- Minimally Invasive Radiofrequency Surgery in Sleep-Disordered Breathing
- Surgery For Sleep Apnea – Sleep Apnea
- What Are the Symptoms of Pediatric SDB?
The FOSQ was developed to measure the impact of sleep on quality of life. Higher FOSQ scores reflect better quality of life. The median age of both of our study groups was relatively young. Due to the conversion in from paper charts to the electronic patient record EPR at our institution, we were limited in the time frame for which we had current contact information for patients in the UNC surgery database.
Although we attempted to frequency match the age of the orthodontic-only group to the age of the surgery group respondents, the median age of the surgery group was approximately 5 years older, which one might have speculated would have magnified a difference in OSA risk if it existed. The increased follow-up time of approximately 1 year for the BOS group compared to the orthodontic-only group is understandable because up to a year of orthodontic finishing remains after surgery.
We were not able to compare deband dates between groups because we did not have access to the deband dates of the surgery group. The majority of the orthognathic surgery patients seen at UNC have their orthodontic treatment carried out by local orthodontists. The BMI used in this study was calculated from self-reported height and weight values. Given that the study design did not evaluate patients clinically, obtaining accurate height and weight data from participants was not possible. The significantly more Caucasians in the surgery group is consistent with the demographics of the surgery patients at UNC.
There was a significant difference in response rate between the BOS group and orthodontic-only group with response rates of The BOS subjects may have been more likely to participate in our study because many had previously agreed to participate in an ongoing surgery stability study at UNC. In addition, the BOS subjects may have felt more of an obligation to participate because of the intense emotional and psychological impact that comes from the profound positive changes in function and facial esthetics after surgery. No institutional effort is made to periodically update the contact information of patients who have completed treatment, which possibly negatively impacts retrospective study response rates, thereby limiting the generalizability of the findings.
Moreover, this is the first study to assess sleep-related quality of life after BOS. Patients have been shown to be at most risk for SDB if the mandible is set back significantly, preventing adaption to their new respiratory position during sleep. This was not an industry supported study. The authors have indicated no financial conflicts of interest. Platinum Sponsors. Gold Sponsors. Silver Sponsor. Contact Us:. Panossian L, Daley J. Sleep-disordered breathing. Continuum Minneap Minn ;— Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med ;— Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the sleep heart health study.
Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep ;—8. Increased prevalence of sleep-disordered breathing in adults.
Minimally Invasive Radiofrequency Surgery in Sleep-Disordered Breathing
Am J Epidemiol ;— Obstructive sleep apnea syndrome following surgery for mandibular prognathism. J Oral Maxillofac Surg ;—2. Effect of mandibular setback surgery on the posterior airway size. Effects of mandibular retropositioning, with or without maxillary advancement, on the oro-naso-pharyngeal airway and development of sleep-related breathing disorders.
Surgery For Sleep Apnea – Sleep Apnea
J Oral Maxillofac Surg ;—6. Effects of orthognathic surgery on oropharyngeal airway: a meta-analysis. Int J Oral Maxillofac Surg ;— Changes in tongue and hyoid positions, and posterior airway space following mandibular setback surgery. J CranioMaxillofac Surg ;— Long-term changes of hyoid bone position and pharyngeal airway size following mandibular setback by sagittal split ramus osteotomy. J CranioMaxillofac Surg ;—7. Long-term stability of surgical class III treatment: a study of 5-year postsurgical results.
What Are the Symptoms of Pediatric SDB?
Three-dimensional changes of the hyoid bone and airway volumes related to its relationship with horizontal anatomic planes after bimaxillary surgery in skeletal class III patients. Angle Orthod ;—9. Cone-beam computed tomography evaluation of short- and long-term airway change and stability after orthognathic surgery in patients with class III skeletal deformities: bimaxillary surgery and mandibular setback surgery. A comparative CT evaluation of pharyngeal airway changes in class III patients receiving bimaxillary surgery or mandibular setback surgery.
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Evaluation of pharyngeal airway space changes after bimaxillary orthognathic surgery with a 3-dimensional simulation and modeling program. Am J Orthod Dentofacial Orthop ;— Volumetric changes in the upper airway after bimaxillary surgery for skeletal class III malocclusions: a case series study using 3-dimensional cone-beam computed tomography.
J Oral Maxillofac Surg ;— Two- and three-dimensional evaluation of the upper airway after bimaxillary correction of class III malocclusion. Comparison of cone-beam CT parameters and sleep questionnaires in sleep apnea patients and control subjects. The impact of Le Fort I advancement and bilateral sagittal split osteotomy setback on ventilation during sleep. Changes in oropharyngeal airway and respiratory function during sleep after orthognathic surgery in patients with mandibular prognathism. Effects of age on sleep apnea in men: I. Screening for obstructive sleep apnea: an evidencebased analysis.
Am J Otolaryngol ;—8. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med ;— A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anaesth ;— An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep ;— Sleep ;—9. The Epworth Sleepiness Scale may not reflect objective measures of sleepiness or sleep apnea.
Neurology ;— The Epworth Sleepiness Scale in the identification of obstructive sleep apnea. Patients go home immediately after surgery and pain is minimal. This procedure involves advancing one of the main tongue muscles, the genioglossus muscle, forward; thereby limiting the tongues backward fall during sleep.
The genioglossus advancement procedure consists of making a rectangular cut in the jaw bone where the genioglossus muscle attaches. The piece of bone is then moved forward with the muscle attached. The bone is fixed into place with a small titanium plate to prevent retraction back into the floor of the mouth. This procedure addresses the same sites of potential obstruction as the hyoid advancement, and numerous studies have shown a high success rate.
This procedure, however, requires an overnight stay in the hospital, as it is more invasive. A less invasive form of advancement involves drawing the tongue forward with a loop of plastic cord that is fastened under the front of the tongue to a titanium screw inserted into the lower jaw bone. As discussed previously, the base of tongue is a common site of obstruction in patients who suffer from OSA.
In addition the advancement procedures, reducing the amount of tissue from the tongue base through a variety of methods is an effective surgical method to reduce apnea. One method is through the application of radiofrequency waves. A surge of energy is introduced to the tissue that results in shrinkage of the tissue. The radiofrequency waves are directed to specific sites in the tongue base without causing surrounding tissue damage. While the procedure is minimally invasive, and can sometimes be done with the patient awake in the clinic, several treatments are necessary.
Another method to reduce the tongue base is through direct excision.
In this procedure, also known as a midline glossectomy, the tongue base tissue is removed by electrocautery or coblation. This is accomplished under general anesthesia in the operating room and is also tolerated with very little pain. Due to the small, but real risk of airway compromise, patients are observed overnight in the hospital. Studies have shown that all methods of tongue base reduction can be effective when properly employed.
Abnormality of the maxillofacial skeleton is a well-recognized risk factor of obstructive sleep apnea. Sleep apnea patients usually have small, narrow jaws that result in diminished airway dimension, which leads to nocturnal obstruction. Maxillomandibular advancement achieves enlargement of the entire upper airway through expansion of the skeletal framework that encircle the airway.