complication rates, such as swallowing problems, taste change, tongue oedema, tooth numbness and mandibular fractures. The midline laser glossectomy was associated with a high incidence of post-operative bleeding.117
Maxillofacial surgery
Published in Philip Stather, Helen Cheshire, Cases for Surgical Finals, 2012
OSAEpworth sleepiness scale. Using the following scale please choose the most appropriate number for each situation. 0 = would never doze or sleep, 1 = slight chance of dozing or sleeping, 2 = moderate chance of dozing or sleeping, 3 = high chance of dozing or sleeping: sitting and readingwatching TVsitting inactive in a public spacebeing a passenger in a motor vehicle for an hourlying down in the afternoonsitting and talking to someonesitting quietly after lunch (no alcohol)stopping for a few minutes in traffic while driving.Morning headaches Insomnia Mood changes Poor concentration Irritability Anxiety Depression Hypertension ObesitySleep studies Polysomnography Home oximetryWeight loss Stopping smoking Avoiding alcoholContinuous positive airway pressure (CPAP) Surgical intervention (tonsillectomy, adenoidectomy, maxillomandibular advancement)OSA is a sleeping pattern whereby people have abnormal pauses in their breathing, leading to hypoxia and wakening. They typically have daytime somnolence, and loud snoring. It is more common in people who are overweight, elderly, smokers, or diabetics.
Obstructive sleep apnea: personalizing CPAP alternative therapies to individual physiology
Published in Expert Review of Respiratory Medicine, 2022
Brandon Nokes, Jessica Cooper, Michelle Cao
Skeletal surgery includes 1) hyoid advancement 2) genioplasty/genioglossus advancement 3) maxillary expansion 4) maxillomandibular advancement 5) mandibular distraction and 6) maxillomandibular expansion. The two most common are maxillomandibular advancement (MMA) and genioglossus advancement (GGA), which are often described as tongue base surgery [91]. Predictors of success for skeletal surgery are complete concentric collapse (CCC) and lateral pharyngeal wall collapse (LPW) on DISE, or congenital dentofacial deformity on physical exam [91]. Previously, MMA was used as a salvage surgical therapy for OSA, but now has more predictable clinical outcomes through visualizing the pattern of collapse at the velum during DISE [91]. The OSA cure rate for MMA is approximately 38%, but again can be optimized through careful patient selection [92].
The value of drug-induced sleep computed tomography in diagnosis of obstructive sleep apnea syndrome: a pilot study
Published in Acta Oto-Laryngologica, 2019
Xiaoman Zhang, Ning Lv, Xin Li, Shasha Sun, Jianfeng Li, Huiming Yang, Zhaoyan Yu, Haibo Wang
In this study, we found that about 61.33% patients had multi-level obstructions and the most common obstructive site was oropharynx (90.67%), followed by the nose area. However, some literatures report that multi-level obstructions occur in 76–80% of patients with moderate to severe OSAS using DISE [15]. The differences might result from the sample size being observed and the inspection method being adopted. In the oropharyngeal stenosis, obstruction of the lateral pharyngeal wall (LPW) appeared in 66 patients. As traditional uvulopalatopharyngoplasty (UPPP) could hardly resolve LPW collapse, maxillomandibular advancement may be the preferred form of treatment by tensing the LPW [16]. We merged the soft palate and lateral sites concluding tonsillar hypertrophy data, because they affect each other and the tonsillectomy usually compared with UPPP. And then, DI-SCT provides data on dynamic airway movements in the sagittal view which can help to differentiate obstructions. Thereby, the results obtained from DI-SCT remind pharyngologist that UPPP [17] or modified UPPP was essential in the treatment of snoring (partial obstruction) and sleep apnea (total obstruction).
The clinical application progress and potential of drug-induced sleep endoscopy in obstructive sleep apnea
Published in Annals of Medicine, 2022
Alonço Viana, Débora Estevão, Chen Zhao
DISE concurrent with wearing CPAP and OA can help physicians understand how UA obstruction is actually improving; whether the degree of improvement can reach expectation; and if it fails, what are reasons and what would be subsequent solutions. The manoeuvres of head rotation or protrusion of mandibular during DISE can predict the effectiveness of postural therapy or mandibular advancement therapy. Several innovative treatments have in turn increase acceptance of DISE among sleep medicine physicians, for example, the success of hypoglossal nerve stimulator implantation clearly demonstrating the necessity of DISE in screening candidates to exclude velopharyngeal complete concentric collapse. The complete lateral pharyngeal collapse can be restored after maxillomandibular advancement.