PHARYNGEAL AIRWAY VOLUME FOLLOWING ...

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Surgical Therapy Surgical treatment is indicated with a respiratory distress index (RDI) greater than 20, 28 oxyhemoglobin desaturation below 90%, excessive daytime sleepiness, significant cardiac arrhythmias associated with obstruction, when a specific anatomic abnormality is identified, non-surgical treatments are rejected, patients are medically stable, and they desire surgical therapy. 16 The respiratory distress index is also known as the apnea- hypopnia index (AHI). 28 It is a measurement of airflow and is calculated as the total number of apnea (complete obstruction of airflow) and partial apnea (partial obstruction of airflow) episodes per hour of sleep. 28 Uvulopalatopharyngoplasty Uvulopalatopharyngoplasty (UPPP) is a surgical procedure introduced by Fujita et al. in 1981, 29 involving “shortening the soft palate, amputating the uvula, and removing redundant lateral and posterior wall mucosa from the oral pharynx.” 4 Even though the soft palate is shortened, it can thicken, resulting in a narrower airway. 4 UPPP has a 50% success rate, 30 possibly because it only addresses the retropalatal region of the airway, when many patients experience obstruction at multiple sites. 31 8
Tongue-Reduction Procedures Other surgical procedures are aimed at reducing the size of the tongue and soft tissues in the inferior oropharynx. Laser midline glossectomy (LMG) involves an excision at the midline of the tongue of 2.5cm by 5cm. 16 Lingualplasty is similar to LMG, but includes removal of tissue laterally and posteriorly in addition to the area removed by LMG. Radiofrequency tissue reduction shrinks the size of the tongue by using a probe to induce “coagulation necrosis and healing by scar and muscle contraction”. 16 Advancement Osteotomies/Hyoid Myotomy Advancement of bones and bone segments has also been performed to enlarge the pharyngeal airway space. Inferior sagittal mandibular osteotomy and genioglossal advancement involve an advancement osteotomy of the bone where the genioglossus muscle attaches at the genial tubercles. 16 After advancement, the bone segment is fixated to the lower border of the mandible. Hyoid myotomy and suspension is a procedure that advances the hyoid bone and its surrounding muscles in order to enlarge the hypopharyngeal airway. 16 The surgical procedures discussed above are often referred to as Phase I surgery. They are performed alone 9
Page 1 and 2: PHARYNGEAL AIRWAY VOLUME FOLLOWING
Page 3 and 4: PHARYNGEAL AIRWAY VOLUME FOLLOWING
Page 5 and 6: ACKNOWLEDGEMENTS I would like to th
Page 7 and 8: LIST OF TABLES Table 3.1: Descripti
Page 9 and 10: CHAPTER 1: INTRODUCTION Combined or
Page 11 and 12: CHAPTER 2: REVIEW OF THE LITERATURE
Page 13 and 14: the posterior pharyngeal wall, 2 or
Page 15: mask discomfort, nasal dryness, and
Page 19 and 20: structures causes the airway muscle
Page 21 and 22: after surgery, the upper retropalat
Page 23 and 24: skeletal tissues, soft tissues, and
Page 25 and 26: Literature Cited 1. Schwab RJ, Gold
Page 27 and 28: 19. Wittels EH, Thompson S. Obstruc
Page 29 and 30: 37. Li KK, Guilleminault C, Riley R
Page 31 and 32: CHAPTER 3: JOURNAL ARTICLE Abstract
Page 33 and 34: patients often have elongated soft
Page 35 and 36: subsequent to orthognathic surgery
Page 37 and 38: years. Females had a mean age of 28
Page 39 and 40: Line from Sella to PNS Posterior of
Page 41 and 42: Line from Maxillary Incisor to Post
Page 43 and 44: counterclockwise rotation of the ma
Page 45 and 46: Table 3.1: Descriptive Statistics f
Page 47 and 48: Volume (cubic mm) 30000.00 25000.00
Page 49 and 50: percent change from T0 to T2 (r=.55
Page 51 and 52: surrounding soft tissues encroachin
Page 53 and 54: the pre-surgical values, but there
Page 55 and 56: Conclusions 1. In this study, patie
Page 57 and 58: 10. Lyberg T, Krogstad O, Djupeslan
Page 59 and 60: 27. Li KK, Powell NB, Riley RW, Tro

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