The pathophysiology of obstructive sleep apnea is poorly defined, but in most patients it is thought to be related to maximal relaxation of the upper airway during rapid eye movement sleep. The patient commonly complains of daytime fatigue or sleepiness; restless, poor quality sleep at night; loud obnoxious snoring; sudden arousal and gasping for breath during sleep; and morning headache. As a result of this, plus frequent obesity, these patients are at great risk for myocardial infarction and early death. A complete work-up includes a polysomnogram, nasopharyngoscopy, cephalometric analysis, and a helical computed tomographic (CT) scan to evaluate the upper airway. Maxillomandibular advancement surgery pulls the tongue base forward and is considered a highly successful operation, with a cure rate of about 85%. Air flow through the upper airway is inversely proportional to the resistance. Therefore, surgical techniques to decrease the resistance and open the upper airway are also a key area for research. Computer fluid dynamics and bioengineering lend themselves to analysis of air flow. Pre- and postoperative CT scans can be digitized and mesh-generated data created. Perhaps in the future a CT scan could be obtained before surgery and manipulated in such a way as to allow the surgeon to accurately determine the millimetres of advancement needed for a specific cure.
Surgical treatment options of OSAS and their long term outcome
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