Figures
- FIGURE 1
Current treatment modalities in obstructive sleep apnoea (OSA). Dashed arrows: mandibular advancement device (MAD) therapy or upper airway surgery indicated in patients who do not tolerate continuous positive airway pressure (CPAP). MMA: maxillomandibular advancement; rEDS: residual excessive daytime sleepiness. #: in selected patients (drug-induced sleep endoscopy); ¶: if position dependent.
Tables
- TABLE 1
Potential side-effects during mandibular advancement device treatment
Transient Persistent Discomfort or pain in the mandibular joint complex Occasional damage to teeth and prosthetic restorations Stiff masticatory muscles Tooth shifting with undesirable occlusion changes Dry mouth Periodontal problems Excessive salivation Tooth sensitivity Gum irritation - TABLE 2
Current upper airway and maxillofacial surgeries for obstructive sleep apnoea (OSA)
Intervention site Main procedures Main indications Nose Septoplasty
TurbinoplastyFor subjects with persistent nasal obstruction, mainly to improve feasibility of CPAP or MAD Nasopharynx Adenoidectomy Adenoid hypertrophy Oropharynx Tonsillectomy
Barbed reposition pharyngoplasty (BRP)
Expansion sphincter pharyngoplasty (ESP)
Soft palate RFITTTonsillar hypertrophy; in adults, mainly with other procedures
Retropalatal obstruction
Retropalatal obstruction
Retropalatal obstruction in mild OSAHyoid bone Hyoidthyroidpexia Hypopharyngeal obstruction Tongue Tongue RFITT
Transoral robotic surgery (TORS)
Tongue suspensionModerate macroglossia and retrolingual obstruction, mainly in mild-to-moderate OSA, or as part of multilevel surgery Maxilla/mandible Maxillomandibular advancement
Maxillary expansionMandibular deficiency, severe OSA with obstruction at multiple sites Larynx Epiglottopexy Obstruction at the epiglottic level Trachea Tracheostomy Only in emergency situations; rarely performed when other treatments are not feasible in severe OSA Multisite Variable combined procedures Obstruction at multiple sites in moderate-to-severe OSA CPAP: continuous positive airway pressure; MAD: mandibular advancement device; RFITT: radiofrequency interstitial thermotherapy.
Vol 18 Issue 3
Table of Contents
Non-CPAP therapy for obstructive sleep apnoea
