Managment of osa

Editor's Notes

1. Topical corticosteroid
2. It supports the jaw in a forward position to help maintain an open upper airway.
3. Dr. George Gregory, 'pneumatic splint', whereby blowing air via a tube and mask through the nasal and/or oral passageway, will support the pharyngeal and palatal walls, preventing collapse of the airway.
4. This reduces inspiratory work, relieves respiratory muscle fatigue and decreases work of breathing
5. CPAP significantly increases airway volume in the retropalatal (RP) and retroglossal (RG) region. Note the progressive thinning of the lateral pharyngeal walls as the level of CPAP increases
6. BiPAP permits independent adjustment of the pressures delivered during inspiration and expiration. The levels are set so that the expiratory positive airway pressure eliminates apneas and the inspiratory positive airway pressure eliminates hypopneas. Indications: cannot tolerate high CPAP difficult exhalations who have barotrauma complications (eg, ear infections, bloating).
7. Most side effects are related to the nasal/face mask
8. Surgery may be initial therapy for patients with mild OSA, RDI < 20 if medical therapy is refused or rejected, noninvasive medical therapy, nasal CPAP, or OA fails 
9. combination of procedures on the palate, tongue base and lateral pharyngeal walls, possibly with tracheostomy cover in severe cases.
10. Illustration of columella cinch suture using a mattress suture with 5-0 clear Prolene placed through small incisions over the lateral feet of the medial cruae in order to decrease the width of the columella and increase the width of the nostrils, (D) Preapplication of columella cinch suture. (E) Post application of the cinch suture, narrowing the columella and widening the nostrils
11.  (A) Harvested bone from septum or posterior maxillary walls. (C) Application of Batten graft inserted through internasal incisions to prevent transverse nasal collapse and stabilize with temporary sutures over for 5 to 7 days
12. Hypertrophied turbinates commonly contribute to nasal airway obstruction. Usually about two-thirds of the turbinates can be resected and removed. For septal deviation, while the maxilla is down fractured, there is direct access to the septum as well where deviations and septal spurs can be removed and the septum repaired and straightened
13. C) Outline for reduction glossectomy. D) Presurgery lateral cephalogram illustrates the decreased oropharyngeal airway with an A-P dimension of 5 mm. E) Following a reduction glossectomy, the oropharyngeal airway increased to 10 mm
14. Landmarks for measuring adenoid tissue; A) before surgery, B) After nasopharyngeal adenoidectomy. ABS, point at junction of atlas and base of skull; AAT, most anterior area of adenoid tissue; PPW, posterior pharyngeal wall
15. stiffen the soft palate by scarring and to increase the space behind the soft palate to minimize obstruction.
16.  A) narrow transverse dimension between the right and left faucial pillars. The incisions are outlined. B) uvula, dissection into the soft palate tissues is performed in a submucosal plane between the oral and nasal sides A horizontal mattress suture is passed submucosally from the base of the maxillary tuberosity out through the incision on the posterior faucial pillar. The suture is then passed in a mattress fashion through the dissected lateral flap on the posterior faucial pillar and then tunneled back to the maxillary tuberosity region. The sutures are then tightened to shorten the soft palate to the desired dimension.
17. eliminates nasal regurgitation and minimizes pharyngeal dryness, globus-type symptoms, hypersecretion and swallowing difficulty reduce morbidity
18. Temperature-controlled RF delivers RF at 460 kHz by a high-frequency alternating current flow into the tissue, creating ionic agitation. This ionic agitation heats the tissue and as the temperature rises higher than 47C, protein coagulation and tissue necrosis ensue
19. Needle like device into soft palate-> liposuction->size and thickness reduction of soft palate and uvula-> after 06wks scarring and stiffness of palate
20. four-lesion group had the most pronounced improvement in snoring, the lowest number of treatments required for cure and the greatest number of patients cured after two treatments.
21. This maneuver places the pharyngeal muscles and the base of the tongue on tension and expands the airway.
22.  Arch bars are placed, and maxillary osteotomies are performed. The maxilla is advanced 8-12 mm. Mandibular osteometries are also performed, and the mandible is advanced to obtain optimal occlusion. Bone grafts are used at the osteotomy sites as needed. Intermaxillary fixation is necessary postoperatively
23. Advances hyoid and epiglottis anteriorly
24. producing simultaneous advancement of both the maxilla and the mandible, and of the soft tissue overlying these structures.
25. 1. Each patient requires between one and five laser procedures spaced approximately one month apart to complete treatment. 2. no reports of significant postoperative nasal regurgitation after LAUP.
26. Introduced by Kamami in France, in 1993. A, Palate injection sites below the dimple., Resection completed with 5 mm of palate remaining below the dimple. Procedure: The laser produces a total of 3 joules of energy for each spot: the central palate, and the right and left superior poles. The CO2 Sharplan laser used in the continuous mode at 20 watts of power, always using the protective backstop. Uvula is grasped with a long-toothed tissue forceps, and the laser is used to excise the lower soft palate and all of the uvula, from the patient’s left to right. The segment of tissue removed varies from 1 to 4 cm in length. At the superior margin, the specimen is at least 1 cm thick because of the prominence of the uvula muscle at this level.
27. owing to increased palatal fibrosis and contraction of the velopharyngeal space
28. The subsequent healing of tissue around the implants stiffens the soft palate, thereby reducing relaxation and vibration of the tissue Pillar implant has a moderate effect on snoring and mild-to-moderate OSA
29. 1. RF generator 2. Foot pedal control 3. Irrigation system 4. Wand. Radiofrequency energy is applied to a conductive medium (usually saline) causing a highly focused plasma field to form around the electrodes. The plasma field is comprised of highly ionized particles. These ionized particles have sufficient energy to break organic molecular bonds within tissue.
30. Depiction of linear passage of the coblation wand.
31. Anterior rhinoscopic view of the coblation wand as it enters the anterior head of the right inferior turbinate.
32. BMI> 40kg/m2 BMI >35kg/m2 with associated comorbidities