Surgical Management Of Sleep Apnea And Snoring

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ISBN: 9780824759100 | 0824759109
Cover: Hardcover
Copyright: 8/12/2005

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Providing a comprehensive review and update on recent advances, that forms a valuable reference for practitioners interested in the latest operative strategies, this state-of-the-art text reviews current and emerging topics in the surgical management of sleep apnea and snoring, inclduing methods for patient evaluation, avoidance of complications, and postoperative care. With more than 30 illustrative chapters and detailed figures that offer clear presentation of the techniques discussed, the book comprehensively delineates the anatomy and physiology of sleep apnea and addresses recent and established surgical approaches to the management of obstructive sleep apnea and snoring.

Preface

iii

Contributors

xiii

Upper Airway Surgical Anatomy

(24)

Vincent D. Eusterman

Brian J. Baumgartner

Introduction

(1)

Nasal Airway

(4)

Oral Airway

(7)

Pharyngeal Airway

(13)

References

(2)

The Anatomy of Sleep Disordered Breathing: An Evolutionary Perspective

(20)

Terence M. Davidson

Introduction

(1)

Anatomy

(4)

Evolutionary Anatomic Changes

(7)

Ontogeny Recapitulates Phylogeny

(1)

Fossil Records

(1)

Studies on Anatomic Correlations with SDB

(3)

Conclusion

(5)

References

(4)

Physiology of Sleep Disordered Breathing

(22)

B. Tucker Woodson

Chris Yang

Introduction

(2)

Static and Dynamic Forces

(4)

Structure

(8)

Balance of Forces and Starling Resistor

(3)

Conclusion

(5)

References

(5)

Maintenance of Wakefulness

(14)

Yau Hong Goh

Kheng Ann Lim

Introduction

(1)

The Circadian Pacemaker

(1)

Wakefulness and Sleepiness

(2)

Obstructive Sleep Apnea

(1)

Respiratory Physiology During Normal Sleep

(1)

Arousal Responses to Respiratory Alterations During Sleep

(1)

Effects of Sleep Apnea on Sleep Architecture

(1)

The Role of Sleep Fragmentation on Wakefulness

(1)

Clinical Implications

(7)

References

(5)

Polysomnography

(14)

Judy L. Chang

Clete A. Kushida

Introduction

(1)

Definitions

(1)

Indications for PSG

(1)

Variables Monitored During Sleep

(4)

Technical Aspects of Recording PSGs

(1)

Scoring Sleep Stages

(1)

Scoring Esophageal Pressure

(1)

Abnormal Respiratory Patterns in SDB

(3)

Comparison of PSGs to Ambulatory Sleep Studies

(1)

Conclusions

(3)

References

(2)

Home Sleep Testing

(48)

Terence M. Davidson

Introduction

(1)

Rationale for Sleep Testing

(4)

The History

(1)

The Examination

(3)

The Multichannel Home Sleep Test

102

(3)

Case Examples

105

(7)

Sleep Machines Available to Otolaryngologists and Primary Care Physicians

112

(21)

Night-to-Night Variability

133

(1)

Evaluation and Treatment Algorithm

134

(5)

Conclusion

139

(4)

References

141

(2)

Video Sleep Nasendoscopy

143

(12)

V. J. Abdullah

C. A. van Hasselt

Video Sleep Nasendoscopy

143

(1)

Indications

144

(1)

The Procedure of VSE

145

(7)

VSE: Where Does It Stand?

152

(3)

References

153

(2)

Special Diagnostic Studies in Sleep Apnea

155

(24)

Mike Yao

Pamela H. Nguyen

Introduction

155

(1)

Lateral Cephalometric X-Rays

155

(4)

Computed Tomography

159

(7)

Magnetic Resonance Imaging

166

(3)

Fluoroscopy

169

(1)

Pharyngoscopy

170

(1)

Manometry

171

(2)

Acoustic Reflection

173

(6)

References

174

(5)

Clinical Staging for Sleep Disordered Breathing: A Guide to Diagnosis, Treatment, and Prognosis

179

(10)

Michael Friedman

Hani Ibrahim

Introduction

179

(1)

Staging Criteria

180

(2)

Physical Findings as a Clinical Predictor of SDB

182

(1)

Stages as a Predictor of Successful UPPP

183

(1)

Discussion

184

(2)

Conclusions

186

(3)

References

186

(3)

Continuous Positive Airway Pressure in Obstructive Sleep Apnea Syndrome

189

(14)

Susmita Chowdhuri

Jed Black

Introduction

189

(1)

Mechanism of Action

189

(1)

Indications for CPAP

190

(1)

Initiation of CPAP Treatment

190

(1)

Special PAP Delivery Systems

191

(1)

Potential CPAP-Use Difficulties

192

(1)

Strategies for Compliance Optimization

193

(1)

Treatment Outcomes

194

(2)

CPAP vs. Other Nonsurgical Modes of Therapy

196

(1)

Conclusion

197

(6)

References

197

(6)

Nonsurgical Management: Oral Appliances

203

(20)

James E. Eckhart

Sites and Causes of Snoring and Obstructive Sleep Apnea

203

(1)

Patient Examination Criteria Favoring Oral Appliances

203

(3)

Treatment Options Other Than Surgery or CPAP

206

(11)

Treatment Protocol for Oral Appliances

217

(6)

References

222

(1)

Patient Selection for Surgery

223

(10)

Samuel A. Mickelson

Introduction

223

(1)

Patient Concerns and Complaints

223

(1)

Assess the Severity of the Disorder and Evaluate Underlying Co-morbidities

224

(1)

Physical Examination: Assess Sites of Airway Narrowing and Collapse

225

(8)

References

230

(3)

Anesthesia Management for Sleep Apnea Surgery

233

(8)

Terry Stephen Vitez

Introduction

233

(1)

Preanesthetic Evaluation

233

(2)

Premedication

235

(1)

Intraoperative Management

235

(3)

PACU/ICU

238

(1)

Key Points

238

(3)

References

239

(2)

Nasal Surgery for Sleep Apnea Patients

241

(14)

Richard L. Goode

Introduction

241

(1)

Evaluation

241

(2)

Therapeutic Trials

243

(1)

Sites of Obstruction

244

(11)

References

252

(3)

Uvulopalatopharyngoplasty

255

(10)

Richard L. Goode

Background

255

(1)

Pre-operative Evaluation

256

(1)

Method

257

(6)

Post-operative Care

263

(2)

References

264

(1)

Surgery of the Palate and Oropharynx: Laser-Assisted Techniques

265

(12)

Regina Paloyan Walker

Laser-Assisted Uvulopalatoplasty

265

(1)

Surgical Techniques

266

(6)

Results

272

(5)

References

275

(2)

Temperature-Controlled Radiofrequency Palatoplasty

277

(10)

Lionel M. Nelson

Introduction

277

(1)

Temperature-Controlled Radiofrequency Basics

277

(1)

Patient Selection

278

(1)

Procedure

279

(5)

Comparative Outcomes

284

(1)

Conclusions

285

(2)

References

285

(2)

Coblation Techniques for Sleep Disordered Breathing

287

(20)

Luc G. Morris

Kelvin C. Lee

Introduction

287

(1)

Technical Aspects of Coblation

288

(4)

Clinical Applications of Coblation

292

(11)

Conclusion

303

(4)

References

303

(4)

Cautery-Assisted Palatal Stiffening Operation

307

(8)

Eric A. Mair

Patient Selection

307

(2)

Procedural Technique

309

(1)

Subsequent Management

309

(2)

Possible Complications

311

(1)

Discussion

311

(4)

References

313

(2)

Transpalatal Advancement Pharyngoplasty

315

(10)

B. Tucker Woodson

Patient Selection

317

(2)

Surgical Technique

319

(3)

Complications

322

(3)

References

323

(2)

Injection Snoreplasty

325

(6)

Scott E. Brietzke

Eric A. Mair

Patient Selection

325

(1)

Procedural Technique

326

(1)

Subsequent Management

327

(2)

Possible Complications

329

(1)

Discussion

329

(2)

References

330

(1)

Skeletal Techniques: Mandible

331

(16)

Robert J. Troell

Introduction

332

(1)

Background

332

(1)

Mandibular Anatomy

332

(2)

Presurgical Evaluation

334

(2)

Treatment Philosophy

336

(1)

Surgical Technique

337

(2)

Surgical Anatomy Concerns

339

(3)

Results

342

(1)

Complications and Avoidance Strategies

343

(1)

Discussion

344

(3)

References

344

(3)

Skeletal Techniques: Hypopharynx

347

(8)

Robert J. Troell

Introduction

348

(1)

Background

348

(1)

Hyoid Anatomy

348

(1)

Presurgical Evaluation

348

(1)

Treatment Philosophy

349

(1)

Surgical Modifications

350

(2)

Surgical Results

352

(1)

Surgical Complications

353

(1)

Conclusions

354

(1)

References

354

(1)

Skeletal Techniques: Mandible and Maxilla

355

(10)

Kasey K. Li

Rationale for Maxillomandibular Advancement

355

(1)

Patient Selection

356

(1)

Maxillomandibular Advancement Procedure

356

(2)

Perioperative Management

358

(1)

Surgical Outcomes

358

(2)

Complications of MMA

360

(1)

Conclusion

361

(4)

References

361

(4)

Radiofrequency Tissue Volume Reduction of the Tongue

365

(8)

Samuel A. Mickelson

Introduction

365

(1)

Basic Science of RF Tissue Volume Reduction

365

(1)

Patient Selection

366

(1)

Technique

366

(1)

Treatment Results

367

(2)

Complications and Avoidance Strategies

369

(4)

References

370

(3)

Tracheotomy

373

(16)

Vincent D. Eusterman

Wayne J. Harsha

Introduction

373

(1)

Indications

374

(1)

Surgical Technique

375

(5)

Post-operative Care

380

(2)

Custom Tracheotomy

382

(2)

Complications

384

(1)

Results

385

(4)

References

387

(2)

Surgery for Pediatric Sleep Apnea

389

(20)

David H. Darrow

Introduction

389

(1)

Causes of SRBD in Children

389

(2)

Diagnosis of SRBD in Children

391

(1)

Management of SRBD in Children

392

(17)

References

403

(6)

Surgery for the Upper Airway Resistance Syndrome

409

(8)

James Newman

References

415

(2)

Electrical Stimulation for Sleep Disordered Breathing

417

(10)

David W. Eisele

Alan R. Schwartz

Philip L. Smith

Introduction

417

(1)

Neuromuscular Stimulation of the Tongue

417

(1)

Direct Selective Hypoglossal Nerve Stimulation

418

(1)

Implantable Hypoglossal Nerve Stimulation System

419

(4)

Therapeutic Hypoglossal Nerve Stimulation in Obstructive Sleep Apnea

423

(1)

Conclusion

424

(3)

References

424

(3)

Temperature-Controlled Radiofrequency Tonsil Reduction

427

(10)

Lionel M. Nelson

Introduction

427

(1)

Basic Technology

427

(2)

Patient Selection

429

(1)

Procedure

429

(3)

Posttreatment Care

432

(1)

Discussion

433

(2)

Conclusions

435

(2)

References

435

(2)

Harmonic Scalpel in Tonsillectomy

437

(8)

Ashkan Monfared

David J. Terris

Introduction

437

(1)

Technological Considerations

437

(2)

Surgical Technique

439

(2)

Advantages

441

(1)

Limitations

442

(1)

Conclusion

442

(3)

References

443

(2)

Post-operative Management of Obstructive Sleep Apnea Patients

445

(8)

Edgar F. Fincher

David J. Terris

Introduction

446

(1)

Identification of Risk Factors

446

(2)

Consideration of Comorbid Risk Factors

448

(1)

Post-operative Management in the Pediatric Population

449

(2)

Conclusions

451

(2)

References

451

(2)

Avoidance of Complications in Sleep Apnea Patients

453

(12)

Samuel A. Mickelson

Introduction

453

(1)

Pre-operative Concerns

453

(2)

Intra-operative Concerns

455

(2)

Post-operative Concerns

457

(5)

Conclusions

462

(3)

References

462

(3)

Failure Analysis in Sleep Apnea Surgery

465

(14)

K. Christopher McMains

David J. Terris

Background

465

(1)

Measuring-Success and Failure

466

(3)

Why Surgical Procedures Fail

469

(1)

Best Current Methods of Evaluation

470

(2)

Future Strategies

472

(7)

References

473

(6)

The Ideal Procedure for Snoring and Obstructive Sleep Apnea

479

(6)

Richard L. Goode

Snoring Without OSA

479

(3)

Obstructive Sleep Apnea

482

(3)

References

483

(2)

Index

485

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Surgical Management Of Sleep Apnea And Snoring

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