Advanced Surgical Techniques in Snoring and Obstructive Sleep Apnea

369 Pages·2013·18.834 MB·English

by  Kenny Peter Pang (editor), Brian Rotenberg (editor), Tucker B. Woodson (editor)

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DVD INCLUDED
www.pluralpublishing.com PLURAL
Advanced Surgical Techniques in
Snoring and Obstructive Sleep Apnea

Advanced Surgical Techniques in
Snoring and Obstructive Sleep Apnea
Kenny P. Pang
Editor
Brian W. Rotenberg
Coeditor
B. Tucker Woodson
Coeditor
5521 Ruffin Road
San Diego, CA 92123
e-mail: [email protected]
Web site: http://www.pluralpublishing.com
Copyright © by Plural Publishing, Inc. 2013
Typeset in 11/13 Garamond by Flanagan’s Publishing Services, Inc.
Printed in the United States of America by Bang Printing
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Every attempt has been made to contact the copyright holders for material originally printed in another
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ments at the first opportunity.
NOTICE TO THE READER
Care has been taken to confirm the accuracy of the indications, procedures, drug dosages, and diagnosis and remedia-
tion protocols presented in this book and to ensure that they conform to the practices of the general medical and health
services communities. However, the authors, editors, and publisher are not responsible for errors or omissions or for
any consequences from application of the information in this book and make no warranty, expressed or implied, with
respect to the currency, completeness, or accuracy of the contents of the publication. The diagnostic and remediation
protocols and the medications described do not necessarily have specific approval by the Food and Drug administration
for use in the disorders and/or diseases and dosages for which they are recommended. Application of this information in
a particular situation remains the professional responsibility of the practitioner. Because standards of practice and usage
change, it is the responsibility of the practitioner to keep abreast of revised recommendations, dosages, and procedures.
Library of Congress Cataloging-in-Publication Data
Advanced surgical techniques in snoring and obstructive sleep apnea / Kenny P. Pang, editor ; Brian W.
Rotenberg, B. Tucker Woodson, coeditors.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-1-59756-471-7 (alk. paper)
ISBN-10: 1-59756-471-0 (alk. paper)
I. Pang, Kenny Peter. II. Rotenberg, Brian W. III. Woodson, B. Tucker, 1957-
[DNLM: 1. Sleep Apnea, Obstructive — surgery. 2. Snoring — surgery. 3. Surgical Procedures,
Operative — methods. WF 143]
RD119.5.N67
617.5'23 — dc23
2013006669
Contents
Preface ix
Contributors xi
Chapter 1 Pathophysiology, Signs, and Symptoms of OSA 1
Rusdian Utama Roeslani and B. Tucker Woodson
Chapter 2 Diagnosis of OSA: Polysomnography Versus Portable Monitoring 15
Stacey L. Ishman, Kavita Mundey, and B. Tucker Woodson
Chapter 3 Airway Evaluation in OSA 23
J. François Malan
Chapter 4 Current Concepts in Evaluation and Surgical Planning: 37
The Pang-Woodson Protocol
Kenny P. Pang and B. Tucker Woodson
Chapter 5 Drug-Induced Sleep Endoscopy 43
Victor James Abdullah, Ioannis Koutsourelakis. Madeline Ravesloot,
Dennis Lip Yen Lee, Stanley Ching Nam Ha, Charles Andrew van Hasselt,
and Nico de Vries
Chapter 6 Clinical Staging of Obstructive Sleep Apnea 67
Michael Friedman, Christian G. Samuelson, and Craig S. Hamilton
Chapter 7 Oral Appliance Therapy in Obstructive Sleep Apnea 75
Brock Rondeau
Chapter 8 Positive Airway Pressure Treatment of Obstructive 85
Sleep Apnea
Raymond Gottschalk
Chapter 9 Nasal Obstruction and Surgical Effects on OSA in Adults 97
Stuart G. MacKay
Chapter 10 Septoplasty, Nasal Turbinate Reduction in Obstructive Sleep Apnea 105
Jin Keat Siow and Kenny P. Pang
Chapter 11 Modified Cautery Assisted Palate Stiffening Operation (CAPSO)/ 111
Anterior Palatoplasty
Kenny P. Pang and David J. Terris
Chapter 12 Palatal Implants for Treatment of Snoring 117
Brian W. Rotenberg
v
vi Advanced Surgical Techniques in Snoring and Obstructive Sleep Apnea
Chapter 13 Tonsillectomy Alone and Tonsillotomy in OSA 123
Jason K. M. Chau
Chapter 14 UPPP, Review of Techniques: Fujita, Simmons, Fairbanks, and Variants 141
J. François Malan
Chapter 15 Uvulopalatal Flap for Treatment of Sleep Apnea 153
Brian W. Rotenberg
Chapter 16 Z-Palatoplasty 159
Michael Friedman, Craig S. Hamilton, and Christian G. Samuelson
Chapter 17 Palatal Advancement Pharyngoplasty 167
B. Tucker Woodson
Chapter 18 Expansion Sphincter Pharyngoplasty 179
Kenny P. Pang, and B. Tucker Woodson
Chapter 19 Tongue Base Radiofrequency Ablation 185
Kenny P. Pang
Chapter 20 Tongue Suspension 191
Kenny P. Pang
Chapter 21 Modified Tongue Suspension 199
Mehmet Omur
Chapter 22 Endoscopic Midline Glossectomy for Obstructive Sleep Apnea 207
B. Tucker Woodson and Supawan Laohasiriwong
Chapter 23 Lingual Tonsillectomy Treatment of Sleep Apnea 217
Sharon Morong and Brian W. Rotenberg
Chapter 24 Genioglossus Advancement Mandibulotomy 223
Chairat Neruntarat
Chapter 25 Hyoid Suspension 229
Kenny P. Pang
Chapter 26 Rapid Maxillary Expansion 235
Kasey K. Li
Chapter 27 Maxillo-Mandibular Advancement 241
Steven Sewall
Chapter 28 Anesthesia Considerations in Surgery for Snoring and Sleep Apnea 263
John Fuller, Mark Schindel, and Brian W. Rotenberg
Contents vii
Chapter 29 Robotic Surgery for OSAHS: Transoral Robotic Tongue Base 277
Reduction and Supraglottoplasty for OSAHS
Claudio Vicini, Filippo Montevecchi, Giulia Tenti, Iacopo Dallan, and
Tod C. Huntley
Chapter 30 Salvage Surgery Techniques for Failed UPPP 295
Jimmy J. Brown and Kenny P. Pang
Chapter 31 Upper Airway Stimulation — Implanted Neurostimulation Device for 303
Treatment of Obstructive Sleep Apnea
Joachim T. Maurer and Nico de Vries
Chapter 32 Tracheostomy in OSA 319
Jason K. M. Chau
Chapter 33 Pediatric Obstructive Sleep Apnea: Diagnosis and Management 327
Dawn T. W. Teo and Ron B. Mitchell
Index 341

Preface
Sleep is a fundamental physiological need that and manual CPAP uses. This device has been
many of us take for granted. We spend 6 to 8 shown to be overall very effective when the
hours per day sleeping, translating to one-third mask is on the face of the patient (in the labo-
of the day, equivalent to one-third of our life. ratory setting), but not efficacious in the long
Sleep is akin to the shadow of the wakeful state; term for OSA treatment. Oral appliances have
it is inseparable from life, yet an essential need shown to be effective in selected patients with
that cannot be grasped and completely under- mild to moderate OSA. One must realize that
stood. One often does not realize the implica- the effectiveness of the mouth appliance for
tions of this simple nocturnal event on one’s OSA hinges on a patent nasal airway. For an
mood, emotion, relationships, marriage, career, oral device to be effective, the mouth should be
success in life, salary, and importantly, health. closed, hence, the nasal passage should be pat-
There have been significant advances in the ent; with an obstructed nasal passage, the jaw
evaluation, diagnosis, and management of sleep- will drop, resulting in a translation of the tem-
disordered breathing over the past several years. poromandibular joint, and a shift of the tongue
The understanding of the pathophysiology of with a narrowing of the retroglossal space.
obstructive sleep apnea (OSA) has been clearer Surgical algorithms in the management of
and more appreciated. It would be too simplistic OSA begin in the nose. Ensuring a patent nasal
to attribute OSA to a balance between the con- passage in OSA management is pivotal, but not
tainer (box/facial/jaw skeleton) and the contents primary. Simple physics would render that an
(soft tissues/tonsil/tongue/pharyngeal tissue); to obstructed nose would require greater negative
treat OSA, one could either remove the soft tissues pressure to inhale air into the lungs, resulting in
in the oral cavity or enlarge the container (jaw a higher negative pressure in the hypopharyn-
advancement), in order to widen the airway geal area and, hence, more retroglossal collapse
diameter. Unfortunately, we know that airway during sleep. A sleep surgeon is not an uvulec-
dynamics in the wakeful state differ from those tomist. Sleep surgery is not ablative surgery but
of the sleep state. There is a fine balance between reconstructive surgery. Reconstructive palatal
the neurophysiological feedback mechanisms surgery includes lateral pharyngoplasty, expan-
and the absolute anatomical patency of the air- sion sphincter pharyngoplasty, transpalatal
way during sleep. Hence, proper upper airway advancement pharyngoplasty, z-pharyngoplasty,
evaluation is crucial. Drug-induced sleep endos- and so forth. Tongue surgery is crucial in the
copy provides the sleep surgeon with a clearer surgical armamentarium of OSA management.
understanding and appreciation of the anatomi- Hypopharyngeal obstruction in sleep apneics
cal site(s) that are obstructing, in order to better plays a huge part in its pathophysiology.
plan the surgical procedures for the patient. Management of the OSA patient is not solely
Diagnostic methods for obstructive sleep surgery; it is the holistic management of the
apnea have also seen a paradigm shift from patient’s hypertension, obesity, nutrition, choles-
the cumbersome hospital-based full polysom- terol level, ischemic heart, and exercise regime.
nogram to the relatively simple portable home- The sleep apneic has anatomical considerations
based wrist-worn peripheral arterial tonometry. (thick fat neck, small jaw, large tongue, thick
The utilization of the bilevel positive airway pharyngeal walls, big tonsils), physiological dif-
pressure device for OSA has slightly improved ferences (narcotic sensitivities, hypoxic events,
the perennial issue of noncompliance in auto hypertensive episodes, lower airway resistance,
ix