The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The document discusses obstructive sleep apnea (OSA). It provides a brief history and epidemiology of OSA, describing the normal anatomy of the upper airway. It discusses the etiology and pathophysiology of OSA, including how reduced muscle tone during sleep can lead to airway collapse when the airway is structurally narrow. It notes that most OSA patients have an anatomically narrowed airway as seen on CT scan. OSA is characterized by repetitive pauses in breathing during sleep due to pharyngeal obstruction, which can cause cardiovascular and other health issues if left untreated.
Atlas anatomy of the nose and paranasal sinusesPrasanna Datta
This document discusses the anatomy of the nose and paranasal sinuses. It describes the external structures of the nose including the nasal vestibule. Internally, it outlines the nasal cavity including the roof, floor, medial and lateral walls. It then details the respiratory mucosa, blood supply from the external and internal carotid arteries, venous drainage and nerve innervation. Finally, it examines the anatomy of the individual paranasal sinuses - maxillary, ethmoid, frontal and sphenoid sinuses - focusing on their locations and drainage pathways.
OSA is an entity that is increasingly being managed by otolaryngologists...Hope this presentation helps to clear any doubts regarding its diagnosis and management!
Pharynx anatomy and part and muscles.
Tonsils and tonsilitis.
Peritonsillar Abscess (Quinsy)
FASCIA AND SPACE OF THE PHARYNX.
Zenker diverticulum (pharyngeal pouch).
Adenoid tonsils.
pharyngitis.
Sleep apnea.
adenoids enlargement and surgical indications and contraindications.
branchial cyst...
and more...
1) Nasal endoscopy is used to examine the nasal passages and paranasal sinuses using specialized equipment like rigid or flexible endoscopes and a light source.
2) The examination involves inserting the endoscope into the nasal cavity to visually inspect different areas like the inferior meatus, nasopharynx, sphenoethmoidal recess, and middle meatus.
3) Nasal endoscopy is useful for evaluating and treating inflammatory diseases of the sinuses, detecting tumors, locating the source of epistaxis, and assisting with other procedures like sinus surgery or skull base repairs. It provides information that CT scans cannot by allowing direct visualization of mucosal changes.
The document discusses obstructive sleep apnea (OSA), a common sleep disorder where breathing stops or decreases during sleep. Key points:
- OSA involves cessation or decrease of airflow despite breathing efforts and is the most common sleep disordered breathing.
- It is characterized by recurrent collapse of the upper airway during sleep, associated with oxygen desaturations and arousals from sleep.
- OSA is diagnosed based on the apnea hypopnea index (AHI), which counts apneas and hypopneas per hour of sleep. AHI of 5 or more with symptoms indicates OSA.
- Risk factors include obesity, age, male sex, and anatomical features restricting the upper
This document provides an overview of obstructive sleep apnea (OSA) and its implications for anesthesia. It defines OSA and discusses its causes, diagnosis, and physiological effects. It outlines risks of anesthesia for those with OSA, including difficult intubation and postoperative respiratory depression. It recommends preoperative screening and treatment with CPAP or weight loss. Intraoperatively, it advises securing the airway and avoiding sedatives that could cause collapse. Postoperatively, supplemental oxygen is important due to risk of apnea and respiratory depression upon waking.
Obstructive sleep apnea /certified fixed orthodontic courses by Indian dental...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The document discusses obstructive sleep apnea (OSA). It provides a brief history and epidemiology of OSA, describing the normal anatomy of the upper airway. It discusses the etiology and pathophysiology of OSA, including how reduced muscle tone during sleep can lead to airway collapse when the airway is structurally narrow. It notes that most OSA patients have an anatomically narrowed airway as seen on CT scan. OSA is characterized by repetitive pauses in breathing during sleep due to pharyngeal obstruction, which can cause cardiovascular and other health issues if left untreated.
Atlas anatomy of the nose and paranasal sinusesPrasanna Datta
This document discusses the anatomy of the nose and paranasal sinuses. It describes the external structures of the nose including the nasal vestibule. Internally, it outlines the nasal cavity including the roof, floor, medial and lateral walls. It then details the respiratory mucosa, blood supply from the external and internal carotid arteries, venous drainage and nerve innervation. Finally, it examines the anatomy of the individual paranasal sinuses - maxillary, ethmoid, frontal and sphenoid sinuses - focusing on their locations and drainage pathways.
OSA is an entity that is increasingly being managed by otolaryngologists...Hope this presentation helps to clear any doubts regarding its diagnosis and management!
Pharynx anatomy and part and muscles.
Tonsils and tonsilitis.
Peritonsillar Abscess (Quinsy)
FASCIA AND SPACE OF THE PHARYNX.
Zenker diverticulum (pharyngeal pouch).
Adenoid tonsils.
pharyngitis.
Sleep apnea.
adenoids enlargement and surgical indications and contraindications.
branchial cyst...
and more...
1) Nasal endoscopy is used to examine the nasal passages and paranasal sinuses using specialized equipment like rigid or flexible endoscopes and a light source.
2) The examination involves inserting the endoscope into the nasal cavity to visually inspect different areas like the inferior meatus, nasopharynx, sphenoethmoidal recess, and middle meatus.
3) Nasal endoscopy is useful for evaluating and treating inflammatory diseases of the sinuses, detecting tumors, locating the source of epistaxis, and assisting with other procedures like sinus surgery or skull base repairs. It provides information that CT scans cannot by allowing direct visualization of mucosal changes.
The document discusses obstructive sleep apnea (OSA), a common sleep disorder where breathing stops or decreases during sleep. Key points:
- OSA involves cessation or decrease of airflow despite breathing efforts and is the most common sleep disordered breathing.
- It is characterized by recurrent collapse of the upper airway during sleep, associated with oxygen desaturations and arousals from sleep.
- OSA is diagnosed based on the apnea hypopnea index (AHI), which counts apneas and hypopneas per hour of sleep. AHI of 5 or more with symptoms indicates OSA.
- Risk factors include obesity, age, male sex, and anatomical features restricting the upper
This document provides an overview of obstructive sleep apnea (OSA) and its implications for anesthesia. It defines OSA and discusses its causes, diagnosis, and physiological effects. It outlines risks of anesthesia for those with OSA, including difficult intubation and postoperative respiratory depression. It recommends preoperative screening and treatment with CPAP or weight loss. Intraoperatively, it advises securing the airway and avoiding sedatives that could cause collapse. Postoperatively, supplemental oxygen is important due to risk of apnea and respiratory depression upon waking.
Obstructive sleep apnea /certified fixed orthodontic courses by Indian dental...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
This document discusses nasorespiratory considerations in orthodontics. It covers the anatomy of the nasal airway and respiratory system. It discusses how evolution has impacted the human airway, separating the epiglottis from the soft palate and allowing for refined vocalization but also increasing risk of airway collapse during sleep. Various pathologies that can cause airway constriction in the nose, nasopharynx, mouth, oropharynx, and larynx are also outlined. The document also discusses the relationship between nasorespiratory function and craniofacial growth, noting it is assumed respiratory function can significantly impact development of the dentofacial complex.
This document provides information about sleep apnea, including its causes, signs and symptoms, risk factors, diagnosis, treatment, and self-care strategies. It defines two main types of sleep apnea - obstructive, which occurs when throat muscles relax and block the airway, and central, which occurs when the brain fails to signal breathing muscles. Common signs include loud snoring, breathing pauses during sleep, daytime sleepiness, and morning headaches. Risk factors include excess weight, neck size, and family history. Treatments may include devices like CPAP machines, oral appliances, surgery, weight loss, and yoga practices targeting the breathing, throat, and nasal areas.
The Nose and nasal cavity, anatomy, and clinical diseases of nasal cavity and...HamzehKYacoub
Nasal cavity is the most superior part of the respiratory system.
Blood supply of nose and Cavernous Sinus.
Epistaxis causes and locations.
Allergic Rhinitis and Non-allergic rhinitis with eosinophilia (NARES).
Ostiomeatal complex (OMC)
Sinusitis.
Nasal polyps.
Headaches types.
Neuralgia.
This is an undergraduate presentation on Snoring and Obstructive Sleep Apnoea in ENT.
It includes Overview, Types, Severity, Symptoms, Risk Factors, Diagnosis and Treatment options(Management), Differences between children and adults, Key points etc.
https://orcid.org/0000-0001-9306-2267
Pamudith Karunaratne
Obstructive sleep apnea (osa)The relationship of airway obstruction and dento...奇卿 黃
1. Enlarged adenoids are a major contributing factor to upper airway obstruction in children and can block nasal breathing, forcing mouth breathing.
2. Mouth breathing can lead to skeletal and dental abnormalities such as a narrow maxilla and mandible, increased overjet, and dental crowding.
3. Both adenoid growth and facial growth occur simultaneously during childhood, and adenoid obstruction of the airway can restrict normal facial development.
The Ear, Anatomy, Physiology, Clinical diseases, and pathology, hearing testsHamzehKYacoub
Ear is composed of three parts: External ear, middle ear, and the Inner ear.
Hearing tests (Rinne's and Weber's tests).
Most important hearing and ear diseases are included.
Naso respiratory function /certified fixed orthodontic courses by Indian dent...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The document discusses various types of airway equipment used in anesthesia including face masks, oral and nasopharyngeal airways, laryngoscopes, and endotracheal tubes. It describes the components, uses, sizes and types of each device. Face masks allow administration of gases without an apparatus in the mouth. Oral and nasopharyngeal airways maintain an open airway. Laryngoscopes are used to visualize the larynx for intubation or foreign body removal. Endotracheal tubes provide a conduit for gases into the trachea during anesthesia. The document provides detailed information on the features and proper use of these important airway management devices.
Snoring and obstructive sleep apnea occur when the muscles in the back of the throat relax during sleep, causing vibration that produces snoring sounds or complete or partial airway obstruction. Obstructive sleep apnea is defined by cessation of breathing lasting 10 seconds or more during sleep and is classified based on the respiratory disturbance index. Polysomnography is the gold standard test used to diagnose sleep apnea and involves monitoring various physiological parameters during sleep. Treatment options include lifestyle changes, oral appliances, continuous positive airway pressure therapy, and various surgical procedures to reduce tissue volumes or advance structures in the throat.
Obstructive sleep apnea /certified fixed orthodontic courses by Indian denta...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Obstructive sleep apnea (OSA) is a common sleep disorder where the airway becomes blocked during sleep, interrupting breathing. It is characterized by loud snoring, breathing pauses, and fatigue. Risk factors include obesity, large neck size, and family history. OSA can be classified by the site of airway obstruction and is diagnosed using tests like polysomnography. Untreated OSA has health consequences and increased mortality. Dentofacial features associated with OSA include a narrow upper airway and retrognathic mandible.
Nasal airway and malocclucion /certified fixed orthodontic courses by Indian ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Anatomy, Physiology & Diseases of nose. Paranasal sinusesEneutron
This document discusses the anatomy, physiology, and clinical presentation of acute and chronic sinusitis. It begins with the anatomy of the nose and paranasal sinuses, including the external nose, nasal cavity, and four paranasal sinuses. It then covers the pathogenesis, clinical manifestations, diagnosis, and treatment of acute and chronic sinusitis. Treatment involves restoring sinus drainage and function through medications, surgery such as endoscopic sinus surgery, and addressing any underlying infections or allergies. Complications of sinusitis are also discussed.
The document discusses the anatomy and physiology of the upper airway. It describes the components of the upper airway including the nose, nasopharynx, oropharynx, laryngopharynx, and larynx. It then discusses the muscles responsible for airway patency and the consequences of loss of upper airway muscle tone. Finally, it covers causes of upper airway obstruction including functional, mechanical, and those that can occur in the peri-operative period.
The document discusses the relationship between nasal airway obstruction and malocclusion. It reviews literature over 100 years old linking nasal obstruction to malocclusion. Tests to diagnose nasal obstruction and mouth breathing are discussed, including cephalometric analysis, spirometry, oximetry, and rhinomanometry. Effects of nasal obstruction include changes to head posture, mandibular rotation, increased facial height and dental arch collapse. Treatment options aim to address etiological factors through tonsillectomy, adenoidectomy, RME, and orthodontics. Further research is still needed to better understand these relationships and prevent obstructed airways.
Obstructive sleep apnea (OSA) is a common sleep disorder where the airway collapses or becomes blocked during sleep, disrupting breathing. Polysomnography is the gold standard test used to diagnose OSA by measuring breathing, oxygen levels, and brain waves during sleep. The main treatment is continuous positive airway pressure (CPAP) therapy, which uses mild air pressure to keep the airway open during sleep. Weight loss, avoiding alcohol, and sleeping on one's side can also help reduce OSA symptoms.
Nasopharynx gross anatomy and applied anatomy in dental and medical aspectsPratapMd
The document provides an overview of the nasopharynx, including its development, structure, blood supply, and clinical significance. The nasopharynx is the uppermost region of the pharynx located behind the nasal cavity. It extends from the skull base superiorly to the soft palate inferiorly and communicates with the nasal cavity via posterior nasal apertures. The roof is supported by bones while the floor is formed by the soft palate. It has important functions such as air conditioning and drainage of the nasal and paranasal sinuses.
Obstructive sleep apnea (OSA) is a disorder where breathing is interrupted during sleep due to the airway becoming blocked or narrowed. It is characterized by pauses in breathing or instances of reduced breathing during sleep. A sleep study can be used to diagnose OSA by measuring the number of breathing pauses per hour. While weight loss and lifestyle changes are recommended, continuous positive airway pressure (CPAP) is the most effective treatment for OSA. Untreated OSA is associated with serious health risks like hypertension, cardiovascular disease, diabetes and stroke.
Obstructive sleep apnea/hypopnea (OSAH) is defined as 5 or more respiratory events per hour of sleep lasting at least 10 seconds, accompanied by oxygen desaturation and arousal from sleep. It is caused by collapse of the upper airway during sleep due to reduced muscle tone. Diagnosis involves polysomnography and is treated primarily with continuous positive airway pressure (CPAP) or oral appliances. Surgical treatments aim to enlarge the upper airway through procedures such as uvulopalatopharyngoplasty (UPPP) or maxillomandibular advancement.
1) Tracheostomy is a surgical opening into the trachea through the neck that allows for an alternative airway. It has several purposes including bypassing upper airway obstruction and making it easier to clear secretions.
2) The procedure involves making incisions through the skin and trachea rings to insert a tracheostomy tube. It can be done via open or percutaneous dilational tracheostomy techniques.
3) Tracheostomy is indicated when normal breathing is compromised due to conditions like upper airway infections/injuries or an inability to cough effectively. It provides benefits like improved ventilation and protection against aspiration.
This document discusses tracheostomy and cricothyroidotomy procedures. Tracheostomy involves making an opening in the trachea and converting it to a stoma on the skin surface. It provides an alternative airway and allows for secretion removal. Indications include respiratory obstruction or insufficiency. Cricothyroidotomy is an emergency procedure done when other intubation methods have failed or are too risky, such as in cases of severe facial injuries. It involves making an incision through the cricothyroid membrane to access the trachea. Both procedures require careful technique and have risks of complications if not performed correctly.
This document discusses nasorespiratory considerations in orthodontics. It covers the anatomy of the nasal airway and respiratory system. It discusses how evolution has impacted the human airway, separating the epiglottis from the soft palate and allowing for refined vocalization but also increasing risk of airway collapse during sleep. Various pathologies that can cause airway constriction in the nose, nasopharynx, mouth, oropharynx, and larynx are also outlined. The document also discusses the relationship between nasorespiratory function and craniofacial growth, noting it is assumed respiratory function can significantly impact development of the dentofacial complex.
This document provides information about sleep apnea, including its causes, signs and symptoms, risk factors, diagnosis, treatment, and self-care strategies. It defines two main types of sleep apnea - obstructive, which occurs when throat muscles relax and block the airway, and central, which occurs when the brain fails to signal breathing muscles. Common signs include loud snoring, breathing pauses during sleep, daytime sleepiness, and morning headaches. Risk factors include excess weight, neck size, and family history. Treatments may include devices like CPAP machines, oral appliances, surgery, weight loss, and yoga practices targeting the breathing, throat, and nasal areas.
The Nose and nasal cavity, anatomy, and clinical diseases of nasal cavity and...HamzehKYacoub
Nasal cavity is the most superior part of the respiratory system.
Blood supply of nose and Cavernous Sinus.
Epistaxis causes and locations.
Allergic Rhinitis and Non-allergic rhinitis with eosinophilia (NARES).
Ostiomeatal complex (OMC)
Sinusitis.
Nasal polyps.
Headaches types.
Neuralgia.
This is an undergraduate presentation on Snoring and Obstructive Sleep Apnoea in ENT.
It includes Overview, Types, Severity, Symptoms, Risk Factors, Diagnosis and Treatment options(Management), Differences between children and adults, Key points etc.
https://orcid.org/0000-0001-9306-2267
Pamudith Karunaratne
Obstructive sleep apnea (osa)The relationship of airway obstruction and dento...奇卿 黃
1. Enlarged adenoids are a major contributing factor to upper airway obstruction in children and can block nasal breathing, forcing mouth breathing.
2. Mouth breathing can lead to skeletal and dental abnormalities such as a narrow maxilla and mandible, increased overjet, and dental crowding.
3. Both adenoid growth and facial growth occur simultaneously during childhood, and adenoid obstruction of the airway can restrict normal facial development.
The Ear, Anatomy, Physiology, Clinical diseases, and pathology, hearing testsHamzehKYacoub
Ear is composed of three parts: External ear, middle ear, and the Inner ear.
Hearing tests (Rinne's and Weber's tests).
Most important hearing and ear diseases are included.
Naso respiratory function /certified fixed orthodontic courses by Indian dent...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The document discusses various types of airway equipment used in anesthesia including face masks, oral and nasopharyngeal airways, laryngoscopes, and endotracheal tubes. It describes the components, uses, sizes and types of each device. Face masks allow administration of gases without an apparatus in the mouth. Oral and nasopharyngeal airways maintain an open airway. Laryngoscopes are used to visualize the larynx for intubation or foreign body removal. Endotracheal tubes provide a conduit for gases into the trachea during anesthesia. The document provides detailed information on the features and proper use of these important airway management devices.
Snoring and obstructive sleep apnea occur when the muscles in the back of the throat relax during sleep, causing vibration that produces snoring sounds or complete or partial airway obstruction. Obstructive sleep apnea is defined by cessation of breathing lasting 10 seconds or more during sleep and is classified based on the respiratory disturbance index. Polysomnography is the gold standard test used to diagnose sleep apnea and involves monitoring various physiological parameters during sleep. Treatment options include lifestyle changes, oral appliances, continuous positive airway pressure therapy, and various surgical procedures to reduce tissue volumes or advance structures in the throat.
Obstructive sleep apnea /certified fixed orthodontic courses by Indian denta...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Obstructive sleep apnea (OSA) is a common sleep disorder where the airway becomes blocked during sleep, interrupting breathing. It is characterized by loud snoring, breathing pauses, and fatigue. Risk factors include obesity, large neck size, and family history. OSA can be classified by the site of airway obstruction and is diagnosed using tests like polysomnography. Untreated OSA has health consequences and increased mortality. Dentofacial features associated with OSA include a narrow upper airway and retrognathic mandible.
Nasal airway and malocclucion /certified fixed orthodontic courses by Indian ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Anatomy, Physiology & Diseases of nose. Paranasal sinusesEneutron
This document discusses the anatomy, physiology, and clinical presentation of acute and chronic sinusitis. It begins with the anatomy of the nose and paranasal sinuses, including the external nose, nasal cavity, and four paranasal sinuses. It then covers the pathogenesis, clinical manifestations, diagnosis, and treatment of acute and chronic sinusitis. Treatment involves restoring sinus drainage and function through medications, surgery such as endoscopic sinus surgery, and addressing any underlying infections or allergies. Complications of sinusitis are also discussed.
The document discusses the anatomy and physiology of the upper airway. It describes the components of the upper airway including the nose, nasopharynx, oropharynx, laryngopharynx, and larynx. It then discusses the muscles responsible for airway patency and the consequences of loss of upper airway muscle tone. Finally, it covers causes of upper airway obstruction including functional, mechanical, and those that can occur in the peri-operative period.
The document discusses the relationship between nasal airway obstruction and malocclusion. It reviews literature over 100 years old linking nasal obstruction to malocclusion. Tests to diagnose nasal obstruction and mouth breathing are discussed, including cephalometric analysis, spirometry, oximetry, and rhinomanometry. Effects of nasal obstruction include changes to head posture, mandibular rotation, increased facial height and dental arch collapse. Treatment options aim to address etiological factors through tonsillectomy, adenoidectomy, RME, and orthodontics. Further research is still needed to better understand these relationships and prevent obstructed airways.
Obstructive sleep apnea (OSA) is a common sleep disorder where the airway collapses or becomes blocked during sleep, disrupting breathing. Polysomnography is the gold standard test used to diagnose OSA by measuring breathing, oxygen levels, and brain waves during sleep. The main treatment is continuous positive airway pressure (CPAP) therapy, which uses mild air pressure to keep the airway open during sleep. Weight loss, avoiding alcohol, and sleeping on one's side can also help reduce OSA symptoms.
Nasopharynx gross anatomy and applied anatomy in dental and medical aspectsPratapMd
The document provides an overview of the nasopharynx, including its development, structure, blood supply, and clinical significance. The nasopharynx is the uppermost region of the pharynx located behind the nasal cavity. It extends from the skull base superiorly to the soft palate inferiorly and communicates with the nasal cavity via posterior nasal apertures. The roof is supported by bones while the floor is formed by the soft palate. It has important functions such as air conditioning and drainage of the nasal and paranasal sinuses.
Obstructive sleep apnea (OSA) is a disorder where breathing is interrupted during sleep due to the airway becoming blocked or narrowed. It is characterized by pauses in breathing or instances of reduced breathing during sleep. A sleep study can be used to diagnose OSA by measuring the number of breathing pauses per hour. While weight loss and lifestyle changes are recommended, continuous positive airway pressure (CPAP) is the most effective treatment for OSA. Untreated OSA is associated with serious health risks like hypertension, cardiovascular disease, diabetes and stroke.
Obstructive sleep apnea/hypopnea (OSAH) is defined as 5 or more respiratory events per hour of sleep lasting at least 10 seconds, accompanied by oxygen desaturation and arousal from sleep. It is caused by collapse of the upper airway during sleep due to reduced muscle tone. Diagnosis involves polysomnography and is treated primarily with continuous positive airway pressure (CPAP) or oral appliances. Surgical treatments aim to enlarge the upper airway through procedures such as uvulopalatopharyngoplasty (UPPP) or maxillomandibular advancement.
1) Tracheostomy is a surgical opening into the trachea through the neck that allows for an alternative airway. It has several purposes including bypassing upper airway obstruction and making it easier to clear secretions.
2) The procedure involves making incisions through the skin and trachea rings to insert a tracheostomy tube. It can be done via open or percutaneous dilational tracheostomy techniques.
3) Tracheostomy is indicated when normal breathing is compromised due to conditions like upper airway infections/injuries or an inability to cough effectively. It provides benefits like improved ventilation and protection against aspiration.
This document discusses tracheostomy and cricothyroidotomy procedures. Tracheostomy involves making an opening in the trachea and converting it to a stoma on the skin surface. It provides an alternative airway and allows for secretion removal. Indications include respiratory obstruction or insufficiency. Cricothyroidotomy is an emergency procedure done when other intubation methods have failed or are too risky, such as in cases of severe facial injuries. It involves making an incision through the cricothyroid membrane to access the trachea. Both procedures require careful technique and have risks of complications if not performed correctly.
Tracheostomy care and suctioning are high-risk procedures that require adherence to evidence-based guidelines to avoid complications, even for experienced nurses. Tracheostomy patients are at risk for airway issues and infection both in intensive care and general units. Skilled nursing care through proper suctioning technique, emergency preparation, trach site care, and securing the trach tube can prevent complications.
Tracheostomy is a surgically created opening in the trachea to facilitate breathing. It is performed for conditions like airway obstruction, difficulty weaning from ventilation, or head/neck surgery. The document outlines the procedure, tube types, potential complications, benefits, and care considerations like decannulation. Tracheostomy allows for easier airway management compared to an endotracheal tube and can enable speech and eating depending on the tube used. Care must be taken to prevent issues like infection, bleeding, or long term complications like stenosis.
This document provides information on tracheostomies including definitions, functions, indications, types of procedures, techniques, care, complications and emergency airway management. A tracheostomy is a surgically created opening in the trachea to allow breathing when the oral airway is compromised. It can be an alternative breathing pathway, protect the airways, allow suctioning of secretions, and enable positive pressure ventilation. Indications include respiratory obstruction, retained secretions, and respiratory insufficiency. Types include emergency, elective, permanent, and percutaneous tracheostomies. The technique, care, complications, and procedures for managing acute airway obstruction are described in detail.
1) Tracheotomy and tracheostomy are surgical procedures that create an opening in the trachea. Tracheotomy involves cutting into the trachea, while tracheostomy involves creating a stoma between the trachea and skin.
2) The first documented references to tracheotomy date back to 2000 BC in the Rig Veda and 1550 BC in the Ebers Papyrus. However, tracheostomy became more popular and established in the 1800s.
3) Complications from tracheostomy can be immediate, intermediate like hemorrhage or tube displacement, or late complications such as stenosis. Careful patient selection, technique, and post-operative management can help reduce complications.
Tracheostomy is an ancient surgical procedure where an opening is created in the trachea to allow for breathing. It has been performed since 3600 BC in Egypt. Modern indications include prolonged intubation, airway obstruction, difficulty managing secretions, and as an adjunct to head and neck or chest surgery where ventilation may be problematic. Potential complications range from minor bleeding or infection to serious issues like tracheal stenosis, tracheoesophageal fistula, or erosion into major blood vessels. Careful surgical technique and postoperative management can help reduce risks.
The document discusses tracheostomy, which is a surgical procedure that creates an artificial opening in the trachea. It can be used to treat upper airway obstruction, assist with pulmonary ventilation, or help clear secretions from the lungs. The document outlines the anatomy of the trachea and various indications for tracheostomy. It also describes different techniques for performing a tracheostomy, as well as potential complications. Home care considerations are discussed.
Tracheostomy ent indications procedure complications pptTONY SCARIA
Tracheostomy is a surgical procedure that creates an opening in the anterior wall of the trachea and connects it to the skin surface, allowing for an alternative airway. It has several functions, including improving breathing, protecting the airways, and permitting removal of secretions. Indications for tracheostomy include respiratory obstruction, retained secretions, and respiratory insufficiency. Complications can occur during or after the procedure and with prolonged use of a tracheostomy tube. Alternative airway management techniques can be used to relieve an obstruction prior to an emergency tracheostomy.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses obstructive sleep apnea syndrome (OSAS), including its characteristics, epidemiology, diagnosis, clinical manifestations, pathophysiology, and surgical treatment considerations. OSAS is characterized by intermittent upper airway obstruction lasting 20-40 seconds on average, but sometimes over 100 seconds. It affects 2-9% of adults, with rates increasing with age. Diagnosis requires polysomnography to measure respiratory distress. Surgical treatments aim to address anatomical abnormalities in the nasal cavity, oropharynx, and hypopharynx that cause airway collapse during sleep. A multilevel treatment approach is often most effective.
Sleep-disordered breathing (SDB) refers to repetitive episodes of cessation of respiration or reductions in airflow during sleep that are associated with sleep fragmentation and reductions in blood oxygen levels. The most common form is obstructive sleep apnea, which is caused by collapse of the upper airway during sleep and affects 4-9% of adult men and 2-4% of adult women. Risk factors include male gender, obesity, large neck size, and specific anatomical features of the upper airway. Clinical presentation includes loud snoring, witnessed breathing pauses during sleep, daytime sleepiness, impaired cognitive function, and increased risk of accidents.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
1. The document discusses the relationship between naso-respiratory function, growth, sleep apnea and dentofacial deformities.
2. Animal studies found that nasal obstruction led to rhythmic activity in additional craniofacial muscles involved in respiration. This induces changes in neuromuscular function.
3. Studies in humans found that the sagittal depth of the nasopharynx increases steadily up to age 16 in females and age 20 in males, with the highest growth between ages 12-14 in males. There is great variation between individuals. Sagittal depth is relatively independent of other facial dimensions.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Sleep apnea01 /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
1. Pneumomediastinum is caused by a rupture of the alveolus or pulmonary bleb which allows air to dissect along blood vessels into the mediastinum.
2. Presentation includes chest pain, difficulty breathing, and neck swelling. Physical exam may reveal subcutaneous air or Hamman's sign.
3. Chest CT scan can identify linear densities, the spinnaker sign, and air in the mediastinum. Treatment focuses on low pressure ventilation and drain placement if life-threatening.
This document discusses sleep disorders, their causes, symptoms, diagnosis, and treatment. It covers several types of sleep disorders including insomnia, hypersomnia, circadian rhythm disorders, and parasomnias. Insomnia is difficulty falling or staying asleep and can be acute or chronic. Hypersomnia involves excessive daytime sleepiness and is often caused by sleep apnea, narcolepsy, or myoclonus. Circadian rhythm disorders disrupt normal sleep-wake cycles. Parasomnias distort normal sleep architecture and include sleepwalking and REM behavior disorder. Diagnosis involves medical history, observation, exams, and tests. Treatment goals are reducing morbidity, mortality, and improving quality of life.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
"Breath Easy: The Role of Orthodontics in Managing Obstructive Sleep Apnea"safabasiouny1
obstructive sleep apnea and orthodontics including diagnosis and treatment
Sleep disruption caused by breathing disorders are potentially life-threatening and therefore an important global health issue.
Sleep disorders, particularly untreated obstructive sleep apnea (OSA) has been known as a risk and possible causative factor in
1.
development of systemic hypertension,
2.
depression,
3.
stroke, angina
4.
cardiac dysrhythmias.
5.
can be associated with motor vehicle accidents,
6.
poor work performance and therefore, also makes a person prone to occupational accidents and reduced quality of life.
7.
adversely affects patients on their personal, social and professional levels.
Obstructive sleep apnea (OSA)
Definition: cessation of airflow for more than 10 seconds and hypopnoea is 50% reduction in air flow
It is Classified as central, obstructive and mixed and can be graded as mild, moderate and severe
This document defines and describes stridor, which is a noisy breathing sound caused by turbulent airflow through a narrowed airway. It discusses the different types of stridor based on timing in the respiratory cycle. It also explores how and why stridor occurs based on airway dynamics and increased resistance from narrowing. The document outlines how to evaluate stridor through history, examination, and various investigations. Finally, it covers the medical and surgical management of stridor, focusing on oxygen therapy, humidification, intubation, and other approaches depending on the underlying cause of stridor.
Obstructive sleep apnea is a sleep disorder where breathing is disrupted during sleep due to the upper airway collapsing or narrowing. It involves cessation (apnea) or reduction (hypopnea) of breathing for 10 seconds or more. The condition is caused by a combination of anatomical narrowing of the airway and loss of muscle tone in the throat during sleep. Polysomnography is used to diagnose by measuring breathing, oxygen levels, and sleep stages. Treatment options include lifestyle changes, oral devices, surgery, and continuous positive airway pressure (CPAP).
1. The nasopharynx lies behind the nasal cavity and extends from the skull base to the soft palate. It communicates with the oropharynx through the velo-pharyngeal sphincter.
2. Nasopharyngeal carcinoma most commonly presents with neck lumps, ear symptoms like fullness and hearing loss, and nasal symptoms like bleeding. It can spread locally and through lymphatic routes.
3. Evaluation involves endoscopic examination, imaging tests like CT/MRI, and biopsy for histopathological examination. Immunological tests help establish association with Epstein-Barr virus.
This document discusses basic airway management. It defines the airway and describes the anatomy involved including the larynx, trachea and bronchi. Common causes of airway obstruction are outlined for the upper airway, larynx and lower airway. Manual maneuvers like head tilt and jaw thrust are described to relieve mild obstruction. Oropharyngeal and nasopharyngeal airways are discussed as adjuncts to maintain a patent airway, with details on proper insertion techniques and patient considerations for each.
Obstructive sleep apnea (OSA) is a common sleep disorder where the airway becomes blocked during sleep, interrupting breathing. It is characterized by loud snoring, breathing pauses, and fatigue. Risk factors include obesity, large neck size, and family history. OSA can be classified by the site of obstruction and severity. Symptoms include excessive daytime sleepiness, impaired cognition, and increased health risks if left untreated. Dentofacial features associated with OSA include a narrow upper airway and retrognathic mandible.
The nose performs important functions like smell, air conditioning, and air purification. Examination of the nose involves history, inspection with speculum/mirror/endoscopy, and imaging tests. Common nose diseases include acute and chronic sinusitis. Acute maxillary sinusitis usually follows a respiratory infection and presents with fever, headache, tooth pain, and nasal discharge. Physical exam may reveal pus in the nose or nasopharynx.
Meconium aspiration syndrome (MAS) is a respiratory distress in infants born through meconium stained amniotic fluid. It occurs in 5% of infants delivered through meconium stained fluid and is caused by mechanical obstruction and chemical pneumonitis from inhaled meconium. Clinical features include respiratory distress, cyanosis, and chest retractions. Diagnosis is confirmed by chest x-ray showing infiltrates and management involves ventilatory support, surfactant therapy, inhaled nitric oxide, and potentially extracorporeal membrane oxygenation. With aggressive treatment, mortality from MAS has decreased to less than 5%.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Opportunity for Dentists (BDS/MDS )to relocate to United kingdom -Register as a DENTAL HYGIENIST/ DENTAL THERAPIST without Board exams and after approval you can register in GDC as a DH/DT and start working as a DH/DT Immediately and get paid.
You can complete the whole process in 3-4 months.Salary range for DH/DT is around 2500-3500 Pounds per month.
Eligibility / requirements-
1. An International English Language Testing System (IELTS) certificate
at the appropriate level.(Within 2 yrs of application date )
2: A recent primary dental qualification that has been taught and examined in English..(Within 2 yrs of application date )
3: A recent pass in a language test for registration with a regulatory authority in a country where the first language is English.
If you are interested Please contact us for more details.
1ST, 2ND AND 3RD ORDER BENDS IN STANDARD EDGEWISE APPLIANCE SYSTEM /Fixed ort...Indian dental academy
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,
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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.
I –Aligners are made with FDA approved transparent thermoplastic materials using 3D scanning, 3D Printing and finally Trays with Pressure vacuum formers.
Dear Doctor,
Indian Dental Academy Now offers comprehensive online Orthodontics course.
Course includes:
1.whiteboard lecture presentations
2.Case Discussions
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4.Demo on Models
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For Demo please visit :www.idalectures.com/preview/
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Thanks & Regards
Indian Dental Academy
--
Indian Dental Academy
Leader in continuing dental education
www.indiandentalacademy.com
skype:indiandentalacademy
+919248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Diagnosis and treatment planning in completely endntulous arches/dental coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Properties of Denture base materials /rotary endodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Use of modified tooth forms in complete denture occlusion / dental implant...Indian dental academy
This document discusses dental occlusion concepts and philosophies for complete dentures. It introduces key terms like physiologic occlusion and defines different occlusion schemes like balanced articulation and monoplane articulation. The document discusses advantages and disadvantages of using anatomic versus non-anatomic teeth for complete dentures. It also outlines requirements for maintaining denture stability, such as balanced occlusal contacts and control of horizontal forces. The goal of occlusion for complete dentures is to re-establish the homeostasis of the masticatory system disrupted by edentulism.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses dental casting investment materials. It describes the three main types of investments - gypsum bonded, phosphate bonded, and ethyl silicate bonded investments. For gypsum bonded investments specifically, it details their classification, composition including the roles of gypsum, silica, and modifiers, setting time, normal and hygroscopic setting expansion, and thermal expansion. It provides information on how the properties of gypsum bonded investments are affected by their composition. The document serves as a comprehensive overview of dental casting investment materials.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Find out more about ISO training and certification services
Training: ISO/IEC 27001 Information Security Management System - EN | PECB
ISO/IEC 42001 Artificial Intelligence Management System - EN | PECB
General Data Protection Regulation (GDPR) - Training Courses - EN | PECB
Webinars: https://pecb.com/webinars
Article: https://pecb.com/article
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For more information about PECB:
Website: https://pecb.com/
LinkedIn: https://www.linkedin.com/company/pecb/
Facebook: https://www.facebook.com/PECBInternational/
Slideshare: http://www.slideshare.net/PECBCERTIFICATION
Assessment and Planning in Educational technology.pptxKavitha Krishnan
In an education system, it is understood that assessment is only for the students, but on the other hand, the Assessment of teachers is also an important aspect of the education system that ensures teachers are providing high-quality instruction to students. The assessment process can be used to provide feedback and support for professional development, to inform decisions about teacher retention or promotion, or to evaluate teacher effectiveness for accountability purposes.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
Thinking of getting a dog? Be aware that breeds like Pit Bulls, Rottweilers, and German Shepherds can be loyal and dangerous. Proper training and socialization are crucial to preventing aggressive behaviors. Ensure safety by understanding their needs and always supervising interactions. Stay safe, and enjoy your furry friends!
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
3. IntroductionIntroduction
Obstructive Sleep Apnea (OSA) was firstObstructive Sleep Apnea (OSA) was first
described bydescribed by Charles Dickens inCharles Dickens in TheThe
Pickwick papersPickwick papers in 1836in 1836
In 1906In 1906 William OslerWilliam Osler said “ ansaid “ an
extraordinary phenomenon in excessivelyextraordinary phenomenon in excessively
fat young persons with an uncontrolledfat young persons with an uncontrolled
tendency to sleeptendency to sleep
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4. In 1950’s the research in sleep disorders gainedIn 1950’s the research in sleep disorders gained
momentum after the works ofmomentum after the works of Aserinsky,Aserinsky,
Klutman and DematKlutman and Demat who also termed the REMwho also termed the REM
and non – REM sleepand non – REM sleep
In 1956In 1956 BurwellBurwell first described the features offirst described the features of
Obesity, hypersomnolesence, decreasedObesity, hypersomnolesence, decreased
alveolar ventilation and cor pulmonale, nowalveolar ventilation and cor pulmonale, now
termed OSA, termed it astermed OSA, termed it as Pickwickan syndromePickwickan syndrome
In 1980’s research showed high incidence ofIn 1980’s research showed high incidence of
mortality and also oral appliances came intomortality and also oral appliances came into
beingbeing
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5. Obstructive sleep apnea syndrome-Obstructive sleep apnea syndrome-
Characterized by constellation of s/s relatedCharacterized by constellation of s/s related
to arterial oxygen desaturation & sleepto arterial oxygen desaturation & sleep
fragmentation caused by pharyngealfragmentation caused by pharyngeal
obstruction during sleep.obstruction during sleep.
Potentially life threatening conditionPotentially life threatening condition
Periodic cessation of breathing during sleepPeriodic cessation of breathing during sleep
inspite of inspiratory effort.inspite of inspiratory effort.
Significant morbiditySignificant morbidity
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6. It was 1It was 1stst
described bydescribed by Gastaut- disorder- disorder
associated with repetitive cessation ofassociated with repetitive cessation of
breathing during sleep.breathing during sleep.
Sleep apnea defined as 30 or more apneicSleep apnea defined as 30 or more apneic
episodes (cessation of airflow for moreepisodes (cessation of airflow for more
than 10 sec) occurring during 7hrs ofthan 10 sec) occurring during 7hrs of
nocturnal sleep.nocturnal sleep.
Most common is obstructive type.Most common is obstructive type.
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7. Reduced blood oxygen saturation leadsReduced blood oxygen saturation leads
to-to-
HypertensionHypertension
Cardiac arrhythmiasCardiac arrhythmias
Nocturnal anginaNocturnal angina
Myocardial ischemiaMyocardial ischemia
Impaired sleep quality leads to-Impaired sleep quality leads to-
Reduced concentrationReduced concentration
Risk of falling asleep during dayRisk of falling asleep during day
Behavioral changesBehavioral changeswww.indiandentalacademy.comwww.indiandentalacademy.com
8. Related to orthodontics-Related to orthodontics-
Peculiar cranio-facial & soft tissuePeculiar cranio-facial & soft tissue
morphologymorphology
Non-invasive modes of therapy i.e dentalNon-invasive modes of therapy i.e dental
appliances used in treatment of syndrome.appliances used in treatment of syndrome.
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9. Snoring-Snoring- produced by vibration of softproduced by vibration of soft
palate or oropharyngeal tissues.palate or oropharyngeal tissues.
Various factors related-Various factors related-
Sleep related loss of m. toneSleep related loss of m. tone
Large tonsilsLarge tonsils
Large tongueLarge tongue
RetrognathiaRetrognathia
ObesityObesity
AlcoholAlcohol
Sedative medicationSedative medication
Certain medical conditionCertain medical condition
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10. ClassificationClassification::
MildMild: 5 to 15 involuntary sleep episodes: 5 to 15 involuntary sleep episodes
occurring during activities that require littleoccurring during activities that require little
attentionattention
ModerateModerate: 15 to 30 sleep episodes during: 15 to 30 sleep episodes during
activities that require some attentionactivities that require some attention
SevereSevere: > than 30 episodes of sleep during: > than 30 episodes of sleep during
conversation, walking, eatingconversation, walking, eating
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11. Epidemiology of obstructive apnea syndrome
Mc NamaraMc Namara found 1-9% prevalence offound 1-9% prevalence of
OSASOSAS
Recent study byRecent study by Young et alYoung et al suggestedsuggested
prevalence of OSAS to be at least 9% inprevalence of OSAS to be at least 9% in
males & 4% in femalesmales & 4% in females
LugaresiLugaresi reported incidence of snoring to bereported incidence of snoring to be
19% in adult population & increased19% in adult population & increased
significantly with agesignificantly with age
KatsantonicsKatsantonics reported snoring 53% in men,reported snoring 53% in men,
38% in women.38% in women.
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12. Normal upper airway anatomyNormal upper airway anatomy
NoseNose- extends from external nares to- extends from external nares to
posterior nasal apertures & subdivided intoposterior nasal apertures & subdivided into
by nasal septum.by nasal septum.
Nasal septum-Nasal septum-
osteocartilagenous partition.osteocartilagenous partition.
Bony part-Bony part-
VomerVomer
Perpendicular plate of ethmoidPerpendicular plate of ethmoid
Nasal spine of frontalNasal spine of frontal
Rostrum of sphenoidRostrum of sphenoid
Nasal crests of palatine boneNasal crests of palatine bone
Maxillary bonesMaxillary bones
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13. Cartilaginous part-Cartilaginous part-
Septal cartilageSeptal cartilage
Septal process of interior nasal cartilageSeptal process of interior nasal cartilage
Cuticular part- fibro fatty tissueCuticular part- fibro fatty tissue
covered with skin lower margin ofcovered with skin lower margin of
septum called columella.septum called columella.
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15. Lateral wallLateral wall
Bony part Cartilaginous partBony part Cartilaginous part
Frontal process of maxilla nasal cartilagesFrontal process of maxilla nasal cartilages
Nasal bone 3-4 cartilages of alaNasal bone 3-4 cartilages of ala
Lacrimal boneLacrimal bone
Labyrinth of EthmoidLabyrinth of Ethmoid
(superior & middle concha)(superior & middle concha)
Inferior nasal conchaInferior nasal concha
Perpendicular plate of palatinePerpendicular plate of palatine
Medial pterygoid platedMedial pterygoid plated
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17. Decreased nasal patency may contribute to OSASDecreased nasal patency may contribute to OSAS
in many ways-in many ways-
Nasal obstruction with closed mouth may result inNasal obstruction with closed mouth may result in
obstructed airway, resulting in arousal.obstructed airway, resulting in arousal.
Nasal congestion may induce mouth breathing which inNasal congestion may induce mouth breathing which in
turn leads to posterior positioning of mandible causingturn leads to posterior positioning of mandible causing
hypo pharyngeal narrowing.hypo pharyngeal narrowing.
With nasal congestion there is large inspiratory pressureWith nasal congestion there is large inspiratory pressure
drop across nose leading to sub-atmospheric pressuredrop across nose leading to sub-atmospheric pressure
within potentially collapsible pharynx.within potentially collapsible pharynx.
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18. Soft palateSoft palate
Movable muscular fold suspended fromMovable muscular fold suspended from
posterior aspect of hard palate. Separatesposterior aspect of hard palate. Separates
nasopharynx from oro-pharynx.nasopharynx from oro-pharynx.
Muscles-Muscles-
Tensor palatiTensor palati
Levator palatiLevator palati
Musculus uvulaeMusculus uvulae
PalatopharyngeasPalatopharyngeas
PalatoglossusPalatoglossus
Enlarged soft palate- Might be contributingEnlarged soft palate- Might be contributing
factor in OSASfactor in OSAS
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19. PharynxPharynx
3 parts-3 parts-
Nasopharynx- posterior aspect of nasalNasopharynx- posterior aspect of nasal
turbinates to soft palateturbinates to soft palate
Oro-pharynx- from soft palate to base ofOro-pharynx- from soft palate to base of
tonguetongue
Laryngopharynx- from base of tongue toLaryngopharynx- from base of tongue to
larynxlarynx
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23. Nasopharyngeal patency can beNasopharyngeal patency can be
compromised by-compromised by-
Local mass lesionsLocal mass lesions
Scarring secondary to surgeryScarring secondary to surgery
Under development of local bonyUnder development of local bony
structuresstructures
Palatal uvular hypertrophy or edemaPalatal uvular hypertrophy or edema
AdenoidsAdenoids
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24. Oropharyngeal patency can beOropharyngeal patency can be
compromised by-compromised by-
Palatine tonsil hypertrophy orPalatine tonsil hypertrophy or
inflammationinflammation
Palatal or uvular enlargementsPalatal or uvular enlargements
MacroglossiaMacroglossia
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25. Hypo pharyngeal patency can beHypo pharyngeal patency can be
compromised-compromised-
MacroglossiaMacroglossia
Posterior & superior displacements of hyoidPosterior & superior displacements of hyoid
bonebone
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26. TongueTongue
Muscular gland situated at floor ofMuscular gland situated at floor of
mouth.mouth.
Muscles-Muscles-
Intrinsic ExtrinsicIntrinsic Extrinsic
Superior longitudinal GenioglossusSuperior longitudinal Genioglossus
Inferior longitudinal HyoglossusInferior longitudinal Hyoglossus
Transverse StyloglossusTransverse Styloglossus
Vertical PalatoglossusVertical Palatoglossus
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30. Etiology & pathophysiology of OSASEtiology & pathophysiology of OSAS
Predisposing factors still debatedPredisposing factors still debated
Syndrome can be-Syndrome can be-
CentralCentral
Obstructive (most common)Obstructive (most common)
Sub-obstructiveSub-obstructive
mixedmixed
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31. Obstruction prevented by action ofObstruction prevented by action of
pharyngeal dilator & abductorpharyngeal dilator & abductor
muscles- sleep reduces activity-muscles- sleep reduces activity-
airway resistance increases.airway resistance increases.
Genioglossus largest & best studiedGenioglossus largest & best studied
upper airway m. Conditions that retractupper airway m. Conditions that retract
mandible lead to posterior movementmandible lead to posterior movement
of tongue & narrowing of airway- canof tongue & narrowing of airway- can
be overcome by moving jaw forward.be overcome by moving jaw forward.
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32. Balance b/w pharyngeal musculatureBalance b/w pharyngeal musculature
& negative intrapharyngeal pressure of& negative intrapharyngeal pressure of
inspiration determines patency ofinspiration determines patency of
upper airway. Structural narrowing ofupper airway. Structural narrowing of
airway- hinders muscular componentairway- hinders muscular component
of balance even at rest.of balance even at rest.
Most pts with OSAS have narrowedMost pts with OSAS have narrowed
airway- confirmed by CT scan.airway- confirmed by CT scan.
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33. Alterations in facial morphology may alsoAlterations in facial morphology may also
be responsible for airway abnormality asbe responsible for airway abnormality as
pharyngeal musculature intimately relatedpharyngeal musculature intimately related
to bony structure. Eg- positive correlationto bony structure. Eg- positive correlation
b/w OSAS & short or posteriorly displacedb/w OSAS & short or posteriorly displaced
mandible in many pts.mandible in many pts.
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34. Most of obstruction in OSAS pts seen inMost of obstruction in OSAS pts seen in
oropharynx & associated with large tongueoropharynx & associated with large tongue
volumes & also mainly in obese personsvolumes & also mainly in obese persons
(excess peripharyngeal & subcutaneous fat)(excess peripharyngeal & subcutaneous fat)
Sleep with their jaws open- passive or activeSleep with their jaws open- passive or active
jaw opening- triggers afferents in TMJ-jaw opening- triggers afferents in TMJ-
reflexly inhibit Genioglossus m.reflexly inhibit Genioglossus m.
Anatomic aberration of pharyngeal airwayAnatomic aberration of pharyngeal airway
&/or neurogenic failure to preserve patency&/or neurogenic failure to preserve patency
of pharyngeal airway- 2 most commonof pharyngeal airway- 2 most common
theories.theories.
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36. Many hereditary or acquired variables have alsoMany hereditary or acquired variables have also
been described that precipitate OSAS-been described that precipitate OSAS-
Adenoid & tonsillar hypertrophy in children & adultsAdenoid & tonsillar hypertrophy in children & adults
Glottic websGlottic webs
Vocal cord paralysisVocal cord paralysis
AcromegalyAcromegaly
Lymphoma or hodgkins dsLymphoma or hodgkins ds
MicrognathiaMicrognathia
Ectopic thyroidEctopic thyroid
Upper airway radiation edema or fibrosisUpper airway radiation edema or fibrosis
RetrognathiaRetrognathia
Severe kyposcoliosisSevere kyposcoliosis
Correlation of velopharyngeal incompetence inCorrelation of velopharyngeal incompetence in
infantsinfants
Cushings dsCushings ds
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37. Physiologic abnormalities predisposing to OSAS-Physiologic abnormalities predisposing to OSAS-
Poliomyelitis, muscular dystrophies, amyotrophicPoliomyelitis, muscular dystrophies, amyotrophic
lateral sclerosis & other ds with bulbar incordinationlateral sclerosis & other ds with bulbar incordination
sec. to brain stem abnormalities.sec. to brain stem abnormalities.
Acquired dysautonomiaAcquired dysautonomia
HypothyroidismHypothyroidism
Flurazepam & other sedative hypnotic agentsFlurazepam & other sedative hypnotic agents
Alcohol ingestionAlcohol ingestion
Testosterone administrationTestosterone administration
EpilepsyEpilepsy
EncephalitisEncephalitis
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38. Mouth breathing and OSAMouth breathing and OSA
The tongue is no more in contact with theThe tongue is no more in contact with the
anterior palate hence producing a dorsal motionanterior palate hence producing a dorsal motion
of the belly of the genioglossus that falls backof the belly of the genioglossus that falls back
into the pharynx.into the pharynx.
Diminishes the axis of action of the genioglossusDiminishes the axis of action of the genioglossus
hence decreasing the efficiency of pulling thehence decreasing the efficiency of pulling the
genioglossus out of the airway.genioglossus out of the airway.
Also the pressure is now exerted across theAlso the pressure is now exerted across the
palate hence further narrowing the soft palate.palate hence further narrowing the soft palate.
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39. Opening of the mouth by 1.5cm pushes back theOpening of the mouth by 1.5cm pushes back the
gonial angle by 1cm, which decreases thegonial angle by 1cm, which decreases the
distance between the ventral attachment of thedistance between the ventral attachment of the
genioglossus and the posterior pharyngeal wallgenioglossus and the posterior pharyngeal wall
hence decreasing the lumen by 1cmhence decreasing the lumen by 1cm
Decrease in nasal airflow decreases theDecrease in nasal airflow decreases the
neuroregulatory mechanism of respirationneuroregulatory mechanism of respiration
-bringing about depression of respiration --bringing about depression of respiration -
predisposing to apneapredisposing to apnea
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40. Clinical & demographic features of OSASClinical & demographic features of OSAS
2 cardinal symptoms-2 cardinal symptoms-
Nocturnal symptom- snoringNocturnal symptom- snoring
Diurnal symptom- excessive day-time sleepinessDiurnal symptom- excessive day-time sleepiness
Other symptoms of sleep deprivation-Other symptoms of sleep deprivation-
Excessive fatigueExcessive fatigue
LethargyLethargy
Early morning headachesEarly morning headaches
Impaired concentration & impotenceImpaired concentration & impotence
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41. Clinical spectrum of sleep apnea-Clinical spectrum of sleep apnea-
Heavy habitual snoringHeavy habitual snoring
Excessive day-time sleepinessExcessive day-time sleepiness
Short term memory deficitsShort term memory deficits
Intellectual deteriorationIntellectual deterioration
Personality changesPersonality changes
Abnormal motor behaviorAbnormal motor behavior
ImpotenceImpotence
nocturnal enuresisnocturnal enuresis
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44. Diagnostic Aids in OSADiagnostic Aids in OSA
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45. Diagnostic aids in OSASDiagnostic aids in OSAS
History –History –
Snoring- 4-5 loud snores followed by silence,Snoring- 4-5 loud snores followed by silence,
followed again by series of loud snoresfollowed again by series of loud snores
Excessive day-time sleepinessExcessive day-time sleepiness
Clinical examination-Clinical examination-
Examination of the entire upperExamination of the entire upper
aerodigestive tract.aerodigestive tract.
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46. Nasal examination:Nasal examination:
Nose : nasal valve examination, alar collapseNose : nasal valve examination, alar collapse
Nasal speculum examination for mucosaNasal speculum examination for mucosa
changes, turbinates, DNS, pathology likechanges, turbinates, DNS, pathology like
cysts and polyps.cysts and polyps.
Oral cavity and the oropharynx:Oral cavity and the oropharynx:
Tongue : size , shape and the position.Tongue : size , shape and the position.
High arched palateHigh arched palate
TonsilsTonsils
Relation of tongue to oropharynxRelation of tongue to oropharynx
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47. Evaluate presence of disproportionate anatomy:Evaluate presence of disproportionate anatomy:
Long soft palate, uvula, base of the tongue, andLong soft palate, uvula, base of the tongue, and
retrognathic mandible and maxillaretrognathic mandible and maxilla
Evaluate hypo pharynx and larynx for presenceEvaluate hypo pharynx and larynx for presence
of tumors, large epiglottal folds, lingual tonsils,of tumors, large epiglottal folds, lingual tonsils,
vocal cords usually done with fibropticvocal cords usually done with fibroptic
endoscopeendoscope
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51. It is best done at night with atleast 4hrs ofIt is best done at night with atleast 4hrs of
sleep time recorded. Most sleep studiessleep time recorded. Most sleep studies
are conducted for atleast 2 consecutiveare conducted for atleast 2 consecutive
nights.nights.
Extreme sleep apnea includes oxygenExtreme sleep apnea includes oxygen
saturations level below 60%, an apneicsaturations level below 60%, an apneic
index greater than 50, prolonged apneaindex greater than 50, prolonged apnea
lasting more than 45 sec. & concurrentlasting more than 45 sec. & concurrent
cardiac arrhythmias.cardiac arrhythmias.
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52. Abdominal or thoracic strain gaugesAbdominal or thoracic strain gauges
provide movement tracings duringprovide movement tracings during
respiratory efforts.respiratory efforts.
When there is simultaneous pause ofWhen there is simultaneous pause of
airflow & thoracic or abdominal movement,airflow & thoracic or abdominal movement,
aa central type of apneacentral type of apnea has occurred.has occurred.
If airflow ceases but respiratory effortIf airflow ceases but respiratory effort
continues,continues, obstructive type of apnea.obstructive type of apnea.
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53. Data then scrutinized. Duration & total no.Data then scrutinized. Duration & total no.
of apnoeic periods, oxygen saturation,of apnoeic periods, oxygen saturation,
time during which oxygen saturation leveltime during which oxygen saturation level
below 90%, no. of arousals, quantity ofbelow 90%, no. of arousals, quantity of
REM sleep seen.REM sleep seen.
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54. Obstructive apnea- upper airway obstruction causesupper airway obstruction causes
cessation of airflow with concomitant continuation ofcessation of airflow with concomitant continuation of
thoracic breathing movements.thoracic breathing movements.
Central apnea- simultaneous cessation of both airflow &simultaneous cessation of both airflow &
thoracic breathing movements.thoracic breathing movements.
Mixed apnea- episodes of central apnea lasts 10 sec orepisodes of central apnea lasts 10 sec or
longer followed by obstructive apnea.longer followed by obstructive apnea.
Apnea – cessation of airflow for more than 10 sec.– cessation of airflow for more than 10 sec.
Hypoapnea – reduction in tidal volume accompanied by– reduction in tidal volume accompanied by
fall in blood oxygen saturation, lasting more than 10 sec.fall in blood oxygen saturation, lasting more than 10 sec.
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55. To diagnose OSA
30 or more apnoeic episodes within a course of30 or more apnoeic episodes within a course of
7hrs of sleep, resulting in excessive sleepiness7hrs of sleep, resulting in excessive sleepiness
during waking hrs.during waking hrs.
5 episodes of apnea or hypo apnea must occur5 episodes of apnea or hypo apnea must occur
per hrper hr
To make diagnosis & access severity of dsTo make diagnosis & access severity of ds
To determine need & urgency of treatment.To determine need & urgency of treatment.
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56. Epworth sleepiness scaleEpworth sleepiness scale
A questionnaire designed to assess how likelyA questionnaire designed to assess how likely
person would doze off in 8 specific situations-person would doze off in 8 specific situations-
Sitting & readingSitting & reading
Watching TVWatching TV
As a passenger sitting in car for an hrAs a passenger sitting in car for an hr
Sitting inactive in public placeSitting inactive in public place
Lying down to rest in afternoonLying down to rest in afternoon
Sitting & talking to someoneSitting & talking to someone
Sitting quietly after lunch, without having consumedSitting quietly after lunch, without having consumed
alcohol.alcohol.
As a driver of a car, stopped for a few min in traffic.As a driver of a car, stopped for a few min in traffic.
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57. Scores-Scores-
0 – no chance0 – no chance
1 – low likelihood1 – low likelihood
2 – moderately possible2 – moderately possible
3 – high chance3 – high chance
A score above 12 indicates subject isA score above 12 indicates subject is
more sleepy than normal individual.more sleepy than normal individual.
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58. Computerized tomography-Computerized tomography-
Non invasive scanning techniqueNon invasive scanning technique
Confines radiation to plane of interestConfines radiation to plane of interest
Minimizes blurringMinimizes blurring
Permits visualization of small variations inPermits visualization of small variations in
tissue density.tissue density.
3 dimensional description of airway, tongue &3 dimensional description of airway, tongue &
other associated structures.other associated structures.
But it is time consuming procedure &But it is time consuming procedure &
expensive.expensive.
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59. Study in AJO 1986
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60. Many studies shown-Many studies shown-
Lowe et al-Lowe et al- large tongue , soft palate &large tongue , soft palate &
reduced airway volumes. Majority ofreduced airway volumes. Majority of
constriction occurred in oropharynxconstriction occurred in oropharynx
Hapnik et al-Hapnik et al- reduced cross sectional areas ofreduced cross sectional areas of
nasopharynx, oropharynx & hypopharynx.nasopharynx, oropharynx & hypopharynx.
Subjects with severe OSA- larger tongue &Subjects with severe OSA- larger tongue &
smaller airway surface volume.smaller airway surface volume.
More obese subjects- large tongue surfaceMore obese subjects- large tongue surface
areas & smaller airway surface areas.areas & smaller airway surface areas.
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61. Magnetic resonance imaging-Magnetic resonance imaging-
Produces high resolution images without use ofProduces high resolution images without use of
ionizing radiation & yields both transverse & sagittalionizing radiation & yields both transverse & sagittal
sections of pharynx.sections of pharynx.
Ideally suited in assessing conditions with increasedIdeally suited in assessing conditions with increased
tissue water content.tissue water content.
Horner et al – used MRI to assess upper airway in– used MRI to assess upper airway in
obese pts showed an excess on fat deposition in softobese pts showed an excess on fat deposition in soft
palate, tongue & surrounding collapsible segment ofpalate, tongue & surrounding collapsible segment of
the pharynx.the pharynx.
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62. Fibre optic endoscopy-Fibre optic endoscopy-
Of value in location site of obstruction inOf value in location site of obstruction in
upper airwayupper airway
Particular emphasis is on the base of tongue,Particular emphasis is on the base of tongue,
its position & its forward movement onits position & its forward movement on
protrusion pf jaws.protrusion pf jaws.
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63. Electromyography-Electromyography-
Genioglossus m. activity in OSAGenioglossus m. activity in OSA
Timing relationship b/w genioglossusTiming relationship b/w genioglossus
inspiratory effort is of physiologic importanceinspiratory effort is of physiologic importance
in pathogenesis in OSAin pathogenesis in OSA
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64. Cephalometry –Cephalometry –
Lowe et al showed following hard & soft tissueshowed following hard & soft tissue
morphological characteristics in pts. with OSA-morphological characteristics in pts. with OSA-
Hard tissue features-Hard tissue features-
Small mandible which is retropositionedSmall mandible which is retropositioned
Increase in anterior facial htIncrease in anterior facial ht
Enlarged occlusal & mandibular plane angleEnlarged occlusal & mandibular plane angle
Over erupted maxillary & mandibular molarsOver erupted maxillary & mandibular molars
Steep occlusal planeSteep occlusal plane
Posteriorly positioned maxillae & mandiblePosteriorly positioned maxillae & mandible
Proclined incisorsProclined incisors
Decreased overbiteDecreased overbite
Inferior position of hyoid boneInferior position of hyoid bone
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65. Soft tissue features-Soft tissue features-
Elongated tongue, soft palate & pharyngeal ltElongated tongue, soft palate & pharyngeal lt
Thickened soft palateThickened soft palate
Decreased A-P pharyngeal space at superior,Decreased A-P pharyngeal space at superior,
middle & inferior levelsmiddle & inferior levels
Enlarged cross-sectional areas of tongue &Enlarged cross-sectional areas of tongue &
soft palatesoft palate
Decreased cross-sectional areas ofDecreased cross-sectional areas of
oropharynx & hypopharynxoropharynx & hypopharynx
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66. Lyberg and KronstadLyberg and Kronstad also documented similaralso documented similar
craniofacial features. Also noticed that in all theircraniofacial features. Also noticed that in all their
patients the hyoid bone was inferiorly positionedpatients the hyoid bone was inferiorly positioned
(usually at junction of C3 and C4) had shifted(usually at junction of C3 and C4) had shifted
much lower to C4, C5, C6 suggesting it couldmuch lower to C4, C5, C6 suggesting it could
be pushed down by the tongue.be pushed down by the tongue.
Large deposits of submental andLarge deposits of submental and
submandibular fat.submandibular fat.
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73. Nasopharyngoscopy:Nasopharyngoscopy:
Widely available easily performed, no radiation,Widely available easily performed, no radiation,
performed sitting or supine, Muller’s maneuver canperformed sitting or supine, Muller’s maneuver can
be performed possibility of predicting the outcomebe performed possibility of predicting the outcome
of UPPP depending on the site of obstructionof UPPP depending on the site of obstruction
Invasive and requires nasal anesthesia, evaluateInvasive and requires nasal anesthesia, evaluate
only the airway lumen and not surrounding softonly the airway lumen and not surrounding soft
tissue and patient is usually awake.tissue and patient is usually awake.
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74. Management of OSAManagement of OSA
Since etiology not precisely understood soSince etiology not precisely understood so
diversity of treatment options.diversity of treatment options.
Treatment of OSA depend on –Treatment of OSA depend on –
Severity of symptomsSeverity of symptoms
Magnitude of clinical complicationsMagnitude of clinical complications
Etiology of upper airway obstructionEtiology of upper airway obstruction
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75. Normally accepted options as outlined byNormally accepted options as outlined by
J.M Battagel-J.M Battagel-
Wt reductionWt reduction
Elimination of aggravating factorsElimination of aggravating factors
ENT assessment plus any necessaryENT assessment plus any necessary
treatmenttreatment
CPAPCPAP
Mandibular advancementMandibular advancement
Surgical optionsSurgical options
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76. Elimination of aggravating factorsElimination of aggravating factors
Chronic obstructive airway dsChronic obstructive airway ds
AsthmaAsthma
HypothyroidismHypothyroidism
Other such medical conditions that may 1Other such medical conditions that may 1stst
be eliminatedbe eliminated
Alcohol intakeAlcohol intake
Sedative medicationSedative medication
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77. Weight loss
Dramatic loss in wt. can result inDramatic loss in wt. can result in
significant decrease in apneic episodes insignificant decrease in apneic episodes in
obese pts suffering from OSA.obese pts suffering from OSA.
Recommended as 1Recommended as 1stst
form of therapy inform of therapy in
mild to moderate cases.mild to moderate cases.
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78. Sleep posture
CartwrightCartwright suggested that change in sleepsuggested that change in sleep
posture from supine posture to a lateralposture from supine posture to a lateral
decubital position can reduce tendency fordecubital position can reduce tendency for
airway collapse.airway collapse.
In supine position especially during REMIn supine position especially during REM
sleep, gravity & reduced tone ofsleep, gravity & reduced tone of
genioglossus m. increase the possibility ofgenioglossus m. increase the possibility of
obstruction.obstruction.
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79. Drug therapyDrug therapy
Progesterone has been used in an effortProgesterone has been used in an effort
to diminish obstructive apneas duringto diminish obstructive apneas during
sleep by acting as respiratory stimulant tosleep by acting as respiratory stimulant to
airway, diaphragm & intercostals.airway, diaphragm & intercostals.
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80. Nasopharyngeal airwayNasopharyngeal airway
Placed beyond clinical obstruction site canPlaced beyond clinical obstruction site can
have positive effect in OSA pts.have positive effect in OSA pts.
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81. Continuous positive airway pressure (CPAP)
Discovered byDiscovered by Collin SullivanCollin Sullivan in Sydneyin Sydney
Continuous stream of air under pressure isContinuous stream of air under pressure is
filtered & delivered to pharynx via a nasal mask.filtered & delivered to pharynx via a nasal mask.
Act asAct as pneumatic splintpneumatic splint..
This constant flow enough to prevent airwayThis constant flow enough to prevent airway
from collapsing but yet not enough to preventfrom collapsing but yet not enough to prevent
periodic expiration. So to be secured firmly inperiodic expiration. So to be secured firmly in
place.place.
Should be worn 6hrs at night, 7 days a week.Should be worn 6hrs at night, 7 days a week.
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82. Advantages –Advantages –
Most common & successful treatment for OSAMost common & successful treatment for OSA
Subject no longer dozes offSubject no longer dozes off
Sleeps well & feel less irritableSleeps well & feel less irritable
Disadvantages –Disadvantages –
Studies byStudies by Clark et al found 10-20% of subjects foundfound 10-20% of subjects found
it extremely uncomfortable & discontinued it.it extremely uncomfortable & discontinued it.
Overall long term compliance with this device-Overall long term compliance with this device-
60-70%60-70%
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84. Dental appliances
InexpensiveInexpensive
Non-invasiveNon-invasive
Easy to fabricateEasy to fabricate
Quite well tolerated by pt.Quite well tolerated by pt.
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85. 3 rationales
Reposition tongue in a more forwardReposition tongue in a more forward
position (TRD)position (TRD)
Reposition mandible forward (nocturnalReposition mandible forward (nocturnal
airway potency appliance NAPA, snoreairway potency appliance NAPA, snore
guard, herbst, mandibular positioner)guard, herbst, mandibular positioner)
To lift soft palate or reposition the uvulaTo lift soft palate or reposition the uvula
(equalizer)(equalizer)
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86. Approach to patientApproach to patient
Evaluate for periodontal health, dental restorations,Evaluate for periodontal health, dental restorations,
occlusion, TMJ function, mandibular movement andocclusion, TMJ function, mandibular movement and
craniofacial skeletal typecraniofacial skeletal type
Enough teeth must be present – at least 6 teeth in eachEnough teeth must be present – at least 6 teeth in each
arch and one good posterior teeth in each quadrant.arch and one good posterior teeth in each quadrant.
patient should be able to protrude the mandible at least 5patient should be able to protrude the mandible at least 5
mm without discomfortmm without discomfort
A patient with deep palate, long soft palate and steepA patient with deep palate, long soft palate and steep
mandibular plane may not be a good candidate, thoughmandibular plane may not be a good candidate, though
there is no set criteria.there is no set criteria.
After insertion and final adjustment a PSG must be doneAfter insertion and final adjustment a PSG must be done
to evaluate the efficiency and a base line Ceph, mustto evaluate the efficiency and a base line Ceph, must
have been obtained.have been obtained.
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87. AppliancesAppliances
Almost 32 commercial appliancesAlmost 32 commercial appliances
available:available:
Basically two types:Basically two types:
Mandibular advancement devices (MAD) andMandibular advancement devices (MAD) and
Tongue repositioning devices.Tongue repositioning devices.
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88. TRDTRD
Described byDescribed by Cartwright & SamelsonCartwright & Samelson inin
1982.1982.
To keep tongue in forward position- placesTo keep tongue in forward position- places
it into cup or bubble positioned in theit into cup or bubble positioned in the
anterior region with surface adhesionanterior region with surface adhesion
holding tongue in position.holding tongue in position.
Jaws to be kept in partly open position.Jaws to be kept in partly open position.
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89. Disadvantages
Tongue not always held in forwardTongue not always held in forward
position- surface adhesion lostposition- surface adhesion lost
Esthetically intolerableEsthetically intolerable
Forces nasal breathing- may beForces nasal breathing- may be
troublesome in some pts.troublesome in some pts.
Tongue may get irritated becoz of lack ofTongue may get irritated becoz of lack of
blood supply.blood supply.
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90. Advantages:Advantages:
Can be used in edentulous patients,Can be used in edentulous patients,
Will not loosen restoration as they do notWill not loosen restoration as they do not
require retention,require retention,
Minimal or no adjustment and no sensitivity toMinimal or no adjustment and no sensitivity to
teethteeth
Offset fluctuation of the genioglossus muscle.Offset fluctuation of the genioglossus muscle.
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92. Ferguson et al 1996-Ferguson et al 1996- TRD mostTRD most
successful in pts who are less than 50%successful in pts who are less than 50%
above ideal wt & in whom OSA is worseabove ideal wt & in whom OSA is worse
when they sleep in supine position.when they sleep in supine position.
Clark et al 1989-Clark et al 1989- TRD effective in 75% ofTRD effective in 75% of
mild to moderate cases compared tomild to moderate cases compared to
CPAP, more easily tolerated.CPAP, more easily tolerated.
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93. TRD & genioglossus m. activityTRD & genioglossus m. activity
Cartwright et al 1982-Cartwright et al 1982- alteredaltered
genioglossus m. activity significantlygenioglossus m. activity significantly
improved with TRD.improved with TRD.
Ono et al 1996-Ono et al 1996-
2 tongue retaining devices made for each2 tongue retaining devices made for each
subjects- TRD A & TRD Bsubjects- TRD A & TRD B
TRD A- no anterior bulbTRD A- no anterior bulb
TRD B- has bulbTRD B- has bulb
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94. Both TRD A & B- reduced apnea-hypoapneaBoth TRD A & B- reduced apnea-hypoapnea
index (AH index)index (AH index)
TRD A-TRD A- activation of genioglossus m. activity byactivation of genioglossus m. activity by
creating passive jaw opening- TMJ receptorscreating passive jaw opening- TMJ receptors
send information to CNS regarding jaw rotationsend information to CNS regarding jaw rotation
which affects tongue protrusion by genioglossuswhich affects tongue protrusion by genioglossus
m. activity.m. activity.
TRD B-TRD B- normalized time lag b/w peak inspiratorynormalized time lag b/w peak inspiratory
genioglossus m. EMG activity & max. inspiratorygenioglossus m. EMG activity & max. inspiratory
effort. Also normalized amplitude of peakeffort. Also normalized amplitude of peak
genioglossus m. EMG activity that fluctuatedgenioglossus m. EMG activity that fluctuated
during AH episodes while used TRD A.during AH episodes while used TRD A.
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95. Anterior tongue position with TRDAnterior tongue position with TRD
alleviates narrowing of upper airway thatalleviates narrowing of upper airway that
produces more positive pressure duringproduces more positive pressure during
inspiration. OSA pts otherwise will sufferinspiration. OSA pts otherwise will suffer
from scarcity of negative pressure-drivenfrom scarcity of negative pressure-driven
reflex during sleep.reflex during sleep.
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96. Anterior mandibular positioning devicesAnterior mandibular positioning devices
Many designs thereMany designs there
2 consistent features-2 consistent features-
Moves mandible forward several mmsMoves mandible forward several mms
Maintains jaw in forward position even thoughMaintains jaw in forward position even though
pt is asleeppt is asleep
Could be 1 piece appliance or 2 pieceCould be 1 piece appliance or 2 piece
appliance with tube & rod attachmentappliance with tube & rod attachment
(herbst appliance)(herbst appliance)
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97. 2 piece appliance2 piece appliance
Advantages-Advantages-
Maintains constant forward position of tongueMaintains constant forward position of tongue
Can be designed to allow continued oral breathingCan be designed to allow continued oral breathing
More esthetically pleasingMore esthetically pleasing
Disadvantages-Disadvantages-
Deleterious effect such as TMJ remodeling &Deleterious effect such as TMJ remodeling &
subsequent dysfunctionsubsequent dysfunction
Occlusal change- proclination or crowding of lowerOcclusal change- proclination or crowding of lower
anteriorsanteriors
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98. Nocturnal airway patency applianceNocturnal airway patency appliance
Designed by George 1987Designed by George 1987
Designed to keep airway open duringDesigned to keep airway open during
sleep by-sleep by-
Posturing tongue more anteriorlyPosturing tongue more anteriorly
Inhibiting wide jaw openingInhibiting wide jaw opening
Assuring adequate air intake through mouthAssuring adequate air intake through mouth
whenever nasal obstruction occurs.whenever nasal obstruction occurs.
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100. Results showed-Results showed-
Improvement in sleepImprovement in sleep
Snoring decreased or completelySnoring decreased or completely
disappeared.disappeared.
Daytime somnolence diminished markedly.Daytime somnolence diminished markedly.
Does produce some discomfort at night butDoes produce some discomfort at night but
pts get used to it.pts get used to it.
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101. Mandibular advancement splintsMandibular advancement splints
Like CPAP, mandibular advancement splints are a non-
Invasive and therefore reversible form of treatment, and
are worn only during sleep.
Many designs have been described, but essentially
these resemble a functional appliance: full coverage
upper and lower splints are constructed to a protrusive
working bite.
To be effective, the appliance must have good retention
to both upper and lower teeth, sufficient protrusion to
prevent pharyngeal collapse in the supine position and
as little vertical opening as possible.
An anterior space between upper and lower segments of
the splint is helpful for those who are mouth breathers.
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102. Seventy-five per cent of maximal protrusion has
been advised.
Furthermore, the amount of protrusion must be
tolerated by the individual. Since tolerance
increases with time, splints which are capable of
incremental advancement would seem to have
clear advantages.
Suitable designs include cribbed activator,
vacuum formed devices & removable herbst.
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104. Magnetic applianceMagnetic appliance
Maximal attractive force b/w magnets wasMaximal attractive force b/w magnets was
8.5N.8.5N.
Intermagnetic distance 0.6-1mm, whichIntermagnetic distance 0.6-1mm, which
reduce force magnitude for mandibularreduce force magnitude for mandibular
advancement to 5-6.5N.advancement to 5-6.5N.
Clasps for additional retention provided.Clasps for additional retention provided.
It is seen decrease in day time sleepinessIt is seen decrease in day time sleepiness
& nocturnal snoring. Blood saturation level& nocturnal snoring. Blood saturation level
improved in some pts. No effect on TMJ.improved in some pts. No effect on TMJ.
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106. Karwetzky activatorKarwetzky activator
Acc. ToAcc. To Marklund et al therapeutic efficacy
of activator is optimal when pts had A-H
index less than 10 events/hr.
Results showed- respiratory parameters
significantly improved, decrease snoring &
day time sleepiness. A-H index increased.
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108. Herbst applianceHerbst appliance
Introduced byIntroduced by Emil Herbst in 1905 &Emil Herbst in 1905 &
reintroduced in 1970’s by Hans Pancherz.reintroduced in 1970’s by Hans Pancherz.
Clark et al in 1993Clark et al in 1993 evaluated the effect of herbstevaluated the effect of herbst
type of anterior mandibular positioning device intype of anterior mandibular positioning device in
24 OSA pts. Results were satisfactory & follow24 OSA pts. Results were satisfactory & follow
up investigation 3 yrs later showed appliance toup investigation 3 yrs later showed appliance to
have been used successfully & continually usedhave been used successfully & continually used
in 52% of the sample.in 52% of the sample.
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109. Potential complications include-Potential complications include-
TMJ remodeling & dysfunctionTMJ remodeling & dysfunction
Jaw painJaw pain
Occlusal changes like lower incisor crowdingOcclusal changes like lower incisor crowding
If not protruded by 75% it did not work.If not protruded by 75% it did not work.
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111. Constructed of vinyl and repositions theConstructed of vinyl and repositions the
mandible in a “neuromuscular balancedmandible in a “neuromuscular balanced
position” determined by “myomonitorposition” determined by “myomonitor
(TENS)”, incorporating “equalizing tubes”(TENS)”, incorporating “equalizing tubes”
which are believed to “decrease thewhich are believed to “decrease the
negative pressure in oropharynx” duringnegative pressure in oropharynx” during
inspiration.inspiration.
The EqualizerThe Equalizer
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114. AdjustmentAdjustment
Initially 70 – 75% of maximum forwardInitially 70 – 75% of maximum forward
positioning of the mandiblepositioning of the mandible
Kept so for a week and if symptoms do notKept so for a week and if symptoms do not
subside then further advancement at asubside then further advancement at a
rate of .25mm per week till symptomsrate of .25mm per week till symptoms
subside or TMJ limitations start to showsubside or TMJ limitations start to show
Recalls at every 2 weeks; 1 month; 6Recalls at every 2 weeks; 1 month; 6
monthsmonths
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115. ProblemsProblems
Disocclussion of the posterior teethDisocclussion of the posterior teeth
Forward movement of the lower teethForward movement of the lower teeth
Excessive salivationExcessive salivation
Feeling of fullnessFeeling of fullness
TMJ sensitivity and sensitivity of teethTMJ sensitivity and sensitivity of teeth
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116. EfficiencyEfficiency
Shows good prognosis in mild to moderate cases.Shows good prognosis in mild to moderate cases.
Many showed immediate symptomaticMany showed immediate symptomatic
improvement.improvement.
Base of the tongue was advanced and dorsalBase of the tongue was advanced and dorsal
surface appeared more superiorsurface appeared more superior
Hyoid bone positioned anteriorly and cross sectionHyoid bone positioned anteriorly and cross section
of oropharynx increased from 41.6 mm to 92.3of oropharynx increased from 41.6 mm to 92.3
mmmm
Airway volume increased by 27.6% and tongueAirway volume increased by 27.6% and tongue
volume decreased by 17.6% due to the forwardvolume decreased by 17.6% due to the forward
and superior tongue posture.and superior tongue posture.
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117. Antisnoring devicesAntisnoring devices
Clark & Nakano 1989Clark & Nakano 1989 described 2 devicesdescribed 2 devices
to have an effect at reducing snoring-to have an effect at reducing snoring-
Labial shield-Labial shield-
Prevent mouth breathing & forces nasalPrevent mouth breathing & forces nasal
breathingbreathing
Maintains patency b/w soft palate & pharynxMaintains patency b/w soft palate & pharynx
Palatal lift-Palatal lift-
Stop soft palate vibration so reduces snoring.Stop soft palate vibration so reduces snoring.
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118. Surgical management of OSASurgical management of OSA
Current surgical techniques used-Current surgical techniques used-
TracheostomyTracheostomy
Uvulopalatopharyngoplasty (UPPP)Uvulopalatopharyngoplasty (UPPP)
Osteomy (anterior sagittal) with hyoid myotomy &Osteomy (anterior sagittal) with hyoid myotomy &
suspension.suspension.
Maxillary, mandibular & hyoid advancement.Maxillary, mandibular & hyoid advancement.
Genioglossus advancementGenioglossus advancement
Partial glossectomyPartial glossectomy
Radiofrequency volumetric shrinkage of soft palate &Radiofrequency volumetric shrinkage of soft palate &
tongue basetongue base
Tongue base suspension suturesTongue base suspension sutures
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119. TracheostomyTracheostomy
11stst
reported as treatment of OSA in 1969 byreported as treatment of OSA in 1969 by
Guilleminault et alGuilleminault et al..
Indications –Indications –
Disabling sleepiness with severe familial & socio-Disabling sleepiness with severe familial & socio-
economic impacteconomic impact
Severe cardiac arrhythmias with sleep apnea.Severe cardiac arrhythmias with sleep apnea.
A high apneic index (>60)A high apneic index (>60)
Notable oxygen desaturation level during sleep i.eNotable oxygen desaturation level during sleep i.e
below 40%below 40%
No improvement of clinical symptoms orNo improvement of clinical symptoms or
polysomnographic findings after medical trials.polysomnographic findings after medical trials.
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120. Results showed-Results showed-
Surgery may result in sec. local & generalSurgery may result in sec. local & general
acute & subacute complications.acute & subacute complications.
But on long term basis pts were completelyBut on long term basis pts were completely
relieved of clinical symptoms.relieved of clinical symptoms.
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121. UvulopalatopharyngoplastyUvulopalatopharyngoplasty
Proposed byProposed by Ikematsu in 1964 & introduced byIkematsu in 1964 & introduced by
Fujita et al in 1981.Fujita et al in 1981.
Resect posterior margin of the soft palate &Resect posterior margin of the soft palate &
redundant lateral pharyngeal wall mucosa.redundant lateral pharyngeal wall mucosa.
Soft palate resection ranges from 8-15mmSoft palate resection ranges from 8-15mm
stopping short of thick muscular part of thestopping short of thick muscular part of the
palate.palate.
Lateral pharyngeal wall treated by resectingLateral pharyngeal wall treated by resecting
redundant mucosa & developing a flap along theredundant mucosa & developing a flap along the
posterior wall.posterior wall.
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122. Flap is advanced & sutured to anterior tonsillarFlap is advanced & sutured to anterior tonsillar
pillar.pillar.
When sites of obstruction included excessiveWhen sites of obstruction included excessive
pharyngeal tissues combined with low-archedpharyngeal tissues combined with low-arched
palates response rate is increased.palates response rate is increased.
Complications of UPPP-Complications of UPPP-
Pharyngeal drynessPharyngeal dryness
Loss of tasteLoss of taste
Nasopharyngeal stenosisNasopharyngeal stenosis
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124. Kamami technicKamami technic
Proposed laser assisted uvuloProposed laser assisted uvulo
palatoplasty.palatoplasty.
Carbon dioxide laser at 20 watts (continuousCarbon dioxide laser at 20 watts (continuous
mode)mode)
Reports success rates comparable or betterReports success rates comparable or better
than convectional UPPP.than convectional UPPP.
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125. Inferior sagittal osteotomy of the mandible withInferior sagittal osteotomy of the mandible with
hyoid myotomy & suspensionhyoid myotomy & suspension
11stst
reported byreported by Riley et al 1984Riley et al 1984
He treated 55 pts-He treated 55 pts-
67% good response67% good response
33% non responders33% non responders
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126. Supra hyoid myotomy: to elevate the redundant lateral
pharyngeal tissues sometimes accomplished with
genioglossal advancement
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128. Maxillary, mandibular & hyoid advancement
Lefort I osteotomy & sagittal split osteotomyLefort I osteotomy & sagittal split osteotomy
Gives more predictable resultsGives more predictable results
Best alternative to Tracheostomy.Best alternative to Tracheostomy.
Indications –Indications –
Pts with normal skeletal development & severe OSAPts with normal skeletal development & severe OSA
Morbidly obese ptsMorbidly obese pts
Severe skeletal deficiencySevere skeletal deficiency
Other modes of treatment failed.Other modes of treatment failed.
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130. ConclusionConclusion
High prevalence of OSA has only been recentlyHigh prevalence of OSA has only been recently
appreciated in part becoz s/s of chronic sleepappreciated in part becoz s/s of chronic sleep
disruption are often overlooked inspite ofdisruption are often overlooked inspite of
debilitating consequences.debilitating consequences.
Challenge to clinician is to routinely consider theChallenge to clinician is to routinely consider the
diagnosis & to incorporate several basicdiagnosis & to incorporate several basic
questions in the historical review of symptomsquestions in the historical review of symptoms
regarding daytime or inappropriate sleepiness.regarding daytime or inappropriate sleepiness.
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131. Clinician s/b aware of the role ofClinician s/b aware of the role of
orthodontists in prevention & treatment oforthodontists in prevention & treatment of
sleep disorders by various orthodonticsleep disorders by various orthodontic
appliances.appliances.
Team approach for management of suchTeam approach for management of such
pts with OSA currently includes support ofpts with OSA currently includes support of
pulmonologist, neurologist, sleep labpulmonologist, neurologist, sleep lab
technician, oral surgeon &technician, oral surgeon &
otolaryngologist.otolaryngologist.
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132. Most recently consistent use of cephMost recently consistent use of ceph
analysis has been recommended to aid inanalysis has been recommended to aid in
diagnosis & treatment planning for OSAdiagnosis & treatment planning for OSA
pts.pts.
This coupled with new & promisingThis coupled with new & promising
treatment alternative of the orthodontictreatment alternative of the orthodontic
appliances, would suggest that theappliances, would suggest that the
orthodontist could contribute to teamorthodontist could contribute to team
management of these pts.management of these pts.
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