Objective and subjective long term outcome of maxillomandibular advancement in obstructive sleep apnea.

Study Objectives: To evaluate the objective and subjective long-term outcome of maxillomandibular advancement (MMA) in Far-East Asian patients with moderate to severe obstructive sleep apnea (OSA).

Methods: This is a long-term follow-up study to evaluate the treatment outcome of MMA in OSA patients by objective polysomnography (PSG) and subjective questionnaires (Pittsburgh Sleep Quality Index-PSQI, Insomnia Severity Index-ISI, Beck Anxiety Inventory-BAI, Beck Depression Inventory-BDI, Epworth Sleepiness scale-ESS, and Short Form-36 Quality of Life-SF-36). Evaluation was done before surgery and we followed these patients one and two years after surgery.

Clinical practice guideline: tonsillectomy in children.

Objective: Tonsillectomy is one of the most common surgical procedures in the United States, with more than 530,000 procedures performed annually in children younger than 15 years. Tonsillectomy is defined as a surgical procedure performed with or without adenoidectomy that completely removes the tonsil including its capsule by dissecting the peritonsillar space between the tonsil capsule and the muscular wall. Depending on the context in which it is used, it may indicate tonsillectomy with adenoidectomy, especially in relation to sleep-disordered breathing.

Maxillomandibular advancement for obstructive sleep apnea.

Although nasal continuous positive airway pressure therapy is considered the first-line treatment of obstructive sleep apnea, surgery has been shown to be a valid option for patients who are intolerant to positive pressure therapy. In the past 20 years, maxillomandibular advancement has been widely accepted as the most effective surgical therapy for obstructive sleep apnea syndrome. Maxillomandibular advancement has been shown to enlarge the pharyngeal and hypopharyngeal airway by physically expanding the facial skeletal framework.

Sleep apnea surgery: putting it all together.

Since the first description of uvulopalatopharyngoplasty (UPPP) in 1972, the surgical management of obstructive sleep apnea syndrome (OSA) has become increasingly popular. This popularity is caused by several reasons. The psychomotor sequelae of OSA, such as excessive daytime sleepiness, daytime fatigue, and poor sleep quality caused by sleep fragmentation, have major deleterious impact on patients' well being, which behooves them to seek treatment.

Surgical treatment of obstructive sleep apnea: upper airway and maxillomandibular surgery.

Upper airway surgery is an important treatment option for patients with obstructive sleep apnea (OSA), particularly for those who have failed or cannot tolerate positive airway pressure therapy. Surgery aims to reduce anatomical upper airway obstruction in the nose, oropharynx, and hypopharynx. Procedures addressing nasal obstruction include septoplasty, turbinectomy, and radiofrequency ablation (RF) of the turbinates.

Hypopharyngeal airway surgery.

Obstructive sleep apnea (OSA) is the result of upper airway obstruction during sleep. Hypopharyngeal airway obstruction can be caused by the prominence or relaxation of the base of the tongue, lateral pharyngeal wall, and occasionally, the aryepiglottic folds or epiglottis. Although nasal continuous positive airway pressure (CPAP) is considered as the first treatment for obstructive sleep apnea, surgery has been shown to be a viable option for patients who are intolerant of positive pressure therapy.

Surgical therapy for obstructive sleep apnea syndrome.

Despite advances in positive pressure therapy for obstructive sleep apnea, compliance continues to be a problem for many patients. Sleep apnea surgery is a viable option for patients who are intolerant of positive pressure therapy. This review presents the current state of the art in sleep apnea surgery, including airway evaluation with fiberoptic nasopharyngoscopy and lateral cephalometric radiography, formulation of a surgical plan with selection of procedures to address specific sites of obstruction, as well as discussion of published surgical outcomes.

Surgical therapy for adult obstructive sleep apnea.

Despite advances in positive pressure therapy for obstructive sleep apnea, compliance continues to be a problem for many patients. Sleep apnea surgery is a viable option for patients who are intolerant of positive pressure therapy. This review will present the current state of art in sleep apnea surgery, including airway evaluation with fiberoptic nasopharyngoscopy and lateral cephalometric radiograph, formulation of a surgical plan through a selection of procedures to address specific sites of obstruction, as well as discussion of published surgical outcomes.

Adult chronic sleepwalking and its treatment based on polysomnography.

Adult sleepwalking affects 2.5% of the general population and may lead to serious injuries. Fifty young adults with chronic sleepwalking were studied prospectively.

Three-dimensional computed tomography and polysomnography findings after extended uvulopalatal flap surgery for obstructive sleep apnea.

Objectives: Using both sleep physiological parameters and image data to evaluate the efficacy of extended uvulopalatal flap (EUPF) surgery in the treatment of obstructive sleep apnea (OSA).

Material And Methods: Fifty patients with OSA underwent EUPF that consisted of bilateral tonsillectomy, dissection and removal of the submucosal adipose tissue of the soft palate and supratonsillar areas, and imbrications and repositioning of the denuded uvulopalatal flap. Polysomnography (PSG) and 3-dimensional computed tomography (3-D CT) data were obtained at baseline and 6 months postoperatively.

Practice parameters for the dopaminergic treatment of restless legs syndrome and periodic limb movement disorder.

Dopaminergic agents, particularly dopamine agonists, have been used with increasing frequency in the treatment of restless legs syndrome and periodic limb movement disorder. These evidence-based practice parameters are complementary to the Practice Parameters for the Treatment of Restless Legs Syndrome and Periodic Limb Movement Disorder, published in 1999. These practice parameters were developed by the Standards of Practice Committee and reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine.

Maxillomandibular expansion for the treatment of sleep-disordered breathing: preliminary result.

Objective: To assess the outcomes of maxillomandibular expansion (MME) by distraction osteogenesis (DO) for the treatment of sleep-disordered breathing (SDB).

Methods: This was a prospective study of six consecutive patients with SDB. All of the patients have maxillary and mandibular constriction and were treated with MME.

Sleep disordered breathing: surgical outcomes in prepubertal children.

Objective: To evaluate the treatment outcomes of sleep disordered breathing (SDB) in prepubertal children 3 months following surgical intervention.

Study Design: Retrospective investigation of 400 consecutively seen children with SDB who were referred to otolaryngologists for treatment.

Method: After masking the identities and conditions of the children, the following were tabulated: clinical symptoms, results of clinical evaluation and polysomnography at entry, the treatment chosen by the otolaryngologists, and clinical and polysomnographic results 3 months after surgery.

Modified uvulopalatopharyngoplasty: The extended uvulopalatal flap.

Objective: To investigate the surgical outcomes of a modified uvulopalatopharyngoplasty-extended uvulopalatal flap in the treatment of obstructive sleep apnea.

Material And Methods: Thirty-three consecutive patients with obstructive sleep apnea underwent extended uvulopalatal flap that consisted of bilateral tonsillectomy, dissection and removal of submucosal adipose tissue of the soft palate and supratonsillar area; imbrication; and reposition of the denuded uvulopalatal flap. Variables of polysomnography included the respiratory disturbance index, snoring index, and minimal oxygen saturation.

An adjunctive method of radiofrequency volumetric tissue reduction of the tongue for OSAS.

Objectives: Temperature-controlled radiofrequency volumetric reduction (TCRF), a minimally invasive procedure, has been used to treat tongue base obstruction in Obstructive Sleep Apnea Syndrome (OSAS). An adjunctive method was objectively evaluated.

Method: A prospective, nonrandomized clinical study was undertaken on 20 consecutive OSAS patients with isolated tongue base obstruction.

Anterior cervical spine fusion and sleep disordered breathing.

The authors reviewed 12 patients who developed obstructive sleep apnea (OSA) syndrome in association with anterior cervical spine fusion. Four subsequent patients were studied prospectively before C2 to C4 anterior fusion and documented to have OSA by questionnaire, visual analogue scales, polysomnography, and multiple sleep latency tests. The authors found that placement of the anterior cervical plates reduced the size of the upper airway.

Surgical management of obstructive sleep apnea.

Nasal CPAP is and should be the first-line treatment for OSA. Any physician who uses nasal CPAP undoubtedly recognizes that this treatment modality has limitations, however. The authors believe that surgery offers a viable alternative to nasal CPAP in patients who are intolerant of nasal CPAP.

Temperature-controlled radiofrequency tongue base reduction for sleep-disordered breathing: Long-term outcomes.

Objective: Our goal was to evaluate the long-term outcomes of temperature-controlled radiofrequency reduction of the tongue base in sleep-disordered breathing.

Methods: The 18 patients from our initial pilot study were reevaluated. Clinical examinations, polysomnography (PSG), questionnaires, visual analog scales, and a comparative SF-36 were used to assess long-term outcomes.