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.
This presentation gives some basic information regarding the definition , etiology and pathophysiology of " obstructive sleep apnea" which is a serious sleep disorder .Treatment methods are briefly reviewed with special emphasis on the role of the oral surgeon and orthodontist in the management of this medical condition .
Perilymph Fistula can be difficult to diagnose as a standalone condition. Post-trauma symptoms such as dizziness, headache, etc. can be linked to other conditions like a traumatic brain injury with a concussion.
The use of voice is an integral part of communication; our voice is one of the defining features of our individuality, and it shares a lot of information about you, your voice tells others if you are happy or sad, healthy or unwell, young or old. Our voice can also reveal to others our background, such as the region of the world where we live, and even our social economic status, when a voice produced that perceived by others as unusual or strange and draws attention to the person who is speaking, it is quite likely the person is demonstrating a voice disorder.
So, I am happy to introduce this presentation about Pubertal voice disorders & Puberphonia, I would like this presentation to be useful and add a lot of information on this topic.
This seminar gives brief description about introduction, normal anatomy of velopharyngeal structure, different closure pattern of velopharynx, diagnostic aids used, VPI in cleft patients
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 presentation gives some basic information regarding the definition , etiology and pathophysiology of " obstructive sleep apnea" which is a serious sleep disorder .Treatment methods are briefly reviewed with special emphasis on the role of the oral surgeon and orthodontist in the management of this medical condition .
Perilymph Fistula can be difficult to diagnose as a standalone condition. Post-trauma symptoms such as dizziness, headache, etc. can be linked to other conditions like a traumatic brain injury with a concussion.
The use of voice is an integral part of communication; our voice is one of the defining features of our individuality, and it shares a lot of information about you, your voice tells others if you are happy or sad, healthy or unwell, young or old. Our voice can also reveal to others our background, such as the region of the world where we live, and even our social economic status, when a voice produced that perceived by others as unusual or strange and draws attention to the person who is speaking, it is quite likely the person is demonstrating a voice disorder.
So, I am happy to introduce this presentation about Pubertal voice disorders & Puberphonia, I would like this presentation to be useful and add a lot of information on this topic.
This seminar gives brief description about introduction, normal anatomy of velopharyngeal structure, different closure pattern of velopharynx, diagnostic aids used, VPI in cleft patients
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
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
\It is a condition of the lung characterized by permanent dilatation of the air spaces distal to the terminal bronchioles with destruction of the walls of these airways.
Chronic Bronchitis
It is a disease characterized by daily cough with sputum for at least 3 months of the year for at least 2 consecutive years and airway obstruction which is irreversible.
"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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
2. APNOEAAPNOEA
Comes from the Greek wordComes from the Greek word
meaning “Without Breathing”meaning “Without Breathing”
There are three types of Apnoea:There are three types of Apnoea:
- Obstructive,- Obstructive,
- Central,- Central,
- Mixed- Mixed
3. APNOEAAPNOEA
Obstructive apnoea – cessation ofObstructive apnoea – cessation of
airflow for at least 10 seconds withairflow for at least 10 seconds with
respiratory effortrespiratory effort
Central apnoea – cessation ofCentral apnoea – cessation of
airflow for at least 10 secondsairflow for at least 10 seconds
without respiratory effortwithout respiratory effort
Mixed apnoea – characteristics ofMixed apnoea – characteristics of
both for at least 10 secondsboth for at least 10 seconds
Hypopnoea – reduction in airflow ofHypopnoea – reduction in airflow of
less than 50% accompanied by 3%less than 50% accompanied by 3%
desaturation.desaturation.
4. WHAT IS OSAWHAT IS OSA
Disorder Of breathing during sleepDisorder Of breathing during sleep
characterized by prolonged partialcharacterized by prolonged partial
upper airway obstruction and /orupper airway obstruction and /or
intermittent complete obstructionintermittent complete obstruction
(obstructive apnoea) that disrupts(obstructive apnoea) that disrupts
normal ventilation during sleep andnormal ventilation during sleep and
normal sleep patternsnormal sleep patterns
5. OSAOSA
85% of adult patients are male.85% of adult patients are male.
Men 4%, Female 2%.Men 4%, Female 2%.
2/32/3rdrd
obese.obese.
Contributes to HTN andContributes to HTN and
cardiovascular disease.cardiovascular disease.
Increased motor vehicle accidentsIncreased motor vehicle accidents
6. RISK FACTORSRISK FACTORS
ObesityObesity
SexSex
Cardiovascular diseaseCardiovascular disease
Cerebrovascular diseaseCerebrovascular disease
Metabolic syndromeMetabolic syndrome
33% of adults are at risk for OSA
7. Criteria of OSACriteria of OSA
AHI>5AHI>5
AHI > 5 & < 15 increases risk ofAHI > 5 & < 15 increases risk of
mortalitymortality
AHI 15-30=moderate, >30=severeAHI 15-30=moderate, >30=severe
10. Pathophysiology of OSAPathophysiology of OSA
Sites of Obstruction:Sites of Obstruction:
Nose & nasopharynxNose & nasopharynx
Oral cavity &Oral cavity &
OropharynxOropharynx
Larynx & hypopharyxLarynx & hypopharyx
12. PATHOPHYSIOLOGYPATHOPHYSIOLOGY
Occlusion of the oropharyngeal airwayOcclusion of the oropharyngeal airway
results in progressive asphyxia until thereresults in progressive asphyxia until there
is a brief arousal from sleep, whereuponis a brief arousal from sleep, whereupon
airway patency is restored and airflowairway patency is restored and airflow
resumes.resumes.
The patient then returns to sleep and theThe patient then returns to sleep and the
process is repeated, up to 300-400 x perprocess is repeated, up to 300-400 x per
night – sleep becomes fragmentednight – sleep becomes fragmented
13. PATHOPHYSIOLOGYPATHOPHYSIOLOGY
The immediated factor leading to collapseThe immediated factor leading to collapse
of the upper airway is generation ofof the upper airway is generation of
subatmospheric pressure duringsubatmospheric pressure during
inspiration and which exceeds ability ofinspiration and which exceeds ability of
airway dilator and abductor muscles toairway dilator and abductor muscles to
maintain airway stability.maintain airway stability.
During wakefulness upper airway muscleDuring wakefulness upper airway muscle
activity is greater than normal toactivity is greater than normal to
compensate for airway narrowing and highcompensate for airway narrowing and high
airway resistanceairway resistance
15. CLINICAL EVALUATIONCLINICAL EVALUATION
Detailed history: snoring duringDetailed history: snoring during
sleep,restless disturbed sleep,gasping,sleep,restless disturbed sleep,gasping,
choking, apnoeic events.choking, apnoeic events.
Physical examination: includes BMI, collarPhysical examination: includes BMI, collar
size, complete head and necksize, complete head and neck
examination, muellers manoevre .examination, muellers manoevre .
Systemic examination: hypertension,Systemic examination: hypertension,
congestive heart faliure, pedal oedma,congestive heart faliure, pedal oedma,
truncal obesity & hypothyroidism.truncal obesity & hypothyroidism.
16. CLINICAL EVALUATIONCLINICAL EVALUATION
CEPHALOMETRIC RADIOGRAPHS: toCEPHALOMETRIC RADIOGRAPHS: to
look for cranio facial anomalies & tonguelook for cranio facial anomalies & tongue
base obstruction.Includes CT scan & MRI.base obstruction.Includes CT scan & MRI.
POLYSOMNOGRAPHY: gold standard forPOLYSOMNOGRAPHY: gold standard for
diagnosis of sleep apnoea.diagnosis of sleep apnoea.
SPLIT NIGHT POLYSOMNOGRAPHY:SPLIT NIGHT POLYSOMNOGRAPHY:
first part of night in usualfirst part of night in usual
polysomnography while the second part ispolysomnography while the second part is
used in titration of pressures for cpap.used in titration of pressures for cpap.
22. MUELLERS MANUEVREMUELLERS MANUEVRE
Nasopharyngoscopy is done in awakeNasopharyngoscopy is done in awake
position either sitting or supine positionposition either sitting or supine position
Patients inhales with mouth closed.Patients inhales with mouth closed.
Can show the anterior posteriorCan show the anterior posterior
compression of the pharyngeal wall.compression of the pharyngeal wall.
23. SLEEP ENDOSCOPYSLEEP ENDOSCOPY
Drug induced sleep endoscopy.Drug induced sleep endoscopy.
First introduced in 1991First introduced in 1991
Pharmacological sedation & fibreopticPharmacological sedation & fibreoptic
telescopic evaluation of upper airwaytelescopic evaluation of upper airway
24. ANALYSISANALYSIS
Analysis 1:global analysis of obstructionAnalysis 1:global analysis of obstruction
at the level of soft palate & hypopharynx.at the level of soft palate & hypopharynx.
Analysis 2: degree of obstruction at theAnalysis 2: degree of obstruction at the
level of palate & hypopharynx.level of palate & hypopharynx.
Analysis 3 : assessment of individual areaAnalysis 3 : assessment of individual area
of pharynx & specific stuctures.of pharynx & specific stuctures.
25. ANALYSISANALYSIS
PALATE: Palatal tonsilsPALATE: Palatal tonsils
lateral pharyngeal at thelateral pharyngeal at the
level of velopharynx.level of velopharynx.
HYPOPHARYNX: Tongue.HYPOPHARYNX: Tongue.
Epiglottis.Epiglottis.
lateral pharyngeal wall atlateral pharyngeal wall at
the level of the hypopharynx.the level of the hypopharynx.
26. OESOPHAGEALOESOPHAGEAL
MANOMETRYMANOMETRY
In conjuction with the sleep studies toIn conjuction with the sleep studies to
diagnose apnoeas & hypoapnoeasdiagnose apnoeas & hypoapnoeas
To evaluate the relationship betweenTo evaluate the relationship between
reflux and OSA.reflux and OSA.
Adaption of the device allows moreAdaption of the device allows more
precise location of upper airwayprecise location of upper airway
obstruction.obstruction.
27. MRIMRI
Ultrafast MRI can be used in awake &Ultrafast MRI can be used in awake &
asleep patients.asleep patients.
To assess the the site of upper airwayTo assess the the site of upper airway
obstruction .obstruction .
Midline saggital section and cross sectionMidline saggital section and cross section
at various level can be used to evaluateat various level can be used to evaluate
29. OVERNIGHT OXYMETRYOVERNIGHT OXYMETRY
Screen tool for diagnosis of osa.Screen tool for diagnosis of osa.
Good specificity & positive predictiveGood specificity & positive predictive
value.value.
Poor sensivity & negitivite predictive value.Poor sensivity & negitivite predictive value.
The device measures o2 saturation &The device measures o2 saturation &
provides pulse rate data.provides pulse rate data.
30. 0VERNIGHT OXIMETRY0VERNIGHT OXIMETRY
Device measures the oxygen dips.Device measures the oxygen dips.
Oxygen desaturation index can beOxygen desaturation index can be
measured.measured.
ODI>15 indicates osa.ODI>15 indicates osa.
Others ESS>10 , BMI> 28 KG / M2.Others ESS>10 , BMI> 28 KG / M2.
31. HOME MULTICHANNELHOME MULTICHANNEL
TESTINGTESTING
Better patient comfort, cost saving,Better patient comfort, cost saving,
prevention of hospital admission ,speed ofprevention of hospital admission ,speed of
analysis of data.it utilizes nasal airflow,analysis of data.it utilizes nasal airflow,
chest & abd movements & pulse oxymetrychest & abd movements & pulse oxymetry
It can differentiate betwwen theIt can differentiate betwwen the
obstructive & central sleep apnoea.obstructive & central sleep apnoea.
Some home portable kits also includesSome home portable kits also includes
EEG probes to determine sleepEEG probes to determine sleep
architecture.architecture.
33. OVERNIGHTOVERNIGHT
POLYSOMNOGRAPHYPOLYSOMNOGRAPHY
Gold standard for diagnosis of osa.Gold standard for diagnosis of osa.
Varieties component of sleep disorder canVarieties component of sleep disorder can
be measured.be measured.
The patient stays overnight at sleepThe patient stays overnight at sleep
centre, most of which have videocentre, most of which have video
monitoring.monitoring.
This allows for any trouble shooting , suchThis allows for any trouble shooting , such
as disconnected leads,but allowsas disconnected leads,but allows
assessment of titration with CPAP .assessment of titration with CPAP .
35. Medical ManagementMedical Management
Weight Loss/ExerciseWeight Loss/Exercise
Nasal Obstruction/AllergyNasal Obstruction/Allergy
TreatmentTreatment
Sedative AvoidanceSedative Avoidance
Smoking cessationSmoking cessation
Sleep hygieneSleep hygiene
Consistent sleep/wake timesConsistent sleep/wake times
Avoid alcohol, heavy meals beforeAvoid alcohol, heavy meals before
bedtimebedtime
Position on sidePosition on side
Avoid caffeine, TV, reading in bedAvoid caffeine, TV, reading in bed
36. CPAPCPAP
Regarded as theRegarded as the
mainstay of OSAmainstay of OSA
treatment.treatment.
Acts as pneumaticActs as pneumatic
splint & preventssplint & prevents
collapse of airways.collapse of airways.
Assumes a closedAssumes a closed
system between thesystem between the
machine & patient.machine & patient.
Pressure must bePressure must be
titrated.titrated.
40. AUTO CPAPAUTO CPAP
Auto cpapAuto cpap
Useful when > 6 cm H2O difference inUseful when > 6 cm H2O difference in
inspiratory and expiratory pressuresinspiratory and expiratory pressures
No objective evidence demonstratesNo objective evidence demonstrates
improved compliance over CPAPimproved compliance over CPAP
42. Nonsurgical ManagementNonsurgical Management
Oral AppliancesOral Appliances
May be as effective as surgicalMay be as effective as surgical
options, especially with sx worse onoptions, especially with sx worse on
patient’s backpatient’s back
However low compliance rate of aboutHowever low compliance rate of about
60% in study by Walker et al in 200260% in study by Walker et al in 2002
rendered it a worse treatment modalityrendered it a worse treatment modality
than surgical proceduresthan surgical procedures
43. Surgical ManagementSurgical Management
Measures of success –Measures of success –
No further need for medical or surgicalNo further need for medical or surgical
therapytherapy
Response = 50% reduction in RDIResponse = 50% reduction in RDI
Reduction of RDI to < 20Reduction of RDI to < 20
Reduction in arousals and daytimeReduction in arousals and daytime
sleepinesssleepiness
44. Surgical ManagementSurgical Management
Perioperative IssuesPerioperative Issues
High risk in patients with severeHigh risk in patients with severe
symptomssymptoms
Associated conditions of HTN, CVDAssociated conditions of HTN, CVD
Nasal CPAP often required afterNasal CPAP often required after
surgerysurgery
Nasal CPAP before surgery improvesNasal CPAP before surgery improves
postoperative coursepostoperative course
Risk of pulmonary edema after relief ofRisk of pulmonary edema after relief of
obstructionobstruction
45. Surgical ManagementSurgical Management
Nasal SurgeryNasal Surgery
Limited efficacy when used aloneLimited efficacy when used alone
Verse et al 2002 showed 15.8%Verse et al 2002 showed 15.8%
success rate when used alone insuccess rate when used alone in
patients with OSA and day-time nasalpatients with OSA and day-time nasal
congestion with snoring (RDI<20 andcongestion with snoring (RDI<20 and
50% reduction)50% reduction)
Adenoidectomy (children)Adenoidectomy (children)
46. Surgical ManagementSurgical Management
UvulopalatopharyngoplastyUvulopalatopharyngoplasty
The most commonly performedThe most commonly performed
surgery for OSAsurgery for OSA
Severity of disease is poorSeverity of disease is poor
outcome predictoroutcome predictor
Levin and Becker (1994) up toLevin and Becker (1994) up to
80% initial success decreased to80% initial success decreased to
46% success rate at 12 months46% success rate at 12 months
Friedman et al showed a successFriedman et al showed a success
rate of 80% at 6 months inrate of 80% at 6 months in
carefully selected patientscarefully selected patients
51. LAUPLAUP
Laser AssistedLaser Assisted
UvulopalatoplastyUvulopalatoplasty
High initialHigh initial
success rate forsuccess rate for
snoringsnoring
Rates decrease, asRates decrease, as
for UP3, at twelvefor UP3, at twelve
monthsmonths
Performed awakePerformed awake
52. RFTVRRFTVR
RadiofrequencyRadiofrequency
Ablation – FischerAblation – Fischer
et al 2003et al 2003
Radiofrequency device is
inserted into various parts
of palate, tonsils and tongue
base at various thermal
energies
53. RFTVRRFTVR
Fischer et al 2003Fischer et al 2003
At 6 months Showed significant reductionAt 6 months Showed significant reduction
of:of:
RDI (but not to below 20)RDI (but not to below 20)
ArousalsArousals
Daytime sleepiness by the Epworth SleepinessDaytime sleepiness by the Epworth Sleepiness
ScaleScale
54. PillarPillar™ Palatal Implant™ Palatal Implant
SystemSystem
Three Implants Per PatientThree Implants Per Patient
Implants are made of Dacron®Implants are made of Dacron®
Implants are 18 mm in length and 1.8Implants are 18 mm in length and 1.8
mmmm
in diameterin diameter
Implants are meant to be PermanentImplants are meant to be Permanent
Implants “can be removed”Implants “can be removed”
FDA Approved for SNORINGFDA Approved for SNORING
FDA Approved for mild to moderateFDA Approved for mild to moderate
SLEEP APNEA - AHI UNDER 30SLEEP APNEA - AHI UNDER 30
55. AnesthesiaAnesthesia
AntibioticAntibiotic 1 hour pre-op or as directed1 hour pre-op or as directed
Mouth RinseMouth Rinse (chlorhexidine gluconate or(chlorhexidine gluconate or
equivalent)equivalent)
Topical JellyTopical Jelly Anesthetic, optional.Anesthetic, optional.
Local Anesthetic Infiltration:Local Anesthetic Infiltration: 2 to 3 cc2 to 3 cc..
Beginning at the junction of the Hard and Soft PalateBeginning at the junction of the Hard and Soft Palate
inject entire “Target Zone”. (lidocaine with epinephrineinject entire “Target Zone”. (lidocaine with epinephrine
or equivalent)or equivalent)
Have availableHave available : Flexible Scope, Angled Tonsil: Flexible Scope, Angled Tonsil
ForcepsForceps
57. Placement of ImplantsPlacement of Implants
Insert the needle through the
mucosa layer into the
muscle. The insertion site
should be as close to the
junction of the hard and soft
palate as possible. Continue
needle advancement in an
arcing motion until the “Full
insertion depth marker” is
no longer visible.
Insertion point
58. Placement of ImplantsPlacement of Implants
INSPECTIONINSPECTION
Inspect the needleInspect the needle
insertion site. If a portioninsertion site. If a portion
of the implant is exposed,of the implant is exposed,
it must be removed with ait must be removed with a
hemostat.hemostat.
Inspect the nasal side ofInspect the nasal side of
the soft palate using athe soft palate using a
FlexibleFlexible Naso ScopeNaso Scope..
If the implant is exposed,If the implant is exposed,
it must be removed.it must be removed. AnAn
angled tonsilangled tonsil forcepsforceps
is recommendedis recommended..
Hard palate
Implant
Muscle
Glandular tissue
59. Patient SelectionPatient Selection
““The Preferred PatientThe Preferred Patient ””
BMI less than 32BMI less than 32
AHI Less than 30AHI Less than 30
No Obvious Nasal ObstructionNo Obvious Nasal Obstruction
Small to Medium Sized TonsilsSmall to Medium Sized Tonsils
Mallampati ClassMallampati Class ІІ or Classor Class ΙΙΙΙ
Friedman Tongue Position I and IIFriedman Tongue Position I and II
Minimum 25mm Palate to treatMinimum 25mm Palate to treat
60. LINGUALLINGUAL
TONSILLECTOMYTONSILLECTOMY
Tongue Base ProceduresTongue Base Procedures
Lingual TonsillectomyLingual Tonsillectomy
may be useful in patients with hypertrophy,may be useful in patients with hypertrophy,
but usually in conjunction with otherbut usually in conjunction with other
proceduresprocedures
61. LINGUALPLASTYLINGUALPLASTY
Tongue BaseTongue Base
ProceduresProcedures
LingualplastyLingualplasty
Chabolle, et alChabolle, et al
success rate ofsuccess rate of
77% (RDI<20,77% (RDI<20,
50% reduction) in50% reduction) in
22 patients in22 patients in
conjunction withconjunction with
UPPPUPPP
Complication rateComplication rate
of 25% - bleeding,of 25% - bleeding,
altered taste,altered taste,
odynophagia,odynophagia,
edemaedema
Can be combinedCan be combined
withwith
epiglottectomyepiglottectomy
63. HYOID SUSPENSIONHYOID SUSPENSION
Hyoid MyotomyHyoid Myotomy
and Suspensionand Suspension
Advances hyoidAdvances hyoid
bone anteriorlybone anteriorly
and inferiorlyand inferiorly
AdvancesAdvances
epiglottis andepiglottis and
base of tonguebase of tongue
Performed inPerformed in
conjunction withconjunction with
other proceduresother procedures
Dysphagia mayDysphagia may
resultresult
64. Surgical ManagementSurgical Management
Maxillary-Mandibular AdvancementMaxillary-Mandibular Advancement
Severe diseaseSevere disease
Failure with more conservativeFailure with more conservative
measuresmeasures
Midface, palate, and mandibleMidface, palate, and mandible
advanced anteriorlyadvanced anteriorly
Limited by ability to stabilize theLimited by ability to stabilize the
segments and aesthetic facial changessegments and aesthetic facial changes
67. Surgical ManagementSurgical Management
TracheostomyTracheostomy
Primary treatment modalityPrimary treatment modality
Temporary treatment while other surgery is doneTemporary treatment while other surgery is done
Thatcher GW. et al: tracheostomy leads to quickThatcher GW. et al: tracheostomy leads to quick
reduction in sequelae of OSA, few complications (seereduction in sequelae of OSA, few complications (see
table II)table II)
Once placed, uncommon to decannulateOnce placed, uncommon to decannulate
68. CONCLUSIONSCONCLUSIONS
Surgical management provides effectiveSurgical management provides effective
management for OSAmanagement for OSA
Can be safely performed in most patientsCan be safely performed in most patients
with proper preoperative preparationwith proper preoperative preparation
Significant perioperative risks in someSignificant perioperative risks in some
patientspatients
Surgery should be considered forSurgery should be considered for
patients unable to utilize nonsurgicalpatients unable to utilize nonsurgical
managementmanagement