Obstructive sleep apnea (OSA) is a common disorder caused by collapse of the pharyngeal airway during sleep, resulting in oxygen desaturation and arousal from sleep. Significant advances have been made in evaluating and treating OSA, including polysomnography to diagnose the severity, and treatments such as CPAP, oral appliances, weight loss, and surgeries like UPPP to enlarge the airway. Surgical treatment is indicated for more severe cases or when other treatments are unsuccessful.
Obstructive sleep apnea (OSA) is a prevalent chronic disease characterized by pharyngeal collapse during sleep.
Sleep disorder that involves cessation or significant decrease in airflow through the upper airway in the presence of breathing effort.
Obstructive sleep apnea is the second most common sleep disorder, insomnia being the most common.
Associated with recurrent oxyhemoglobin desaturations and arousals from sleep
Apnea index- no. of apneas /hr of total sleep time.
AHI (APNEA-HYPOPNEA INDEX)- No of apneas and hypoapneas/hr of total sleep time.
RDI (Respiratory Disturbance Index) – no. of apneas, hypoapneas and respiratory effort related arousals(RERA)/hr of total sleep time.
Obstructive sleep apnea (OSA) is a prevalent chronic disease characterized by pharyngeal collapse during sleep.
Sleep disorder that involves cessation or significant decrease in airflow through the upper airway in the presence of breathing effort.
Obstructive sleep apnea is the second most common sleep disorder, insomnia being the most common.
Associated with recurrent oxyhemoglobin desaturations and arousals from sleep
Apnea index- no. of apneas /hr of total sleep time.
AHI (APNEA-HYPOPNEA INDEX)- No of apneas and hypoapneas/hr of total sleep time.
RDI (Respiratory Disturbance Index) – no. of apneas, hypoapneas and respiratory effort related arousals(RERA)/hr of total sleep time.
This 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 .
Surgical options for Obstructive sleep apnoea syndromeGirish S
OBSTRUCTIVE SLEEP APNEA SYNDROME- REVIEW AND VARIOUS SURGICAL OPTIONS IN DETAIL.. based on Cummings & Scott new edition.. MS OTORHINOLARYNGOLOGY...
complete and detailed review of each operations like uvulopalatoplasty,epiglottoplasty, pillar implantation, tongue base reduction, laser and coblation techniques.. .
ECochG is a variant of brainstem audio evoked response (ABR) where the recording electrode is placed as close as practical to the cochlea. We will use the abbreviation ECOG and ECochG interchangeably below. ECOG is preferable to us as it is shorter.
ECOG is intended to diagnose Meniere's disease, and particular, hydrops (swelling of the inner ear). ECOG may also be abnormal in perilymph fistula, and in superior canal dehiscence. The common feature connecting these illnesses is an imbalance in pressure between the endolymphatic and perilymphatic compartment of the inner ear.
ECOG can also be used to show that the cochlea is normal, in persons who are deaf. The cochlear microphonic of ECOG may be normal in auditory neuropathy (Santarelli and Arslan 2002) as well as other disorders in which the cochlea is preserved but the auditory nerve is damaged (Yokoyama, Nishida et al. 1999).
Finally, ECOG's have also been used to as a indicator of the temporary threshold shift that may follow noise injury (Nam et al, 2004).
Obstructive sleep apnea (OSA)—also referred to as obstructive sleep apnea-hypopnea—is a sleep disorder that involves cessation or significant decrease in airflow in the presence of breathing effort. It is the most common type of sleep-disordered breathing and is characterized by recurrent episodes of upper airway collapse during sleep. These episodes are associated with recurrent oxyhemoglobin desaturations and arousals from sleep.
What are the main sleeping disorders and what are the sleeping disorders related to respiratory system ? how to deal with it and how to diagnose and treat?
Snoring and Obstructive Sleep Apnea:ManagementDr. Paulose
By Dr.K.O.Paulose FRCS DLO
Consultant ENT Surgeon, Jubilee Hospital, Trivandrum, South India.www.drpaulose.com
www.snorefreesleep.com
Presentation in Indian Medical Association meeting on 07102011, Trivandrum Chapter.
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 .
Surgical options for Obstructive sleep apnoea syndromeGirish S
OBSTRUCTIVE SLEEP APNEA SYNDROME- REVIEW AND VARIOUS SURGICAL OPTIONS IN DETAIL.. based on Cummings & Scott new edition.. MS OTORHINOLARYNGOLOGY...
complete and detailed review of each operations like uvulopalatoplasty,epiglottoplasty, pillar implantation, tongue base reduction, laser and coblation techniques.. .
ECochG is a variant of brainstem audio evoked response (ABR) where the recording electrode is placed as close as practical to the cochlea. We will use the abbreviation ECOG and ECochG interchangeably below. ECOG is preferable to us as it is shorter.
ECOG is intended to diagnose Meniere's disease, and particular, hydrops (swelling of the inner ear). ECOG may also be abnormal in perilymph fistula, and in superior canal dehiscence. The common feature connecting these illnesses is an imbalance in pressure between the endolymphatic and perilymphatic compartment of the inner ear.
ECOG can also be used to show that the cochlea is normal, in persons who are deaf. The cochlear microphonic of ECOG may be normal in auditory neuropathy (Santarelli and Arslan 2002) as well as other disorders in which the cochlea is preserved but the auditory nerve is damaged (Yokoyama, Nishida et al. 1999).
Finally, ECOG's have also been used to as a indicator of the temporary threshold shift that may follow noise injury (Nam et al, 2004).
Obstructive sleep apnea (OSA)—also referred to as obstructive sleep apnea-hypopnea—is a sleep disorder that involves cessation or significant decrease in airflow in the presence of breathing effort. It is the most common type of sleep-disordered breathing and is characterized by recurrent episodes of upper airway collapse during sleep. These episodes are associated with recurrent oxyhemoglobin desaturations and arousals from sleep.
What are the main sleeping disorders and what are the sleeping disorders related to respiratory system ? how to deal with it and how to diagnose and treat?
Snoring and Obstructive Sleep Apnea:ManagementDr. Paulose
By Dr.K.O.Paulose FRCS DLO
Consultant ENT Surgeon, Jubilee Hospital, Trivandrum, South India.www.drpaulose.com
www.snorefreesleep.com
Presentation in Indian Medical Association meeting on 07102011, Trivandrum Chapter.
OSA is an entity that is increasingly being managed by otolaryngologists...Hope this presentation helps to clear any doubts regarding its diagnosis and management!
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
"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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Osas iran
1. OBSTRUCTIVE SLEEP APNOEA
SYNDROME
Prof. Mohan Kameswaran
MS, FRCS, FICS, FAMS, DSc, DLO
Madras ENT Research Foundation
Chennai
2. OBSTRUCTIVE SLEEP APNOEA SYNDROME
• OSA is a common disorder resulting from collapse of
the pharyngeal airway during sleep
• Significant advances have been made in the
evaluation and treatment of OSAS over the past
several years
4. RDI O2 desaturation Day time
sleepiness
Primary < 5 / hr SaO2 > 90% No
snoring
UARS < 5 / hr SaO2 > or = 90% Yes
OSAS > 5 / hr SaO2 < 90% Yes
SLEEP-RELATED UPPER
AIRWAY OBSTRUCTION
5. SLEEP APNOEA SYNDROME -
Semantics
• Apnoea - cessation of airflow at the nostrils and mouth
for atleast 10 seconds
• SAS - 30 or more apnoeic episodes during a
7-hour period of sleep or an apnoea index (number of
apnoeas per hour of sleep) equal to or greater than 5
6. • Hypopnoea (reduction in tidal volume) - 50% reduction
in airflow, lasting for 10 seconds in the presence of
continued respiratory effort
• Respiratory Disturbance Index (RDI) or Apnoea
Hypopnoea index (AHI) - number of apnoeas and
hypopnoeas per hour of sleep
• In OSAS, RDI is greater than 10
7. SLEEP APNOEA - TYPES
• Obstructive sleep apnoea - cessation of airflow in the
presence of continued respiratory effort
• Central sleep apnoea - no airflow at the nose or mouth
associated with a cessation of all respiratory effort
• Mixed apnoea - begins initially as central apnoea, then
becomes obstructive
8. OBSTRUCTIVE SLEEP APNOEA
• Intrinsic dyssomnia characterized by recurrent episodes
of upper airway collapse and obstruction during sleep
• Associated with recurrent oxyhemoglobin desaturation
and arousal from sleep
• Both anatomic and neuromuscular factors are important
9. OSA - PATHOPHYSIOLOGY
Abnormal neuromuscular control of pharyngeal dilators
(genioglossus, geniohyoid, palatoglossus, medial pterygoids)
during sleep
Airway narrowing
(space occupying lesion from
the nasal vestibule to glottis)
Venturi effect
Increased intraluminal negative pressure
UPPER AIRWAY OBSTRUCTION
10. How many people have sleep apnea?
Older guidelines (AHI > 10) - 2 - 4% of the population
Children: 1- 3%
Newer guidelines (AHI > 5 with symptoms) - 9 - 24%
11. OSAS
3 major levels of obstruction (Fujita)
• Retropalatal (Type1)
• Retropalatal and retrolingual (Type 2)
• Exclusively retrolingual (Type 3)
22. OSAS - HISTORY & EXAMINATION
• General appearance, weight, height, blood pressure
• H/O alcohol, drugs e.g. sedatives
• Thyroid evaluation
• ENT & Head and Neck examination - nasal airway, tongue
size, soft palate, uvula, tonsils, naso / hypopharynx, larynx
• Craniofacial morphology
Snoring / OSAS
If OSAS, the site of obstruction
Associated problems
23. ENT & Head and Neck examination
• Short thick neck (Collar size > 17.5)
• Enlarged floppy uvula
• Elongated soft palate
• Tonsillar hypertrophy
• Enlarged tongue
• Micrognathia / retrognathia
24. INVESTIGATIONS
• FBC, ECG, chest X-ray, Lung function tests
• Polysomnography (Holland, Dement, Raynall, 1974)
- Level 1 PSG - gold standard investigation
- Overnight monitoring of pulse oximetry, End tidal CO2,
ECG, EEG, anterior tibialis EMG, EOG, nasal & oral
airflow, chest & abdominal movements & sleeping position
- Differentiates obstructive from central sleep apnoea
- Evaluates the severity
33. Nasal Continuous Positive Airway Pressure
(Colin Sullivan, 1981)
• Noninvasive and highly effective primary treatment
modality
• Delivers a continuous flow of air & provides a pneumatic
splint to the upper airway during inspiration preventing
collapse during sleep by increasing airway volume, area and
lateral dimensions in retropalatal and retroglossal regions
35. Nasal CPAP
• Problems: dermal irritation, dryness, sneezing,
rhinorrhoea, claustrophobia, panic attacks leading to
noncompliance
• Auto-CPAP is as effective as constant CPAP
• The auto-CPAP is characterized by its ability to
modify the positive-pressure level applied
36. Nasal CPAP
• Restores normal respiration during sleep, normalizes
sleep organization
• Improves day time alertness, neuropsychiatric
function, right heart function, and systemic blood
pressure
• Success rate - 90%
• Compliance - 50%
37. SURGICAL TREATMENT
Indications
• Primary snoring
• AHI > 15
• O2 desaturation < 90%
• AHI > 5 or < 14, with excessive daytime sleepiness
• UARS
• Unsuccessful medical treatment
• Type 1 collapse (mainly retropalatal)
• Failure of compliance for CPAP
43. LASER ASSISTED
UVULOPALATOPHARYNGOPLASTY
(Dr. Kamami, 1993)
• Effective and has the advantage of a bloodless field
• Success rates: short term - 77 - 89%
long term - 75%
no snoring - 52%
44.
45.
46. Sleep MRI – post UPPP
showing retrolingual obstruction
47. UPPP / LAUP - Anesthetic considerations
• Pre-op evaluation
• Avoid sedatives, narcotics
• Difficult intubation (FO intubation may be required)
• After extubation - nasopharyngeal airway, pulse oximetry and
avoidance of narcotic analgesia, monitoring for post obstructive
pulmonary edema
NASOPHARYNGEAL AIRWAY
48. RADIOFREQUENCY IN OSAS
• Radiofrequency thermal ablation uses low levels of RF
energy to create targeted tissue ablation resulting in
tissue volume reduction
• The procedure is quick, painless and is associated with
minimal edema
50. COBLATION
• Voltages applied to convert conductive fluid between
electrodes and tissue into ionized vapor layer (plasma)
• Ionized layer contains excited particles which, when in
contact with tissue, break tissues molecular bonds with
minimal thermal penetration
• Energy used - up to 8 eV
51.
52. Enlargement of retrolingual space
• Tongue base reduction procedures
• Mandibular osteotomy with genioglossal advancement
• Repose tongue suspension intraoral approach
• Hyoid Myotomy and suspension
• Genioglossal advancement and hyoid suspension (GAHM)
• Maxillofacial techniques
• Uvulopalatopharyngoglossoplasty (UPPGP)
(UPPP with limited resection of the tongue base)
53. Tongue base reduction procedures
Type 3 (Riley)
• Tracheostomy required
• Midline Laser glossectomy - laser is used to extirpate a
rectangular strip (2.5 into 5 cms) of the posterior portion of
tongue, useful in Down’s syndrome, Mucopolysaccharidosis
• Lingualplasty - modification of LMG, involves additional
excision of lateral tongue tissue
• Radiofrequency tissue ablation of tongue base - RF probe with
465 KHZ
54. GENIOGLOSSUS ADVANCEMENT PROCEDURE
Osteotomies in the mandible at the geniotubercle advancing the
insertion of genioglossus or geniohyoid by 10-14 mm & rotating
it by 90%. This increases the tension placed on the tongue
57. Tongue suspension
Tongue base is pulled forward and secured anteriorly
by a titanium screw placed at the lingual cortex of genial
tubercle of mandible
59. Genioglossal advancement and hyoid
suspension (GAHM)
• Combined procedure of inferior mandibular osteotomy
with genioglossal advancement with hyoid myotomy &
suspension
• Success rates - 70%
• Complications: infection, need for root canal therapy,
permanent anesthesia, seroma, mandibular fracture,
aspiration
60. Hyoid distraction procedure
(Tucker Woodson)
The hyoid bone is split and two separate loops of suture
are used to pull the bone not only anteriorly and
superiorly, but also laterally
61. MAXILLOFACIAL TECHNIQUES
• Used in severe OSAS where the tongue base is the cause
of obstruction
• Advances the skeletal support of soft tissues (tongue and
pharynx) that collapse during sleep
63. MAXILLOMANDIBULAR OSTEOTOMY
& ADVANCEMENT (Riley & Powell)
• Phase 2 surgery
• Improves retropalatal and retrolingual space and increases
airway caliber in an anteroposterior direction
• Success rates: 95%
• Complications: malocclusion, inferior alveolar, lingual or
infraorbital paresthesia, nonunion/malunion, relapse of
advancement, TMJ complications, need for restorative dental
work
65. Presurgical evaluation
Phase I
(site of obstruction)
UPPP UPPP + MOHM MOHM
Type I oropharynx Type 2 oro - hypopharynx Type 3 hypopharynx
Postop polysomnogram (6 months)
Failure
Phase II - MMO
Riley-Powell-Stanford surgical protocol
67. OSAS - Adults Vs Children
Adults Children
Symptoms Sleepiness, fatigue, nocturia Behavioral problems,
learning difficulty, nocturnal
enuresis
Gender More common and severe in No difference prior to
males puberty
Physical findings Obese, large neck High-arched palate, enlarged
circumference tonsils, orthodontic
problems, less likely obese,
failure to thrive
Apnea duration 10 seconds Two breaths
Diagnostic criteria AHI > = 5 AHI > =1
Primary treatment Positive airway pressure Adenotonsillectomy
68. Snoring Intermittent with pauses Continuous
Mouth breathing Less common Common
Weight Commonly obese Underweight
Enlarged tonsils / adenoids Uncommon Common
Sex distribution Male:Female (8:1) Male:Female (1:1)
Obstructive pattern Mostly apneas Mostly hypopneas
Clinically obvious arousals Common Uncommon
Sleep architecture disruption Common Uncommon
Sequelae Excessive daytime sleepiness Behavioral changes
Hypertension Neurocognitive
Cardiovascular Cardiovascular
Treatment Most often CPAP Most often T & A
Less often UPPP Less often CPAP
69. CONCLUSION
• OSA is a common disease of adult & pediatric age groups
with a myriad of presentations
• Often the patient is unaware of his condition
• A detailed history, clinical examination & simple
overnight observation will help to clinch the diagnosis
70. • Sleep MRI ( dynamic MRI ) with F.O.nasendoscopy
has obviated the need for cumbersome cephalometric
measures to establish the site of obstruction
• A comprehensive presurgical evaluation to identify the
site of airway obstruction improves surgical success
rates