FACIAL TRAUMA & RECONSTRUCTION

 Sleep Apnea

People with obstructive sleep apnea (OSA) have disrupted sleep and low blood oxygen levels. When obstructive sleep apnea occurs, the tongue is sucked against the back of the throat. This blocks the upper airway and airflow stops. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears, and the flow of air starts again, usually with a loud gasp.

Repeated cycles of decreased oxygenation lead to very serious cardiovascular problems. Additionally, these individuals suffer from excessive daytime sleepiness, depression, and loss of concentration.

Some patients have obstructions that are less severe called Upper Airway Resistance Syndrome (UARS). In either case, the individuals suffer many of the same symptoms.

The first step in treatment resides in recognition of the symptoms and seeking appropriate consultation.

In addition to a detailed history, Dr. Milne will assess the anatomic relationships in the maxillofacial region. With cephalometic (skull x-ray) analysis the level of obstruction can be ascertained. Sometimes a naso-pharyngeal exam is done with a flexible fiber-optic scope. To confirm the amount of cardiovascular compromise and decreased oxygenation levels, a sleep study may be recommended to monitor an individual overnight.

There are several treatment options available. An initial treatment may consist of using a nasal CPAP machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night. When the level of obstruction is at the level of the tongue, sometimes an oral repositioning appliance can be fabricated to thrust the jaw (and obstructing tongue) foward.
 
Depending on the level of obstruction ( nasal, pharyngeal oral) several surgical options may be recommended. In the case of Snoring as well as mild to moderate obstructive sleep apnea , the Pillar procedure may be recommended as a minimally invasive procedure. Another surgical option is an uvulo-palato-pharyngo-plasty (UPPP), which is performed in the back of the soft palate and throat. A similar procedure is sometimes done with the assistance of a laser and is called a laser assisted uvulo-palato-plasty (LAUPP). In other cases, a radio-frequency probe is utilized to tighten the soft palate or the base of the tongue. When obstruction occurs at the level of the nose, due to a deviated septum or other causes, a septorhinoplasty may be recommended. These procedures usually performed under light IV sedation in the office.

In more complex cases, the bones of the upper and lower jaw may be repositioned to increase the size of the airway (orthognathic surgery). This procedure is done in the hospital under general anesthesia and requires an overnight stay in the hospital.