1. Sleep disordered breathing such as snoring and obstructive sleep apnea can affect both adults and children and have significant health consequences if left untreated.
2. Screening for snoring is important for diagnosing potential sleep disorders, with polysomnography considered the gold standard test.
3. Treatment options include adenotonsillectomy, CPAP, oral appliances, and addressing underlying risk factors. Prompt diagnosis and management are important to prevent long-term complications.
The Dentist's Role in Treatment of Sleep Disordered BreathingRobbie Schaack, DDS
This document discusses the dentist's role in treating sleep disordered breathing through oral appliances. It begins with an overview of sleep apnea types and risk factors. Diagnosis is through a sleep study and treatment options include CPAP, oral appliances, and surgery. The document focuses on oral appliances, describing major types like mandibular repositioning devices. It discusses factors in determining a patient's suitability for oral appliances and outlines the dentist's treatment protocol, including medical evaluation, sleep study interpretation, clinical exam, communication with physicians, patient consent, and initial fitting and adjustments.
This document discusses snoring, its causes, and potential treatments. It is authored by Dr. Ornouma Sriwanishvipat, an ENT surgeon. Snoring is caused by turbulent airflow from tissues in the nose and throat vibrating during sleep. Left untreated, habitual snoring can increase risks of health issues like high blood pressure. The doctor examines patients to determine if snoring is caused by issues like nasal problems, enlarged tonsils, or sleep apnea. Lifestyle changes and devices like oral appliances or CPAP machines can help. For severe cases, surgery like uvulopalatopharyngoplasty may be recommended to reduce vibrations and open the airway.
This patient presented with hard of hearing and tinnitus. Examination showed normal ear drums with normal mobility. The audiogram showed a characteristic notch known as Carhart's notch, centered around 2000Hz, which is typically seen in otosclerosis. Otosclerosis is likely the diagnosis for this patient based on the clinical findings and audiogram results.
This patient presented with conductive hearing loss and tinnitus in the left ear. Examination showed normal appearing ear drums with normal mobility. The audiogram showed a characteristic Carhart's notch, indicating the probable diagnosis of otosclerosis. Otosclerosis causes stapes fixation leading to conductive hearing loss and is identified by the notch on bone conduction testing.
Snoring is caused by obstructed air movement during sleep and may indicate obstructive sleep apnea (OSA). OSA is characterized by recurrent collapse of the pharyngeal airway during sleep despite breathing efforts, and can be diagnosed through an overnight sleep study. Risk factors include age, anatomy, smoking, alcohol, and obesity. Treatment options include weight loss, avoiding triggers, dental appliances like mandibular advancement devices (MADs) that protrude the lower jaw to open the airway, surgery, and CPAP machines. Oral appliances are generally less invasive than other options and can effectively treat mild to moderate OSA.
The document discusses sleep apnea, its types, causes, symptoms, diagnosis and various treatment options. It defines sleep apnea as cessation of breath lasting at least 10 seconds during sleep. The main types are obstructive, central and mixed apnea. Common risk factors include obesity, retrognathia and tonsillar hypertrophy. Diagnosis involves polysomnography and questionnaires. Treatments include oral appliances, CPAP, surgery like maxillomandibular advancement and tracheostomy. The role of orthodontists is in diagnosis and oral appliance therapy.
This document discusses various types of breathing circuits and airway management devices. It describes Mapleson breathing circuit classifications and notes that the Magill and Bain systems are efficient for spontaneous and controlled ventilation, respectively. The Jackson Rees or Type F circuit has a larger reservoir bag, allowing for assisted or controlled ventilation, especially in children. The document also outlines various airway assessment techniques, predictors of difficult intubation/mask ventilation, and management strategies and devices for securing the airway, including oral/nasal airways, face masks, laryngeal mask airways, and tracheal intubation equipment.
The document summarizes Dr. Ornouma Sriwanishvipat, an ENT surgeon who specializes in voice change surgery and other procedures like snoring and sinus surgeries. It details her experience and the various surgeries she performs, including over 300 voice change surgeries. It then describes the process of voice feminization surgery, including preparation, the surgical procedure which shortens the vocal cords, and post-operation instructions like complete voice rest for a week.
The Dentist's Role in Treatment of Sleep Disordered BreathingRobbie Schaack, DDS
This document discusses the dentist's role in treating sleep disordered breathing through oral appliances. It begins with an overview of sleep apnea types and risk factors. Diagnosis is through a sleep study and treatment options include CPAP, oral appliances, and surgery. The document focuses on oral appliances, describing major types like mandibular repositioning devices. It discusses factors in determining a patient's suitability for oral appliances and outlines the dentist's treatment protocol, including medical evaluation, sleep study interpretation, clinical exam, communication with physicians, patient consent, and initial fitting and adjustments.
This document discusses snoring, its causes, and potential treatments. It is authored by Dr. Ornouma Sriwanishvipat, an ENT surgeon. Snoring is caused by turbulent airflow from tissues in the nose and throat vibrating during sleep. Left untreated, habitual snoring can increase risks of health issues like high blood pressure. The doctor examines patients to determine if snoring is caused by issues like nasal problems, enlarged tonsils, or sleep apnea. Lifestyle changes and devices like oral appliances or CPAP machines can help. For severe cases, surgery like uvulopalatopharyngoplasty may be recommended to reduce vibrations and open the airway.
This patient presented with hard of hearing and tinnitus. Examination showed normal ear drums with normal mobility. The audiogram showed a characteristic notch known as Carhart's notch, centered around 2000Hz, which is typically seen in otosclerosis. Otosclerosis is likely the diagnosis for this patient based on the clinical findings and audiogram results.
This patient presented with conductive hearing loss and tinnitus in the left ear. Examination showed normal appearing ear drums with normal mobility. The audiogram showed a characteristic Carhart's notch, indicating the probable diagnosis of otosclerosis. Otosclerosis causes stapes fixation leading to conductive hearing loss and is identified by the notch on bone conduction testing.
Snoring is caused by obstructed air movement during sleep and may indicate obstructive sleep apnea (OSA). OSA is characterized by recurrent collapse of the pharyngeal airway during sleep despite breathing efforts, and can be diagnosed through an overnight sleep study. Risk factors include age, anatomy, smoking, alcohol, and obesity. Treatment options include weight loss, avoiding triggers, dental appliances like mandibular advancement devices (MADs) that protrude the lower jaw to open the airway, surgery, and CPAP machines. Oral appliances are generally less invasive than other options and can effectively treat mild to moderate OSA.
The document discusses sleep apnea, its types, causes, symptoms, diagnosis and various treatment options. It defines sleep apnea as cessation of breath lasting at least 10 seconds during sleep. The main types are obstructive, central and mixed apnea. Common risk factors include obesity, retrognathia and tonsillar hypertrophy. Diagnosis involves polysomnography and questionnaires. Treatments include oral appliances, CPAP, surgery like maxillomandibular advancement and tracheostomy. The role of orthodontists is in diagnosis and oral appliance therapy.
This document discusses various types of breathing circuits and airway management devices. It describes Mapleson breathing circuit classifications and notes that the Magill and Bain systems are efficient for spontaneous and controlled ventilation, respectively. The Jackson Rees or Type F circuit has a larger reservoir bag, allowing for assisted or controlled ventilation, especially in children. The document also outlines various airway assessment techniques, predictors of difficult intubation/mask ventilation, and management strategies and devices for securing the airway, including oral/nasal airways, face masks, laryngeal mask airways, and tracheal intubation equipment.
The document summarizes Dr. Ornouma Sriwanishvipat, an ENT surgeon who specializes in voice change surgery and other procedures like snoring and sinus surgeries. It details her experience and the various surgeries she performs, including over 300 voice change surgeries. It then describes the process of voice feminization surgery, including preparation, the surgical procedure which shortens the vocal cords, and post-operation instructions like complete voice rest for a week.
Approach to Neurogenic Dysphagia (1) 24_07.pptxNeurologyKota
Approach to neurogenic dysphagia GUSS Swallow test
Individuals with Subcortical Strokes have a higher incidence of dysphagia and aspiration than those with cortical damage.
This document discusses the connections between breathing disorders like sleep apnea and asthma and their impacts on facial development and dental health. It suggests that medicine and dentistry should be in conversation to address these issues. Early intervention is important to guide proper facial growth and establish nasal breathing. Removing obstacles to nasal breathing like tonsils/adenoids and using palatal expansion or orthotropic techniques can help. Establishing proper tongue posture is also key to supporting development.
The document discusses snoring, its causes, treatments, and self-care approaches. Snoring occurs when throat tissues vibrate from air flow during breathing while sleeping and can be caused by factors like mouth anatomy, alcohol, and sleep apnea. Treatments may include lifestyle changes, oral appliances, surgery, or CPAP machines. Yoga practices like breathing exercises, inversions, and meditation can help address muscle tension and relaxation to reduce snoring.
Airway assessment is important to predict difficult ventilation and intubation. Several physical exam findings and tests can help assess the airway. The passage of air includes the upper airway of the mouth, nose, pharynx and lower airway of the trachea and bronchi. Predictors of difficult mask ventilation include obesity, beards, lack of teeth, age and snoring. Predictors of difficult laryngoscopy include limited range of neck motion, receding chin and large tongue. Specific tests evaluate mouth opening, neck flexibility, jaw movement and spine mobility to help identify potential airway challenges.
This presentation outlines sleep dentistry whiten the context of sleep medicine. Dr John Viviano DDS prepared this presentation to educate and encourage local dentists interested in the practice of Sleep Disorders Dentistry
sleeping disorder and their dental relation AyabellaEida
Sleep-disordered breathing (SDB) refers to breathing difficulties during sleep ranging from snoring to obstructive sleep apnea. Obstructive sleep apnea involves cessation of breathing due to airway obstructions and is associated with excessive daytime sleepiness. Dentists can play a role in diagnosing and treating SDB through intraoral and extraoral examination to identify risks like enlarged tonsils or uvula. Oral appliances are commonly used treatments that advance the mandible to open the airway and may reduce SDB symptoms. Some studies found associations between SDB, like snoring, and increased risk of periodontal disease, possibly due to factors like dry mouth and tongue positioning during sleep.
Airway assessment is important for identifying patients at risk of a difficult airway. Several tests can be used including Mallampati scoring, mouth opening, neck mobility, and thyromental distance. A difficult airway is when facemask ventilation or intubation is not possible using conventional methods. It is important to prepare for difficult airway scenarios by having proper equipment and involving senior help. Identifying difficult airway risks pre-operatively allows time for planning alternative strategies to ensure patient safety.
This document discusses airway, breathing, and sleep from an airway-centric approach. It provides information on examining the airway and contributing factors to sleep disorders. Treatment involves using oral appliances like NYU and Farrar appliances to improve the airway and breathing by advancing the mandible. Positive results are seen in improved sleep quality, reduced snoring and apnea, decreased pain symptoms, and stabilization of the airway and temporomandibular joints.
Cleft lip and palate are common birth defects that affect speech, hearing, breathing, and appearance. They require a team-based approach involving multiple specialists like otolaryngologists. The document discusses the management of cleft lip and palate, including the roles of different specialists in examining, diagnosing, and treating issues related to feeding, airway, speech, hearing, and surgery. Surgical techniques aim to restore normal anatomy and function through procedures on the lip and palate.
Airway assessment and pedictors of difficult airway....must know for anaesthe...drriyas03
This document discusses the importance of airway management expertise and outlines factors that can indicate a difficult airway. It notes that respiratory events are the second most common cause of injuries in anesthesia practice. Various anatomical measurements and assessments are described that can help predict a difficult airway, including Mallampati score, thyromental distance, neck mobility, and mandibular range of motion. Radiographic assessments like CT scans can also provide useful information. No single test is perfectly predictive, so anesthesiologists must always be prepared for an unanticipated difficult airway.
This document discusses voice therapy considerations following laryngeal cancer treatment. It covers the impact of radiation, chemotherapy, and surgery on the vocal folds. For non-laryngectomy patients, therapy may focus on techniques like inhalation phonation to address stiffness. Post-laryngectomy, patients lose their larynx and ability to speak normally. Communication options include electrolarynx, esophageal speech, or tracheoesophageal puncture. Support groups can help patients cope with the physical and emotional impacts of losing their voice box and learning alternative communication methods.
Prevention, etiology, diagnosis and treatment of inappropriate oral habits that cause various problems and sometimes can lead to irreversible & serious Maxillofacial / mental / skeletal / occlusal malfunctions.
The used reference was contemporary orthodontics wrote by Dr. Ali Akbar Bahreman.
Tonsillectomy is the surgical removal of the palatine tonsils. It is indicated for recurrent throat infections, tonsillitis causing medical issues, or enlarged tonsils obstructing breathing.
Pre-operative assessment involves evaluating the patient's medical history, examining the throat, and in some cases checking coagulation or doing a sleep study. Certain conditions like bleeding disorders or Down syndrome require special pre-operative management.
The surgery involves using various techniques like dissection and snare to separate the tonsils from surrounding tissue and remove them. Post-operative care focuses on pain management, diet, hygiene and watching for potential complications like bleeding or infection. Newer techniques aim to reduce morbidity through less invasive procedures
This document summarizes the anesthetic management of a 28-year-old male patient presenting for coronoidotomy of the temporomandibular joint who was anticipated to have a difficult airway. Due to restricted mouth opening and limited jaw movement from a previous surgery, fiberoptic intubation while awake was chosen. Various airway assessments were performed and difficult airway cart prepared. Fiberoptic intubation was successful with local anesthesia. General anesthesia was maintained uneventfully and the patient was extubated at the end of the 2-hour surgery. Recommendations for difficult airway management include considering awake fiberoptic intubation and having alternative airway plans.
Being invited to Florence, Italy to address an international medical meeting about our work for
head and neck tumors was a great honor. The symposium – organized under the auspices of
the President of Italy was held in a once-ancient hospital that is now a museum in the historic
city of Tuscany.
Obstructive sleep apnea (OSA) is a prevalent chronic disease characterized by pharyngeal collapse during sleep.
Sleep disorder that involves cessation or significant decrease in airflow through the upper airway in the presence of breathing effort.
Obstructive sleep apnea is the second most common sleep disorder, insomnia being the most common.
Associated with recurrent oxyhemoglobin desaturations and arousals from sleep
Apnea index- no. of apneas /hr of total sleep time.
AHI (APNEA-HYPOPNEA INDEX)- No of apneas and hypoapneas/hr of total sleep time.
RDI (Respiratory Disturbance Index) – no. of apneas, hypoapneas and respiratory effort related arousals(RERA)/hr of total sleep time.
This document discusses the relationship between restricted breathing mechanics, airway, and posture. It outlines assessments that should be performed to evaluate the temporomandibular joint (TMJ), cervical spine, breathing, and posture. These include tests of joint range of motion, muscle strength, hypermobility, and breathing efficiency. Restricted breathing is found in many patients and is linked to forward head posture. Correcting breathing mechanics and posture can help resolve TMJ and neck pain by restoring proper joint alignment in the upper body.
This document summarizes a patient's septoplasty procedure. It provides background on the patient's history and diagnosis of a deviated septum. It then describes the septoplasty surgery performed to correct the septal deviation, including related nursing interventions during admission, surgery, and post-operative care. Finally, it outlines health education provided to the patient on post-operative instructions and potential complications.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
Approach to Neurogenic Dysphagia (1) 24_07.pptxNeurologyKota
Approach to neurogenic dysphagia GUSS Swallow test
Individuals with Subcortical Strokes have a higher incidence of dysphagia and aspiration than those with cortical damage.
This document discusses the connections between breathing disorders like sleep apnea and asthma and their impacts on facial development and dental health. It suggests that medicine and dentistry should be in conversation to address these issues. Early intervention is important to guide proper facial growth and establish nasal breathing. Removing obstacles to nasal breathing like tonsils/adenoids and using palatal expansion or orthotropic techniques can help. Establishing proper tongue posture is also key to supporting development.
The document discusses snoring, its causes, treatments, and self-care approaches. Snoring occurs when throat tissues vibrate from air flow during breathing while sleeping and can be caused by factors like mouth anatomy, alcohol, and sleep apnea. Treatments may include lifestyle changes, oral appliances, surgery, or CPAP machines. Yoga practices like breathing exercises, inversions, and meditation can help address muscle tension and relaxation to reduce snoring.
Airway assessment is important to predict difficult ventilation and intubation. Several physical exam findings and tests can help assess the airway. The passage of air includes the upper airway of the mouth, nose, pharynx and lower airway of the trachea and bronchi. Predictors of difficult mask ventilation include obesity, beards, lack of teeth, age and snoring. Predictors of difficult laryngoscopy include limited range of neck motion, receding chin and large tongue. Specific tests evaluate mouth opening, neck flexibility, jaw movement and spine mobility to help identify potential airway challenges.
This presentation outlines sleep dentistry whiten the context of sleep medicine. Dr John Viviano DDS prepared this presentation to educate and encourage local dentists interested in the practice of Sleep Disorders Dentistry
sleeping disorder and their dental relation AyabellaEida
Sleep-disordered breathing (SDB) refers to breathing difficulties during sleep ranging from snoring to obstructive sleep apnea. Obstructive sleep apnea involves cessation of breathing due to airway obstructions and is associated with excessive daytime sleepiness. Dentists can play a role in diagnosing and treating SDB through intraoral and extraoral examination to identify risks like enlarged tonsils or uvula. Oral appliances are commonly used treatments that advance the mandible to open the airway and may reduce SDB symptoms. Some studies found associations between SDB, like snoring, and increased risk of periodontal disease, possibly due to factors like dry mouth and tongue positioning during sleep.
Airway assessment is important for identifying patients at risk of a difficult airway. Several tests can be used including Mallampati scoring, mouth opening, neck mobility, and thyromental distance. A difficult airway is when facemask ventilation or intubation is not possible using conventional methods. It is important to prepare for difficult airway scenarios by having proper equipment and involving senior help. Identifying difficult airway risks pre-operatively allows time for planning alternative strategies to ensure patient safety.
This document discusses airway, breathing, and sleep from an airway-centric approach. It provides information on examining the airway and contributing factors to sleep disorders. Treatment involves using oral appliances like NYU and Farrar appliances to improve the airway and breathing by advancing the mandible. Positive results are seen in improved sleep quality, reduced snoring and apnea, decreased pain symptoms, and stabilization of the airway and temporomandibular joints.
Cleft lip and palate are common birth defects that affect speech, hearing, breathing, and appearance. They require a team-based approach involving multiple specialists like otolaryngologists. The document discusses the management of cleft lip and palate, including the roles of different specialists in examining, diagnosing, and treating issues related to feeding, airway, speech, hearing, and surgery. Surgical techniques aim to restore normal anatomy and function through procedures on the lip and palate.
Airway assessment and pedictors of difficult airway....must know for anaesthe...drriyas03
This document discusses the importance of airway management expertise and outlines factors that can indicate a difficult airway. It notes that respiratory events are the second most common cause of injuries in anesthesia practice. Various anatomical measurements and assessments are described that can help predict a difficult airway, including Mallampati score, thyromental distance, neck mobility, and mandibular range of motion. Radiographic assessments like CT scans can also provide useful information. No single test is perfectly predictive, so anesthesiologists must always be prepared for an unanticipated difficult airway.
This document discusses voice therapy considerations following laryngeal cancer treatment. It covers the impact of radiation, chemotherapy, and surgery on the vocal folds. For non-laryngectomy patients, therapy may focus on techniques like inhalation phonation to address stiffness. Post-laryngectomy, patients lose their larynx and ability to speak normally. Communication options include electrolarynx, esophageal speech, or tracheoesophageal puncture. Support groups can help patients cope with the physical and emotional impacts of losing their voice box and learning alternative communication methods.
Prevention, etiology, diagnosis and treatment of inappropriate oral habits that cause various problems and sometimes can lead to irreversible & serious Maxillofacial / mental / skeletal / occlusal malfunctions.
The used reference was contemporary orthodontics wrote by Dr. Ali Akbar Bahreman.
Tonsillectomy is the surgical removal of the palatine tonsils. It is indicated for recurrent throat infections, tonsillitis causing medical issues, or enlarged tonsils obstructing breathing.
Pre-operative assessment involves evaluating the patient's medical history, examining the throat, and in some cases checking coagulation or doing a sleep study. Certain conditions like bleeding disorders or Down syndrome require special pre-operative management.
The surgery involves using various techniques like dissection and snare to separate the tonsils from surrounding tissue and remove them. Post-operative care focuses on pain management, diet, hygiene and watching for potential complications like bleeding or infection. Newer techniques aim to reduce morbidity through less invasive procedures
This document summarizes the anesthetic management of a 28-year-old male patient presenting for coronoidotomy of the temporomandibular joint who was anticipated to have a difficult airway. Due to restricted mouth opening and limited jaw movement from a previous surgery, fiberoptic intubation while awake was chosen. Various airway assessments were performed and difficult airway cart prepared. Fiberoptic intubation was successful with local anesthesia. General anesthesia was maintained uneventfully and the patient was extubated at the end of the 2-hour surgery. Recommendations for difficult airway management include considering awake fiberoptic intubation and having alternative airway plans.
Being invited to Florence, Italy to address an international medical meeting about our work for
head and neck tumors was a great honor. The symposium – organized under the auspices of
the President of Italy was held in a once-ancient hospital that is now a museum in the historic
city of Tuscany.
Obstructive sleep apnea (OSA) is a prevalent chronic disease characterized by pharyngeal collapse during sleep.
Sleep disorder that involves cessation or significant decrease in airflow through the upper airway in the presence of breathing effort.
Obstructive sleep apnea is the second most common sleep disorder, insomnia being the most common.
Associated with recurrent oxyhemoglobin desaturations and arousals from sleep
Apnea index- no. of apneas /hr of total sleep time.
AHI (APNEA-HYPOPNEA INDEX)- No of apneas and hypoapneas/hr of total sleep time.
RDI (Respiratory Disturbance Index) – no. of apneas, hypoapneas and respiratory effort related arousals(RERA)/hr of total sleep time.
This document discusses the relationship between restricted breathing mechanics, airway, and posture. It outlines assessments that should be performed to evaluate the temporomandibular joint (TMJ), cervical spine, breathing, and posture. These include tests of joint range of motion, muscle strength, hypermobility, and breathing efficiency. Restricted breathing is found in many patients and is linked to forward head posture. Correcting breathing mechanics and posture can help resolve TMJ and neck pain by restoring proper joint alignment in the upper body.
This document summarizes a patient's septoplasty procedure. It provides background on the patient's history and diagnosis of a deviated septum. It then describes the septoplasty surgery performed to correct the septal deviation, including related nursing interventions during admission, surgery, and post-operative care. Finally, it outlines health education provided to the patient on post-operative instructions and potential complications.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
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Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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3. Physiology of Snoring
Mandible back
Tongue back
Partial closure
upper airway
space
Speed airflow
increases
Vibration of uvula
* Other cause???
4. Snoring Demographics
z 40 - 60% over 50 years snore
z Males twice as likely as females
z Overweight / neck size
z Males 17” or greater
z Females 16” or greater
5. Snoring Significance
z Snorers awaken their partners and
occasionally themselves by the
loudness of their snoring resulting in
loss of sleep (to be discussed later)
z 10 - 20 % have a Severe Upper
Airway Sleep Disorder!
6. Severe Upper Airway
Sleep Disorders
Upper Airway Resistant Syndrome
(Tx – Same as OSA)
Obstructive Sleep Apnea (OSA)
8. Obstructive Sleep Apnea
z Complete or almost complete reduction in
airflow through the upper airway lasting
for more than 10 seconds, resulting in
severe oxygen depletion leading to medical
problems
z Causes - Tongue, obesity, inflammation of
any soft tissues in the upper airway
(tonsils, adenoids), polyps, tumors, etc
z Demographics - 4% of adult middle-aged
males and 2% of females
9. Physiology of OSA
Loss of muscle
activity
Mandible/
Tongue back
Partial/total
closure airway
Decreased oxygen
to lungs
Blood oxygen
desaturation
10. Patients With OSA
z Snore loudly
z Stop breathing - snort to start again
z Choke
z Suffer from acid reflux
z Toss and turn
z Wake up frequently
z Daytime sleepines
11. Significance of OSA
z Loss of air to lungs may happen many
times per hour
z Blood oxygen drops below the 90% level
causing the patient to arouse to breath
z Arousal causes loss of sleep, daytime
sleepiness, decreased production,
increased accidents, etc.
z May cause medical problems ranging
from mild to “life threatening”
12. Medical Responsibility
z Diagnosis and determine presence and
severity of an UASD - “Sleep Study”
z Determine treatment
z Treat patient or refer for oral device
Dental Responsibility
z Recognize and refer
z Provide support when requested
14. Behavior Modification
z Sleep on side rather than back
z Avoid alcohol late in day and evening
(CNS Depressant)
z Minimize use of sedatives
z Weight loss
Long term success poorly documented
15. Surgical Procedures
z UPPP - UvuloPalatoPharyngoPlasty
z LAUP - Laser-Assisted Uvula-
Palatoplasty
z High Frequency Radio Waves to uvula
z Tonsillectomy, adenoidectomy
z Tracheostomy - life saving procedure
z Craniofacial operations -
Maxillomandibular Advancement,
Hyoid lift
16.
17. z The most effective acceptable surgical
treatment of OSA (excluding tracheostomy)
z Success rates of 96%, 97%, 98% and 100%
reported in the literature
z Caution – Reports of devitalization of teeth
cause by surgical procedures
Maxillomandibular Advancement
(MMA)
Prinsell JR. Maxillomandibular advancement (MMA) in a Site-
Specific treatment approach for obstructive sleep apnea: A surgical
approach. Sleep Breath. 2000;4:147-54.
18. Continuous Positive Air
Pressure - CPAP
z Most effective of all treatment
modalities
z Patient must wear mask while sleeping
z Very noisy equipment, uncomfortable
z Equipment not easily portable
z Compliance poor
19.
20. Medications
z Only for those patient who are not
good candidates for CPAP, Oral
Devices or Surgical Procedures
z Should not be considered by
dentistry
24. z Snoring/OSA caused by loss of airway
space
z Most oral devices advance the mandible
z This pulls the genioglossus forward
z This pulls the tongue forward
z Upper airway space is regained
z Snoring/OSA diminished or eliminated
z Others simply keep the tongue protruded
How Does An Oral Device Work?
26. Diagnosing Snoring / OSA
z Medical history
z Sleep history
z Extended dental examination including
TMJ evaluation
z Epworth Sleepiness Scale
z Preliminary diagnosis
z Referral for medical evaluation (sleep
study)
27. z Snore loudly
z Stop breathing - snort to start again
z Choke
z Suffer from acid reflux
z Toss and turn during sleep
z Wake up frequently
z Have daytime sleepiness
Quality of Sleep Questions
28. 1. Weight Compared to Year Ago?
2. Ever Treated for Nasal Congestion
3. Neck Circumference
4. Alcohol/Sedatives- How Often?
5. Tired/Sleepy During the Day?
6. Sleep Position - Back, sides, stomach
Questions I’ll Ask
29. 6. Frequency and loudness of snoring
7. Previous Sleep Studies or Past
Treatment for Snore Problems?
8. Do You Ever Awaken Gasping for
Air?
9. Ever Been Told That You Stop
Breathing While You Sleep?
Questions I’ll Ask
30. How much air space is present?
z Open fairly wide and slightly protrude
your tongue
z Grade - I, II, or III
(Jamieson AO, Becker PM. Snoring: its
evaluation and treatment. Hospital
Medicine. March 1996)
31. Grade I
The tonsillar pillars, soft palate, and uvula
can be seen, with at least 5 mm between the
tip of the uvula and the base of the tongue
32. Grade II
Tonsillar pillars and soft palate remain
visible, tip of the uvula is obscured by the
base of the tongue: part of the free edge of
the soft palate is still visible
34. Epworth Sleepiness Scale
z Likeliness to doze off or fall asleep in certain
situations versus to just feeling tired
z Use the following scale to choose the most
appropriate number for each situation:
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
37. Oral Devices Indications
Recommended for snoring and mild
to moderate sleep apnea if CPAP
unsuccessful.
Practice parameters for the treatment of
snoring and obstructive sleep apnea with
oral devices. An American Sleep
Disorders Association Report. Sleep.
1995;18(6):511-13
38. Problems with MADs after long term
use (3 years or more)
z Minor jaw/facial, tooth, muscle pain – 40%
z Xerstomia – 30%
z Very Satisfied – 82%
z Satisfied – 15%
z Painless but irreversible change in
occlusion - 26%
GT, Sohn JW, Hong CN. Treating obstructive sleep apnea
and snoring: assessment of an anterior mandibular
positioning device. J Am Dent Assoc. 2000;131:765-71.
39. CLINICAL IMPLICATIONS
z Patients with mild-to-moderate OSA
who receive a two-piece, adjustable
MAD should be informed that 50
percent of patients quit using the
device in a three-year period and
some will experience shifts in their
occlusion.
42. Indications for TRDs
z Edentulous patients
z Patients with potential
temporomandibular joint problems
Problems with TRDs
z Sore tongue
z Tongue elongation
49. TRD Findings
z Altered the timing of the inspiratory
genioglossus (GG) activity and the onset of
inspiration effort
z Oxygen desaturation index dropped to
fewer than 10 events/ h in 75% of patients
z Significantly improved the blood oxygen
saturation level in infants
z Helped patients with mild to moderate
OSA; however, patients with more severe
OSA may also be treated effectively
63. Patient instructions for adjustment
(depends on device but typical):
z No adjust for first 3 nights to allow patient
to become accustom to device
z Protrude device 0.25 mm per night for 3 –
4 nights, stop, check for improvement
z Protrude device 0.25 mm per night for 3 –
4 nights, stop, check for improvement
z Continue until symptoms are relieved or
reduced or TMJ symptoms develop
64. Evaluation
z Following relief of symptoms allow patient
to wear device for 2 – 4 weeks
z Have patient wear a Pulse Oximetry device
and determine success of treatment
z Continue adjustments and followup Pulse
Oximetry or
z Refer to Physician for reevaluation
(2nd polysomnography)
65.
66. Patient Should Expect
z Lips will be very dry - lip balm
z Difficulty going to sleep for a few nights
z Lots of saliva - on pillow
z Teeth may become sensitive - seek care
immediately - usually slight adjustment
67. z For approximately 20 minutes upon
awakening teeth will not close together -
don’t force closure - no treatment
z TMJ discomfort - May be sore for a few
minutes during early adjustment, must be
relieved by moving mandible posteriorly
Patient Should Expect
68. z Device for treatment of snoring and/or OSA
z Cease wearing and return to dentist
immediately if any problems develop
z Device may only be partially successful
z May cause existing dental restorations to
loosened or fail
z Device may increase severity of an existing
OSA
Consent Form Before Treating
69. Is Insurance Coverage
Available? Yes and No
z Yes - medical insurance coverage is
possible for treatment of a diagnosed sleep
apnea condition. Very hard to collect
z No - medical insurance coverage for a
snoring only problem
z No - dental insurance coverage for either
70. Treating OSA with Oral Devices
MD exam $100 – 500
Initial Sleep Study $900 – 1800
Device and Follow-up $800 – 2000
Pulse Oximetry $35 – 200
Repeat Sleep Study $900 – 1800
Total $2735 – 6300
72. Prevalence in Infants and Children
z 3 – 12% snore
z 1 – 10% have OSA
When do problems occur
z Snoring – 22.7 months
z Apnea – 34.7 months
73. Symptoms - 352 OSA children exhibited :
z Chronic mouth breathing (84%)
z Otitis media (middle ear infection) (64%)
z Sinusitis (56%)
z Sore throat (51%)
z Choking (47%)
z Daytime drowsiness (42%)
z Less observed symptoms included poor school
performance, enuresis (bed wetting), poor
appetite and/or weight gain, dysphagia, and
vomiting.
74. What Do Studies Show?
z 7% of the children were habitual snorers and
exhibited a higher prevalence of difficulty in
breathing, observed apneas, restless sleep, and
nocturnal enuresis than non-snorers
z Subjects were more likely to fall asleep while
watching television and in public places and
were hyperactive
75. z The presence of asthma and hay fever
increased the likelihood of habitual snoring
with exposure to cigarette smoking at home
z Primary snoring was corrected with
adenotonsillectomy resulting in weight gain
and a restoration of normal growth
z 26% of children with mild symptoms of
Attention-Deficit/Hyperactivity Disorder
(ADHD) also demonstrate OSA as observed
during polysomnography testing
76. z Almost 25% of OSA children had clinically
significant behavioral sleep problems such as
sleep walking and nightmares as well as a
greater incidence of daytime externalizing
behavior problems
z Children 11 to14 years of age who were
diagnosed as being sleep deficient exhibited
lowered self-esteem, significantly lower grades
and higher levels of depressive symptoms than
those students registering more normal sleep
duration
77. z The early onset of alcohol, marijuana or illicit
drug use by the adolescent as well as an early
onset of cigarette use by the age of 12 to 14
could be significantly predicted by the mother’s
ratings of their children’s sleep problems at
ages 3 to 5 years
z Children with sleep disorders and attention
deficit hyperactivity disorder had a verbal IQ
(intelligence quotient) up to 20 points lower
than control subjects
78. z Children with lower academic
performance in middle school were more
likely to have snored in early childhood
and have required tonsillectomy and
adenoidectomy
z Persistent sleep disturbance is likely to
adversely affect cognition, mood, behavior
and family function
79. z Habitual snoring was significantly
associated with lowered academic
performances in mathematics, science and
spelling in third grade children
z Infantile OSAS does occur in infants due
to hypertrophic adenoids and tonsils and
that among other things these infants
failed to gain weight
80. Recognition
z Of all observations made by parents, that
of “snoring every night”, is the most
significant factor in predicting OSA
z Children with sleep breathing disorders
had the dolico facial pattern
(disproportionately long face)
z Migraine headaches may be indicative of
sleep disturbances
81. Risk Factors for sleep apnea
in children include:
z Obesity
z African-American race
z Sinus problems
z Persistent wheezing
82. Guideline for Diagnosis of
OSAS
1. All children should be screened for
snoring
2. Complex high-risk patients should be
referred to a specialist
3. Patients with cardiorespiratory failure
cannot await elective evaluation
4. Diagnostic evaluation is useful in
discriminating between primary snoring
and OSAS, the gold standard being
polysomnography
83. 5. Adenotonsillectomy is the first line of
treatment for most children, and
continuous positive airway pressure is
an option for those who are not
candidates for surgery or do not respond
to surgery
6. Patients should be reevaluated
postoperatively to determine whether
additional treatment is required
Guideline for Diagnosis of
OSAS
84. Treatment
z Children with OSA have marked increases in
healthcare-related costs
z If prompt diagnosis and management are not
implemented some of these complications may
not be completely reversible, resulting in long-
lasting consequences
z Adenotonsillectomy is the treatment of choice
for most children and continuous positive
airway pressure may be an option for those
patients who are not a candidate for surgery or
who do not respond to surgery
85. z Caregivers detected a long-term improvement in
quality of life following adenotonsillectomy for
OSA although the results were not uniform
z Decreasing nasal congestion associated with
allergic rhinitis can improve sleep in these
patients and lead to improved daytime quality of
life
z CPAP can be effectively used in children less
than 2 years of age
Treatment
86. z Children with primary snoring were unlikely to
develop polysomnography-confirmed OSA and
therefore delayed treatment was safe
z For patients with residual problems following
adenotonsillectomy, collaboration with
orthodontists to improve craniofacial risk factors
should be considered
Treatment
87. Summary
z Failure to diagnose and treat these patients can
result in serious but usually reversible problems
which may include impaired growth,
neurocognitive and behavioral dysfunction and
cardiorespiratory failure
z Identifying these patients may be difficult
because they may not exhibit signs or symptoms
while awake
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