Sleep Apnea and Cosmetic Surgery Jubilee Hospital, Trivandrum

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ENT Lecture in Jubilee Hospital, Trivandrum, South India: 25-10-2011.
Dr.K.O.Paulose FRCS DLO
Consultant ENT Surgeon

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  • I am 60 yrs man from Iraq >wt. 112kg .tall 190cm. my work is veterinarian . Istill smoke since 35 yrs. I am suffering from snoring from long time . my dr said that there is nothing et the airway . he said that this condition is OSA , I want to know everything about trt. my case by any you see even the cost..
    pleace help me

    neamah yaseen
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Sleep Apnea and Cosmetic Surgery Jubilee Hospital, Trivandrum

  1. 1. ENT Surgery in Jubilee Hospital Trivandrum Dr.K.O.Paulose FRCS.DLO Consultant ENT Surgeon Jubilee Hospital Trivandrum web:www.drpaulose.com www.snorefreesleep.com
  2. 2. 33 years experience in ENT Surgery ABOUT ME 1968-1973-MBBS Medical College Trivandrum 1968-1969- Inmate of Louis catholic Hostel(Now Jubilee Hospital) 1978-1987 UK various NHS Hospital (10 yrs) 1981-FRCS UK, 1984 DLO London 1987-2003 Bahrain(Military Hospital-Consultant(17yrs) 2003-2004 Bahrain-Kims Hospital (locum Consultant) 2005-2010-SUT Hospital, Trivandrum-Consultant (5 yrs) 16th Sept 2010- on wards Jubilee Hospital Trivandrum LASER EXPERIENCE 1996- onwards laser surgery started In Bahrain Feb 2008 Laser and Coblator surgery in SUT Hospital Total number of Laser surgery in BDF .>1000 cases(Using Sharplan Co2 laser-Germany) Feb 2008-Sept 2010- 421 cases(Co2 laser and coblator Arthrocare®)in India+ 6 cases in first one week jubilee Hospital- 19th October onwards
  3. 3. 16th September 2010-Blessing of ENT Clinic by Most Rev Soosapakyam, Archbishop of Trivandrum
  4. 4. Blessing Prayer by Fr.Andrews Kosmos MBA, MD of Jubilee Hospital
  5. 5. ENT Clinic cum Endoscopy room
  6. 6. Co2 Laser parts
  7. 7. Laser Saftey guidlines
  8. 8. Co2 Laser in Jubilee Hospital
  9. 9. Laser Surgery Started in Jubilee 19th October 21010 For Snoring-OSA and Nasal allergy
  10. 10. Kumbhakarna and snoring snoring kumbhakarna.jpg
  11. 11. Stop snoring and save your marriage
  12. 12. Day time sleepiness daytime-sleepy.jpg
  13. 13. Broken marriages-Divorce !!!!
  14. 14. Car accidents 8 car crash.jpg
  15. 15. How Snoring and OSA
  16. 16. Causes of Snoring Nasal Obstruction Enlarged, Uvula, Soft Palate, Tougue Enlrged Ts Ads Lack of Muscle tone upper airway Air Turbulance in the oropharynx Vibration of soft palate and uvula Venturi Effect-Bernoulli principle
  17. 17. Causes of Snoring 1
  18. 18. Causes of Snoring -Nasal
  19. 19. Sleep ApneaWhat is Sleep apnea? Stoppage of breathing while asleep More than 10 seconds 100-500 episode of apneas in one night Plus Hypopneas Cause Hypoxia and HypercarbiaTypes of sleep apnea Obstructive Sleep Apnea (OSA) Most common-loud snoring Obstruction of upper airway Central Sleep Apnea (CSA) Brain stem lesion, stroke, polio, tumors No snoring Mixed sleep apnea (OSA+CSA) Chronic respiratory failure>central
  20. 20. Signs and symptoms of sleep apnea Choking or gasping during sleep Loud snoring Sudden awakenings to restart breathing Waking up in a sweat during the night Feeling tired in the morning Headaches Daytime sleepiness Lack of concentration,fatigue,irritable Low O2- Brain and Heart
  21. 21. Diagnosis of Sleep Apnea Good History from spouse or parents Physical examination-Nose and Throat Voice recording Flexible Endoscopy CT imaging or MRI retropalatal and pharyngeal airway Sleep study-Polysomnogram Cardiac evaluation
  22. 22.  C:Documents and SettingsAdministrato drpaulose clinic.jpg
  23. 23. CT Scan Retroplatal Airway-PN Ratio CT adenoid and soft palate.JPG
  24. 24. CT imaging adenoid.JPG
  25. 25. Sagital CT-PN ratio Pharyngeal Narrowing Ratio-Its significance Soft palate-tongue contact and automatically calculated pharyngeal narrowing ratio (PNR), defined as a ratio between the airway cross- section at the hard palate level and the narrowest cross-section from the hard palate to the epiglottis Soft palate should therefore be the target for causal treatment of snoring, LAUP, CAUP, RF somnoplasty all aimed at the soft palate in OSA surgery.
  26. 26. Polysomnography - Sleep lab study Brain electrical activity –EEG ECG Eye and jaw muscle movement Leg muscle movement Airflow Respiratory effort (chest and abdominal excursion) EKG Oxygen saturation
  27. 27. CPAP CPAP3.jpg
  28. 28. Treatment of Snoring and Sleep ApneaConservative Weight Loss Avoid Alcohol Dental devices, dilators Avoid sleeping pills or narcotics before bed Stop Smoking Dont sleep on your backSurgical Treatment Glossectomy Mandibular osteotomy Hyod advancement Nasal surgery, Septal surgery,LAPT RF Somnoplasty UPPP-LAUP+Coblator surgery Ts Ads Tracheostomy-last option
  29. 29. LASER TYPESLaser is an acronym that stands for Light Amplification by Stimulated Emission of Radiation. The first concept of the laser was initiated by Albert Einstein in 1917.CO2 LaserArgon laserThe Nd:YAG (Neodymium:Yttrium-aluminum- garnet)The potassium-titanyl-phosphate (KTP)Diode Laser
  30. 30. Co2 Laser CO2Laser The CO2 laser is the most versatile laser in otolaryngology. The carbon dioxide (CO2) laser emits a colorless, infrared light at a specific wavelength of 10,600 microns, which has an extremely high affinity for the intercellular water of cells. A second, built-in, coaxial helium neon laser is necessary to indicate with its red color the site where the invisible CO2 laser beam will impact the target tissue. This laser, then, acts as an aiming beam for the invisible CO2 laser beam.Advantages of Laser Surgery Fast Painless Bleeding-nil Fast recovery No hospitalization if done under LA GA for difficult casesDisadvantages of Laser Cost of equipment and maintenance Special surgical skills Increased setup time of equipment Need of safety eyewear Increased care for patient safety - explosion or fire hazard. smoke
  31. 31. Other Non surgical treatment Dental splint Nasal dilator Nasal drops Treatment of allergy CPAP Machine Yoga breathing Tennis ball on pyjama!!!
  32. 32. Laser surgery for snoring and OSA LAUP (Laser Assisted Uvulopalatopharyngoplasty) involves removal of the uvula, shorten the soft palate and reduce the volume of the tonsils using CO2 laser done under-LA / GA LAPT-Laser assisted Partial turbinectomy LAS-Laser assisted septoplasty LAT-Laser assisted Tonsillectomy
  33. 33. Results of Laser surgery showed the correction of sleep apnea by an average of 70-80% However, the snoring sound reduction was between 75-95%.Side Effects post op infection -rare nasal fluid reflux –temporary nasal regurgitation for few days, but rarely permanent no voice changes were noted Bleeding-rare Dryness of throat-rareCauses of fauilure if any mixed apnea-central component Inadequate excision of tissues-Redo Obesity,alcohol,sedative Lack of muscle tone in the neck Base of tongue factor-coblator reduction Jaw factor-need mandibular advancement
  34. 34.  laser sugery4.JPG
  35. 35. After LAUP-LA 12 after operation.jpg
  36. 36. Intubation-GA C:Documents and SettingsAdministrato intubatiC :Documents and SettingsAdministrator
  37. 37. Laser surgery under GA
  38. 38. Laser Surgery for OSA in Jubilee
  39. 39. LAUP
  40. 40. LAUP+Partial Tonsillectomy
  41. 41. Tonsils,soft palate and uvula
  42. 42. Laser Surgery-LAUP GA
  43. 43. Laser surgery for Nasal allergy/ -LA
  44. 44. Laser Surgery Nose-LA
  45. 45. Laser Surgery for Nasal allergy LA
  46. 46. “Doubting Thomas”
  47. 47. Laser Nose
  48. 48. Laser nose
  49. 49. After Laser Surgery
  50. 50. Oldest LAUP
  51. 51. Post op LAUP
  52. 52. COBLATOR SURGERYCold Ablation-Coblation Technology a controlled, non-heat driven process — uses radiofrequency energy to excite the electrolytes in a conductive medium, such as saline Temperature 40-70*C-less thermal damage Coblator II, Arthrocare ® USA MachineCoblator Surgery done in SUT Royal RF turbinate-Turbinoplasty Polypectomy Tonsillothomy-pediatric CAUP –Snoring and OSA Tongue base reduction
  53. 53.  IMG_2028.jpg
  54. 54. Coblator machine 2coblator machine.JPG
  55. 55. Coblation Technology plasma glow.jpg
  56. 56. CAUP CAUP01.jpg
  57. 57. CAUP Picture4.jpg
  58. 58. Septal surgery septoplasty-nisha5.jpg
  59. 59.  coblator-nisha1.jpg
  60. 60. Coblator stiffening soft palate coblator chaneling soft palate2-nisha3. coblator chaneling soft palate2-nisha3.jpgjpg
  61. 61. Laser surgery Nose
  62. 62. Happily living after
  63. 63. Diode laser surgery
  64. 64. Next ? -Harmonic Scalpel and Starion Tissue welding harmonic scalpel1.jpg
  65. 65. Rhinoplasty Procedure
  66. 66. Rhinoplasty Surgery
  67. 67. Rhinoplasty procedure
  68. 68. Micro Ear Surgery in Jubilee
  69. 69. Micro ear surgery in Jubilee 2
  70. 70. Cosmetic Surgery of Nose-Rhinoplasty
  71. 71. Rhinoplasty-Pocedure
  72. 72. Pre and Post op Rhinoplasty
  73. 73. Pre and Post op Rhinoplasty
  74. 74. THANK YOU
  75. 75. THANK YOUFor details please visit my web site: www.drpaulose.com www.snorefreesleep.com

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