Evolving Clinical Experiences in Aesthetic Hip Implant Body Contouring.

Background: Hip augmentation increases the hip width utilizing fat transfer and/or subcutaneous implants, creating a more feminine hourglass shape. Custom hip implant surgery requires proper patient selection, correct body frame analysis, appreciation of hip aesthetics, understanding surgical anatomy, optimal aesthetic planning, a favorable implant design and fabrication, skilled surgical implant placement, diligent postoperative patient care, and proper complication management.

Objectives: The authors sought to evaluate the pioneering clinical experience with cosmetic custom hip silastic implants.

Oral nonprescription treatment for insomnia: an evaluation of products with limited evidence.

Purpose: To evaluate the level of evidence regarding the safety and efficacy of nonprescription therapies used for insomnia.

Reviewers: Members of the American Academy of Sleep Medicine's Clinical Practice Review Committee.

Methods: A search of the World Wide Web was conducted using the terms insomnia, herbal remedies, and alternative treatments to develop a list of therapies.

Upper airway management of the adult patient with obstructive sleep apnea in the perioperative period--avoiding complications.

Purpose: To help practitioners avoid adverse perioperative events in patients with obstructive sleep-disordered breathing.

Reviewers: Members of the American Academy of Sleep Medicine's Clinical Practice Review Committee.

Methods: A search of MEDLINE database using MeSH terms apnea, obstructive sleep apnea and anesthesia was conducted in October 2001.

Radiofrequency techniques in the treatment of sleep-disordered breathing.

The current medical information reviewing the use of radiofrequency in tissue volumetric reduction in the upper airway for nasal obstruction, primary snoring, and sleep-disordered breathing is reviewed. Reviews of the pathophysiology of sites of obstruction of the upper airway, indications for radiofrequency, procedure, technique, results, limitations and potential complications for each procedure, with the author's recommendations, are presented. The radiofrequency procedures are technically simple, minimally invasive, are associated with reduced postoperative pain compared with traditional surgical approaches, and can be performed on an outpatient basis under local anesthesia with a low complication rate and generally good therapeutic results.

Nonprescription treatments of snoring or obstructive sleep apnea: an evaluation of products with limited scientific evidence.

Purpose: To evaluate the level of evidence regarding the safety and efficacy of nonprescription therapies used to treat snoring and obstructive sleep apnea, and form a consensus statement based on available data.

Reviewers: Members of the American Academy of Sleep Medicine's Clinical Practice Review Committee.

Methods: A search of PubMed database using MeSH terms snore, apnea, and obstructive sleep apnea in August, 2002, including only articles published in English between 1990 and 2002 and of the World Wide Web, using Google search engine and the key words snoring and obstructive sleep apnea.

Long-Term Results of Maxillomandibular Advancement Surgery.

Surgery is a major modality in the treatment of obstructive sleep apnea syndrome (OSAS), and maxillomandibular advancement (MMA) has been shown to be the most effective surgical option. However, despite the successful short-term (6-9 months) results reported by various investigators, little is known of the long-term clinical outcomes. A review of our long-term clinical results demonstrated that MMA achieves long-term cure in most patients.

Radiofrequency treatment of turbinate hypertrophy in subjects using continuous positive airway pressure: a randomized, double-blind, placebo-controlled clinical pilot trial.

Objectives: To estimate the treatment effect of temperature-controlled radiofrequency (TCRF) reduction of turbinate hypertrophy in patients with sleep-disordered breathing (SDB) treated with nasal continuous positive airway pressure (CPAP), and to assess the impact of study design on this estimate.

Study Design: Prospective, randomized, double-blind, placebo-controlled clinical pilot trial.

Methods: Twenty-two CPAP-treated patients with SDB with turbinate hypertrophy were randomly assigned to either TCRF turbinate treatment (mean energy 415 +/- 37 J/turbinate; n = 17) or placebo control (n = 5).

Obstructive sleep apnea surgery: genioglossus advancement revisited.

Purpose: This study evaluated the accuracy of a genioglossus advancement (GA) technique (rectangular window) to incorporate the genial tubercle/genioglossus muscle complex (GGC) in patients with obstructive sleep apnea.

Methods: This prospective study consisted of 38 consecutive patients who underwent GA. Preoperative localization of the GGC was based on the cephalometric and panoramic radiographs, as well as digital palpation in the floor of mouth.

Uvulopalatopharyngoplasty, maxillomandibular advancement, and the velopharynx.

Objective: To evaluate the presence of velopharyngeal insufficiency (VPI) symptoms and the associated changes of the velopharyngeal anatomy in patients who underwent maxillomandibular advancement (MMA) for persistent obstructive sleep apnea (OSA) after uvulopalatopharyngoplasty (UPPP).

Methods: Preoperative and postoperative cephalometric radiographs were analyzed to assess the anatomic changes of the velopharynx. In addition, a questionnaire survey was sent to the patients between 6 to 12 months after MMA.

The road to danger: the comparative risks of driving while sleepy.

Objectives/hypothesis: A large sector of the population of the United States has sleep deprivation directly leading to excessive daytime sleepiness. The prevalence of excessive daytime sleepiness in this population ranges from 0.3% to 13.

Obstructive sleep apnea surgery: patient perspective and polysomnographic results.

Objective: The goal of this study was to assess the outcomes of obstructive sleep apnea (OSA) surgery based on the patient perspective and polysomnographic data.

Study Design: Fifty-six patients with severe OSA completed the 2-phase reconstructive protocol. A minimum of 6 months after the phase II surgery and after the postoperative polysomnography, questionnaires with visual analog scales (VAS 0-10) were mailed to the patients to assess their perceptions of treatment results.

Surgery and obstructive sleep apnea: long-term clinical outcomes.

Objective: Outcome data on the surgical treatment of obstructive sleep apnea are, in general, based on short-term follow-up (<6-9 months). This examination was undertaken to assess long-term results.

Methods: Forty patients who underwent soft tissue and skeletal surgery were the subjects of this review.

Radiofrequency volumetric reduction of the palate: An extended follow-up study.

Objective: The goal was to evaluate the effect of radiofrequency (RF) of the palate on speech, swallowing, taste, sleep, and snoring 12 to 18 months after treatment.

Methods: Twenty-two patients were evaluated by clinical examination, questionnaires, and visual analog scales. The patients with relapse of snoring were offered further RF treatment.

Comparison of postoperative pain between laser-assisted uvulopalatoplasty, uvulopalatopharyngoplasty, and radiofrequency volumetric tissue reduction of the palate.

Objectives: This study compares the posttreatment discomfort between laser-assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP), and radiofrequency volumetric tissue reduction (RFVTR) of the palate through the use of visual analog pain scales and a quantitative assessment of the analgesic medication taken.

Methods: In one group, LAUP (n = 10) or UPPP (n = 9) was used to treat patients' snoring or sleep-disordered breathing (SDB), and the other group underwent RFVTR (n = 22).

Results: The mean numbers of days with pain after RFVTR, LAUP, and UPPP were 2.

Postoperative airway findings after maxillomandibular advancement for obstructive sleep apnea syndrome.

Objective: To evaluate the upper airway characteristics in the early postoperative period after maxilomandibular advancement for obstructive sleep apnea syndrome.

Methods: Nasopharyngolaryngoscopy was performed before and 48 hours after surgery on 70 consecutive patients who underwent maxillomandibular advancement for obstructive sleep apnea syndrome. The preoperative and the postoperative evaluations were performed by the same examiner for consistency.

Evaluation of a new procedure for nasal alar rim and valve collapse: nasal alar rim reconstruction.

Objective: A new operative technique to improve nasal valve collapse by placement of cartilage struts along the alar rim was compared with the standard nasal valve cartilage graft (NVG) technique.

Methods And Patients: A retrospective study of consecutive patients with nasal valve collapse was performed at Stanford University Medical Center. Seventy-nine patients with nasal valve collapse underwent reconstruction with either the classic NVG technique or a newly developed nasal alar rim reconstructive (NARR) procedure.

Overview of phase II surgery for obstructive sleep apnea syndrome.

Maxillomandibular advancement is an extremely effective surgical procedure for the treatment of obstructive sleep apnea syndrome. When properly executed, it is associated with minimal morbidity and is well accepted by patients. It is a treatment option that achieves long-term care.

Overview of phase I surgery for obstructive sleep apnea syndrome.

It is well established that obstructive sleep apnea syndrome is associated with increased morbidity and mortality. Surgical therapy has been demonstrated to be a viable treatment option for cure. Thorough presurgical evaluation with the identification of the type of airway abnormality is mandatory to allow for the utilization of a surgical protocol that results in improved clinical outcomes.

Radiofrequency volumetric tissue reduction for treatment of turbinate hypertrophy: a pilot study.

Objectives: Ideal treatment for nasal obstruction caused by turbinate hypertrophy remains in question. Medical therapy is often ineffective. Surgical procedures have associated morbidity including pain, bleeding, crusting, adhesion, infection, and dryness.

Long-term results of surgical management of sleep disordered breathing: are our patients really benefiting?

The etiology of sleep disordered breathing (SDB), which includes upper airway resistance syndrome (UARS) and obstructive sleep apnea syndrome (OSAS), is collapse or obstruction of the upper airway during sleep. Surgical management was the first treatment modality available for SDB. Since the introduction of the tracheotomy to treat OSAS, there have been numerous procedures discovered to address the various sites of obstruction of the upper airway.

Surgical management of the hypopharyngeal airway in sleep disordered breathing.

The etiology of sleep disordered breathing is collapse or obstruction of the upper airway during sleep. This obstruction may be localized to one or two areas or may encompass the entire upper airway passages to include the nasal cavity, nasopharynx, oropharynx, hypopharynx, and larynx. The presurgical evaluation, which includes polysomnography, a comprehensive head and neck physical examination, fiberoptic nasopharyngoscopy, and lateral cephalometric analysis is essential in directing surgical therapy in a site specific approach.

Radiofrequency volumetric tissue reduction of the palate in subjects with sleep-disordered breathing.

Study Objectives: To evaluate pain, swallowing, speech, edematous response, tissue shrinkage, sleep, snoring, and safety (energy limits and adverse effects) following radiofrequency (RF) treatment to the palate in 22 subjects with sleep-disordered breathing.

Design: This investigation is a prospective nonrandomized study. Polysomnography, radiographic imaging, and infrared thermography, along with questionnaires and visual analog scales, were used to evaluate the effects of RF treatment to the palate.

Obstructive sleep apnea surgery: risk management and complications.

Background: Hypoxemia, hypertension, airway obstruction, and death have been associated with surgery for obstructive sleep apnea syndrome (OSAS). Patient analysis was undertaken to identify potential factors that could affect risk-management outcome.

Methods: One hundred eighty-two consecutively treated patients with OSAS undergoing 210 procedures were evaluated.