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Obstructive Sleep Apnea Diagnosis and Treatment - part 3

Để dự đoán sự thành công của thiết bị bằng miệng, các nhà điều tra đang bắt đầu sử dụng kỹ thuật hình ảnh đường hô hấp trên để truy cập vào kích thước và vị trí của đường hô hấp trên (77). Thượng Đường hàng không phẫu thuật (xem Chương 11) Có một vài lựa chọn phẫu thuật cho bệnh nhân ngưng thở khi ngủ bao gồm UPPP (cắt amiđan và loại bỏ các lưỡi gà | 80 Patel and Schwab is complex. To predict the success of oral appliances investigators are beginning to use upper airway imaging techniques to access the size and position of the upper airway 77 . Upper Airway Surgery See Also Chapter 11 There are several surgical options for sleep apnea patients including UPPP tonsillectomy and removal of the uvula distal margin of soft palate and any excessive tissue uvulopalatopharyngo-glossoplasty UPPGP combines UPPP with limited resection of the tongue transpalatal advancement pharnyngoplasty TPAP resection of the posterior hard palate with advancement of the soft palate to enlarge the retropalatal airway sliding genioplasty or genioglossus advancement advancing the tongue forward by displacing its attachment to the genial tubercle forward hyoid advancement displacement of the hyoid bone forward to enlarge the retro-glossal airway and maxillary-mandibular advancement forward displacement of the maxillae and mandible to advance the soft tissue structures 162 . Typically surgical options to treat sleep apnea are invasive and may require a staged approach. Since the upper airway obstruction may not be at one site selecting the appropriate sleep apnea patient and a suitable surgical approach is important. Surgical selection may be achieved by examining data from clinical fiberoptic and radiologic sources. The Muller maneuver voluntary inspiration against a closed mouth and obstructed nares permits visualization of the airway structures during a simulated apneic event and has been used to identify surgical candidates 78 . CT and MRI can also be employed to provide detailed information about structural dimensions during wakefulness and sleep 28 163 and may predict surgical outcome 70 . UPPP the most common upper airway surgical procedure was introduced in 1981 and although there have been many studies in OSA patients examining this surgical technique its failure rate exceeds 50 162 . UPPP only corrects one vulnerable upper airway .