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Re: point/points of obstruction in OSA

Posted by Carolyn on May 18, 1998 at 21:51:35:

In Reply to: point/points of obstruction in OSA posted by Jeff on May 18, 1998 at 11:43:16:

Methods to identify upper airway obstruction can include: physicial examination, fiberoptic endoscopy with Mueller's maneuver, lateral cephalogram, Afrin test results, rhinomanometry, Rapid Cine-CT imaging, MRI and Somnofluorscopy.

Some upper airway anatomy abnormalities: large uvula, webbed posterior pillars, large palatine &/or lingual tonsils, vertical pharyngeal rugae, low palatal arch, large tongue, nasal septal deviations, nasal turbinate hypertrophy, and orthognathic skeletal abnormalities

Where the obstruction is depends on the type of surgery done.
Examples:
Nose surgical treatment could be: septoplasty, turbinate surgery, polypectomy

Nasopharynx surgical treatment could be: Adenoidectomy

Upper pharynx surgical treatment could be: tomsillectomy, uvulopalatopharyngoplasty

Lower pharynx surgical treatment could be: midline glossectomy and lingualplasty, lingual tonsillectomy, epiglottoplasty & removal of obstructive supralaryngeal tissues, limited mandibular osteotomies and genioglossus advancement, inferior sagittal osteotomy, hyomandibular & hyolaryngeal suspension, maxillo-mandibular advancement

Bypass upper airway-- Tracheostomy ( and yes it is 100% effective)

Until your obstruction is identified I would see no reason to have any surgery. The success rates for instance UPPP are not all that favorable between 40% & 60%. Success measured in reducing RDI (respiratory disturbance index) by 50%.There are some success UPPP where the patient is cured but they are few and far between. Generally they are still on CPAP or return to CPAP after time. Any form of success seems to depend on where the obstruction is-- best results has been associated with enlargement of the volopharynx and decreased collapsibility of the pharynx.

Sorry at the moment there is no "magic bullet" for OSA. If you are not a good surgical candidate for UPPP,GAHM, or Maxillomandibular osteotomy with advancement then the only options are CPAP or tracheostomy. Oral applicance is generally used for mild OSA.

best of luck

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