Posted by sleepsurgeon on March 03, 2009 at 19:14:02:In Reply to: Re: UPPP-Is it so bad? posted by bruinmd on March 03, 2009 at 07:55:13:
I appreciate your frankness. I don’t disagree that many surgeons performing UPPPs have no business doing them. It is the same with some dentists making oral appliances for snoring that have no clue about sleep apnea. Similarly, many dental/oral surgeons performing sleep apnea surgery including MMAs have absolutely no understanding of sleep or how to manage the airway that unfortunately have led to the ultimate complication (I somehow end up reviewing many of these legal cases). Clearly, we all have to practice with our conscience. Early on, I told myself that when I offer to perform an operation, I want to know in my heart that I am the best person in the world to do the operation. That is why I did two residencies and a fellowship before specializing in sleep apnea surgery. Despite extensive training of numerous procedures, I only perform about 5 procedures which I do every week. Some ENTs may do just as many UPPPs or some oral surgeon may do just as many MMAs, but they do not have the training in both specialty or expertise in managing the airway or jaws in OSA patients like me. It certainly is not their fault. They have never been exposed to it and ignorance is bliss. Does every one need to do what I have done? Obviously, the answer is no. What is the right way, I certainly don’t know. Any primary care physician or internist can take care of patients with hypertension. Should these patients be treated by a cardiologist? Does a cardiologist have a better knowledge in managing hypertension as compared to a primary care physician? Is a CPA better at preparing a tax return than someone at HR Block? It is up to you all to decide. The intent of my initial post was simply to point out that UPPP isn’t uniformly bad and I wanted to point out the problem with it so patients can have better understanding of it.
I have explained the rationale of using a 50% reduction of AHI and less than 20 events per hour as a cut off for “success” in the surgical literature and I have explained it in depth in my past post so I won’t labor it further. By the say, I would like to point out that similar criteria is used for assessing MMA “success” for sleep apnea as well as oral appliance “success” in the medical and dental literature.
I certain agree that there are many “junk” papers in the medical literature and UPPP literature is no exception. It is up to the individual to evaluate the quality of the published papers. I would disagree with your statement that the UPPP literature is scant. I am not going to quote numerous literatures on this forum. But there is quite a bit of support for the efficacy of UPPP in reducing heart disease, driving accidents and reducing mortality. I know most of you are supporter of MMAs because of the benefits you have achieved with the operation. I am certainly in agreement as I see it in my patients daily. However, if you compared the MMA literature to the UPPP literature, some MMA papers are better but some UPPP papers are clearly better in quality.
- Re: UPPP-Is it so bad? flip 09:14 3/05/09 (0)