Posted by sleepsurgeon on March 02, 2009 at 13:25:05:In Reply to: Re: UPPP-Is it so bad? posted by Captin Cannuck on March 02, 2009 at 08:54:53:
The short term and long term response from UPPP is going to be very different in a 30 year old, non-obese man with moderately large tonsils with mild to moderate sleep apnea as compared to a 50 year old overweight man with moderate to severe sleep apnea and excessive amount of pharyngeal soft tissues. How the airway collapses is very different between the two. Even if the 50 year old man respond to UPPP, the duration of response is going to be short, 1-2 years possibly as compared to the 30 year old man. That is why the quoted response rate of surgery needs to be modified to each individual patient. I often tell patients forget about UPPP as it is not going to help them sufficiently but for some patients, I believe there is a decent chance of response to warren it.
At the end, it all comes down to patient selection, surgical technique and how you manage the patient as well as the patient’s desire. I often tell my patients that we are in it together and on the same team. It is a decision that we make together, in terms of how to deal with the problem. I am sure Dr. Elshaug is an excellent statistician, but he has never treated a patient. When patients are properly selected, the short and long term success rate is much better than what he has concluded. At the same time, we all know that CPAP is the first line treatment and the treatment that can give the best “potential” result. If we take the well-accepted compliance rate of 60%, should we offer CPAP when there is a 40% failure rate? By the way, even in patients using CPAP for more than 3 years, there is a 10% drop off rate. My point is that we need to educate the surgeons, the sleep physicians and the public to understand the options, to understand how to evaluate the outcomes data to formulate treatment options.
In terms of MMA and phased treatment, it also comes down to patient selection. I do not believe all patients should go straight to MMA either. You have to evaluate all the factors that I have mentioned in the past. Again, it comes down to the divider cross specialty line. Just because someone has experience with jaw surgery doesn’t mean that they know how to manage the airway. One person’s 10mm advancement is another person’s 3 mm advancement. Obviously, I have the luxury of being able to point out the faults of each specialty. Unfortunately, when all you have is a hammer, the whole world looks like a nail.
- Re: UPPP-Is it so bad? Captin Cannuck 18:57 3/02/09 (2)
- Re: UPPP-Is it so bad? Gremlin 22:15 3/04/09 (1)
- Re: UPPP-Is it so bad? Gremlin 22:27 3/04/09 (0)