PHARYNGEAL AIRWAY VOLUME FOLLOWING ...

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or in combination depending upon the site(s) of airway constriction or collapse. Given that surgical procedures focused solely on one area of the airway do not have a high success rate, various surgical procedures have been performed simultaneously to address airway obstruction in multiple areas. 16 The success rates vary by procedure(s) and by patient. Traditionally, patients who undergo Phase I surgery without success are recommended for Phase II surgery. Maxillomandibular Advancement Osteotomies Advancement osteotomies of both the maxilla and the mandible have traditionally been considered Phase II surgery when non-surgical therapies and single-site surgeries, such as UPPP, hyoid suspension, and mandibular advancement, have been unsuccessful. 28 Many advocates of maxillomandibular advancement surgery are now recommending this procedure as a first surgical option in patients who have been diagnosed with multiples levels of airway collapse and those with craniofacial skeletal abnormalities. 28,32,33 Maxillomandibular advancement (MMA) osteotomies have had success in treating obstructive sleep apnea. It has been proposed that advancing the surrounding skeletal 10
structures causes the airway muscles to elongate, become more tense, and have a lesser tendency towards collapse during sleep. 34 The success rate of MMA surgery has largely been measured by the Respiratory Distress Index (RDI). Criteria for success vary between an RDI of less than 10 and an RDI of less than 20. Utilizing an RDI criteria of less than 10, the success rates of MMA have been reported as 65%, 35 80%, 32 and 97%. 36 Success rates of 83%, 37 90%, 38 97%, 39 and 100% 33 have been documented when an RDI of less than 20 was the treatment goal. Cephalometric Studies Several researchers have quantified the amount of surgical advancement and measured the structural anteroposterior (A-P) airway changes following MMA osteotomy utilizing a lateral cephalogram. The most frequently measured site is the posterior airway space (PAS), which is the distance between the base of the tongue and the posterior pharyngeal wall (PPW). 40 A reference line from point B through gonion to the PPW is typically used. 41 Other measurements include the upper retropalatal airway space, narrowest retropalatal space, lowest retropalatal space, and narrowest retroglossal airway space. The upper 11
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 and 16: mask discomfort, nasal dryness, and
Page 17: Tongue-Reduction Procedures Other s
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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