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Surgical Management Of Sleep Apnea And Snoring,9780824759100
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Surgical Management Of Sleep Apnea And Snoring


Author(s): Terris, David J.
ISBN10:  0824759109
ISBN13:  9780824759100
Format:  Hardcover
Pub. Date:  8/12/2005
Publisher(s): Informa Healthc

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Table of Contents
Preface iii
Contributors xiii
Upper Airway Surgical Anatomy
1(24)
Vincent D. Eusterman
Brian J. Baumgartner
Introduction
1(1)
Nasal Airway
1(4)
Oral Airway
5(7)
Pharyngeal Airway
12(13)
References
23(2)
The Anatomy of Sleep Disordered Breathing: An Evolutionary Perspective
25(20)
Terence M. Davidson
Introduction
25(1)
Anatomy
26(4)
Evolutionary Anatomic Changes
30(7)
Ontogeny Recapitulates Phylogeny
37(1)
Fossil Records
37(1)
Studies on Anatomic Correlations with SDB
37(3)
Conclusion
40(5)
References
41(4)
Physiology of Sleep Disordered Breathing
45(22)
B. Tucker Woodson
Chris Yang
Introduction
45(2)
Static and Dynamic Forces
47(4)
Structure
51(8)
Balance of Forces and Starling Resistor
59(3)
Conclusion
62(5)
References
62(5)
Maintenance of Wakefulness
67(14)
Yau Hong Goh
Kheng Ann Lim
Introduction
67(1)
The Circadian Pacemaker
68(1)
Wakefulness and Sleepiness
68(2)
Obstructive Sleep Apnea
70(1)
Respiratory Physiology During Normal Sleep
71(1)
Arousal Responses to Respiratory Alterations During Sleep
72(1)
Effects of Sleep Apnea on Sleep Architecture
73(1)
The Role of Sleep Fragmentation on Wakefulness
73(1)
Clinical Implications
74(7)
References
76(5)
Polysomnography
81(14)
Judy L. Chang
Clete A. Kushida
Introduction
81(1)
Definitions
81(1)
Indications for PSG
82(1)
Variables Monitored During Sleep
82(4)
Technical Aspects of Recording PSGs
86(1)
Scoring Sleep Stages
87(1)
Scoring Esophageal Pressure
88(1)
Abnormal Respiratory Patterns in SDB
89(3)
Comparison of PSGs to Ambulatory Sleep Studies
92(1)
Conclusions
92(3)
References
93(2)
Home Sleep Testing
95(48)
Terence M. Davidson
Introduction
95(1)
Rationale for Sleep Testing
95(4)
The History
99(1)
The Examination
99(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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