x-Ray of Cause of obstruction

mckooi · Post by **mckooi** » Tue Nov 20, 2007 7:31 pm

Just to cheer you up when you find him and this how he looks like.....:)

http://www.filmworkshop.net/english/fws ... es/li3.jpg

jskinner · Post by **jskinner** » Tue Nov 20, 2007 7:42 pm

I'm thinking my treatment options are as follows:

1. Figuring out whats going on in the nose so that I can use CPAP again. However I think my day time breathing may need to be improved as well with the narrow airway.

2. Genioglossus Advancement

3. Hyoid Advancement

4. Advance System (http://www.aspiremedical.com/)

5. Submucosal Lingualplasty?

Am I missing any options that people know of?

-James

sleepycarol · Post by **sleepycarol** » Tue Nov 20, 2007 7:45 pm

Sounds painful!!

Good luck!!!

Love your software!!

RosemaryB · Post by **RosemaryB** » Tue Nov 20, 2007 7:54 pm

Wow, James. That certainly is narrow. Is there any chance that this is partially due to swelling?

I hope you hear some good suggestions from Dr. Li.

Snoredog · Post by **Snoredog** » Tue Nov 20, 2007 7:56 pm

Dr. Kasey Li has got to be a good DDS, he got his DDS at UCLA, same place as my daughter

jskinner · Post by **jskinner** » Tue Nov 20, 2007 9:28 pm

RosemaryB wrote:Wow, James. That certainly is narrow. Is there any chance that this is partially due to swelling?

yeah I have wondered that myself. Could some of that be caused by the same swelling thats in my nose? I donno?

RosemaryB wrote:I hope you hear some good suggestions from Dr. Li.

I emailed him tonight to ask about reviewing my case.

Guest · Post by **Guest** » Tue Nov 20, 2007 9:30 pm

FYI.... James

Li KK (Kasey)

Latest papers:
Sleep Breath. 2000 ;4 (3):137-140 11868133
Long-Term Results of Maxillomandibular Advancement Surgery.
[My paper] Kasey Li , Nelson Powell , Robert Riley , Robert Troell , Christian Guilleminault
Surgery is a major modality in the treatment of obstructive sleep apnea syndrome (OSAS), and maxillomandibular advancement (MMA) has been shown to be the most effective surgical option. However, despite the successful short-term (6-9 months) results reported by various investigators, little is known of the long-term clinical outcomes. A review of our long-term clinical results demonstrated that MMA achieves long-term cure in most patients. Aging and minor weight gain did not appear to have a significant adverse effect on the long-term results; however, major weight gain did seem to have a significant negative impact on the long-term outcomes. Therefore, long-term follow-up with proper counseling on weight maintenance or reduction is essential in improving long-term results.

Guest · Post by **Guest** » Tue Nov 20, 2007 9:33 pm

FYI...James

Li KK (Kasey K)

Latest papers:
Otolaryngol Clin North Am. 2007 Aug ;40 (4):845-53 17606026
Hypopharyngeal airway surgery.
[My paper] Kasey K Li
Obstructive sleep apnea (OSA) is the result of upper airway obstruction during sleep. Hypopharyngeal airway obstruction can be caused by the prominence or relaxation of the base of the tongue, lateral pharyngeal wall, and occasionally, the aryepiglottic folds or epiglottis. Although nasal continuous positive airway pressure (CPAP) is considered as the first treatment for obstructive sleep apnea, surgery has been shown to be a viable option for patients who are intolerant of positive pressure therapy. This article presents the current state of hypopharyngeal surgery for sleep apnea. Preoperative airway evaluation with fiberoptic nasopharyngoscopy, the use of lateral cephalometric radiograph, and the formulation of a surgical plan with selection of procedures to address hypopharyngeal obstruction are discussed.

mckooi · Post by **mckooi** » Tue Nov 20, 2007 9:39 pm

FYI James,

Controversy in surgical versus nonsurgical treatment of obstructive sleep apnea syndrome.Li KK.

Adjunct Clinical Associate Professor, Stanford Sleep Disorders Clinic and Research Center, Stanford, CA, USA. drli@sleepapneasurgery.com

http://lib.bioinfo.pl/pmid:16860221

GeneS · Post by **GeneS** » Tue Nov 20, 2007 10:09 pm

I had the MMA surgery a number of years ago. I found a report a few months ago that listed a number of measurements of my head, airway, etc plus calculations on how far to move my tongue. I think the measurements came from an x-ray. I always ask to many questions so I probably got a copy from the surgeon. It did not cure my apnea but it is possible that it helped. I do not know. I always wondered why doctors do not do more things like x-rays to find the cause of apnea. It might be because cpap works so well?
GeneS

split_city · Post by **split_city** » Tue Nov 20, 2007 10:28 pm

GeneS wrote: I always wondered why doctors do not do more things like x-rays to find the cause of apnea. It might be because cpap works so well?
GeneS

One of the reasons why is that OSA is a state-dependent disorder i.e. it occurs when you are asleep. Imaging the airway while awake, be it via x-rays, MRI, CT is all well and good, but the final result cannot be simply extrapolated to the sleep state. Yes, these images "may" help determine factors which might be contributing to the apnoeas, but they realistically cannot determine the cause behind them.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP

jskinner · Post by **jskinner** » Tue Nov 20, 2007 10:47 pm

split_city wrote:Imaging the airway while awake, be it via x-rays, MRI, CT is all well and good, but the final result cannot be simply extrapolated to the sleep state.

So I think we need to invent cheap ways to realtime image the airway during sleep

split_city · Post by **split_city** » Tue Nov 20, 2007 10:53 pm

jskinner wrote:
split_city wrote:Imaging the airway while awake, be it via x-rays, MRI, CT is all well and good, but the final result cannot be simply extrapolated to the sleep state.
So I think we need to invent cheap ways to realtime image the airway during sleep

"cheap" is hardly a word used in the medical field

Imaging during sleep has been done. However, patients were often sleep-deprived for 24hrs prior to the study and/or provided with sedatives. Both factors are likely to impact upon airway dynamics.

Imaging during anesthesia has also been done. But again, you are moving away from the "natural" sleep state.....

rested gal · Post by **rested gal** » Tue Nov 20, 2007 10:54 pm

As with many kinds of surgery, I'd think the experience and skill of the surgeon performing the MMA could make all the difference in the world between a successful outcome and...didn't work.

Guest · Post by **Guest** » Wed Nov 21, 2007 7:26 am

Not sure if this is the fat dissolver treatment mentioned earlier, but at least in the DC area there are advertisements on the radio for a procedure called lipo-dissolve. If you google the term, there are lots of links.

TM