Multi-Level 3D Surgery for Obstructive Sleep Apnea: Could It Be the Future? (original) (raw)
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The efficacy of anatomically based multilevel surgery for obstructive sleep apnea
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2003
Most reports in the literature focus on the efficacy of a single procedure for obstructive sleep apnea (OSA). We review the overall efficacy of a surgical methodology based on localizing the level of anatomic obstruction for each patient and surgical correction of the nasal, oropharyngeal, or hypopharyngeal obstruction. Study design and setting Retrospective review of cases performed by a single practitioner using a systematic approach to surgery for OSA with preoperative and postoperative sleep studies. Forty-two patients with a respiratory disturbance index (RDI) greater than 15 were included in the study. Surgery involved at least 2 levels of obstruction usually performed in 2 stages. All patients reported symptomatic improvement. Overall, 83.3% (35 of 42) of patients were cured according to the accepted RDI criteria of more than 50% reduction and final RDI of less than 20. All 21 patients with mild OSA (RDI, <29), 73% of patients with moderate OSA (RDI, 30 to 49), and 50% of ...
Surgical Algorithm for Obstructive Sleep Apnea: An Update
Clinical and Experimental Otorhinolaryngology, 2020
Sleep surgery is part of a continuum of care for obstructive sleep apnea (OSA) that involves medical, pharmacologic, and behavioral therapy. Upper airway surgery for OSA can significantly improve stability by way of modulating the critical negative closing pressure. This is the same mechanism of action as positive airway pressure or oral appliance therapy. The updated surgical algorithm in this review adds precision in three areas: patient selection, identification of previously unaddressed anatomic phenotypes with associated treatment modality, and improved techniques of previously established procedures. While the original Riley and Powell phase 1 and 2 approach to sleep surgery has focused on individual surgical success rate, this algorithm strives for an overall treatment success with multi-modal and patient-centric treatments.
Three-dimensional Evaluation of Nasal Surgery in Patients with Obstructive Sleep Apnea
Chinese Medical Journal, 2016
Obstructive sleep apnea (OSA) is a chronic and increasingly common condition affecting adults today. It is characterized by recurrent collapse of the upper airway during sleep and has an impact on a series of biomechanical and physiological changes that occur during the development of upper airway stenosis. [1] The typical symptoms of OSA include snoring, apnea and hypopnea during sleep, and excessive daytime sleepiness. [2] Left untreated, OSA may also have a strong association with increased cardiovascular morbidity and mortality, impairment of cognitive function, motor vehicle collisions, and reduced quality of life (QOL). [3-5] Examination by polysomnography (PSG) is used for the diagnosis and evaluation of OSA traditionally. Treatment for OSA consists of continuous positive airway pressure (CPAP), which has become the standard therapy for OSA since first described in 1982 by Bridgman and Dunn. Recently, there is a rapidly growing body of literature studying surgical intervention as the treatment of OSA. The long-term effectiveness of surgical treatment is estimated to range between 50% and
Multilevel Combined Surgery With Transoral Robotic Surgery for Obstructive Sleep Apnea Syndrome
Journal of Craniofacial Surgery, 2016
Objective: To evaluate the results of combined multilevel surgery with transoral robotic surgery (TORS) in patients with obstructive sleep apnea/hypopnea syndrome for multilevel upper airway obstruction. Methods: Subjects who underwent combined sleep surgery via TORS were evaluated. The drug-induced sleep endoscopy was used in diagnosing the presence of level-specific upper airway collapse and to detect the type of surgery. Pre-and postoperative Apneahypopnea index, Epworth sleepiness scale lowest oxygen saturation, total operation time, robotic setup time and robotic surgery time, blood loss value, and complications were recorded. Results: Twenty five subjects were identified. All subjects underwent base of tongue (BOT) þ epiglottoplasty. The tracheotomy was not performed for any patient. Overall, 72% of patients met the criteria for cure, 8% met the criteria for cure, and 20% of patients met the criteria for failure. There was a significant decrease between preoperative and postoperative Apnea-hypopnea index scores (28.7 AE 17.8 SD versus 9.4 AE 12.4, P ¼ 0.000) and Epworth sleepiness scale scores (13.5 AE 2.8 versus 3.4 AE 1.6, P ¼ 0.000). There was a significant increase between preoperative and postoperative ED SPO2 levels (80.7 AE 7.6 versus 82.6 AE 18.1, P ¼ 0.001). Conclusion: TORS BOT, epiglottoplasty, and multilevel procedures in patients with obstructive sleep apnea/hypopnea syndrome can be regarded as feasible, safe, and effective technique.
Combined Surgical Approach for Obstructive Sleep Apnea Patient
Case Reports in Otolaryngology
Obstructive sleep apnea (OSA) is a disease that is associated with high morbidity and mortality and can significantly impact the quality of life in a patient. OSA is strongly associated with obesity, and literature showed that weight loss will lead to improvement in OSA. The gold standard treatment for OSA is continuous positive airway pressure (CPAP). However, other methods of treatment are available. One of these methods is multilevel sleep surgery (MLS). Literature showed that bariatric surgery can also improve OSA. A common question is which surgical procedure of these two should be performed first. We present a 5-year follow-up of a patient who underwent simultaneously bariatric surgery and MLS. His apnea-hypopnea index (AHI) decreased from 53 episodes per hour to 5.2 per hour within the first 18 months, which was measured via a level 3 polysomnography. Five years after the surgery, a repeat level 3 polysomnography showed an AHI of 6.8 episodes per hour, and the patient is asym...
American Journal of Orthodontics and Dentofacial Orthopedics, 2014
lntroduction: Airway size increases are associated with maxillomandibular advancement (MMA) surgery and improvement or elimination of obstructive sleep apnea (OSA). The 3-dimensional morphologic, volumetric, height, cross-sectional surface area, and diameter changes of the upper airway in patients with OSA after MMA, however, are not well understood. Methods: Patients with moderate or severe OSA who underwent MMA surgery were evaluated by preoperative and postoperative cone-beam computed tomography scans and polysomnograms. The upper airway space was also divided into retropalatal and retroglossal spaces and was analyzed for volumetric, height, cross-sectional surJace area, transverse, and anteroposterior diameter changes. Results: Ten consecutive OSA patients with an average preoperative apnea/hypopnea index of 46 and treated with MMA surgery were included in this study. There were 8 men and 2 women, with an average age of 46 years and an average body mass index of 28. There was an average of a 2.5Jold increase in the total volume of the upper airway space. The retropalatal space increased by 3.S-fold. The retroglossal space increased by 1.S{old. The greatest change in a cross-sectional area occurred in the transverse axis in both the retroglossal and retropalatal spaces. The average apnea/hypopnea index was 4 postoperatively. Conclusion:
Diagnosis, Treatment Planning, and Surgical Correction of Obstructive Sleep Apnea
Journal of Oral and Maxillofacial Surgery, 2009
The aim of this report is to present the scientific rationale for considering maxillomandibular advancement as the surgical treatment of choice in selected patients with obstructive sleep apnea syndrome; review the treatment planning that will identify those patients who would benefit from this procedure; review the surgical techniques; and review the patient outcomes after maxillomandibular advancement surgery. Patients with obstructive sleep apnea syndrome who have demonstrable retropositioning of the maxilla and mandible should be informed of maxillomandibular advancement as the primary surgical treatment for obstructive sleep apnea syndrome.
Surgical management of obstructive sleep apnea
Clinics in Chest Medicine, 2003
Obstructive sleep apnea (OSA) syndrome is a common disorder that has recently received much attention by the medical community due to its potentially serious physiological consequences. The clinical significance of OSA results from hypoxemia and sleep fragmentation caused by collapse of the airway, which leads to apnea or hypopnea during sleep. This paper reviews common surgical techniques used for clinical management of OSA patients, with emphasis on jaw advancement surgical procedures.
Robotic Surgery for Obstructive Sleep Apnea
Current Otorhinolaryngology Reports, 2013
Nocturnal upper airway collapse often involves obstruction at the level of the tongue base. A number of surgical procedures have been developed in recent years to address this area in patients non-compliant with CPAP therapy. This paper outlines a novel way to treat obstructive sleep apnea related to lingual obstruction, utilizing the da Vinci Ò robotic surgical system. This technique offers significant potential advantages over other established approaches, and should be included in the surgical armamentarium of sleep surgeons.