Preop Assessment Periop Management

Preoperative Assessment & Perioperative Management Ho-Sheng Lin, MD Associate Professor Department of Otolaryngology/ Head and Neck Surgery SCS Educational Day 11/27/07

Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object]

Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Powell Riley 2-Phase Surgical Protocol 66% GAHM BOT only Type III 60% UPPP and GAHM Palatal and BOT Type II 80% UPPP Palatal only Type I Response Rate Type of Surgical Procedure(s) Site of Obstruction Fujita Classification

Powell Riley 2-Phase Surgical Protocol

Powell Riley 2-Phase Surgical Protocol ,[object Object],[object Object],[object Object],[object Object],N=306 Phase I Surgery N=239 Failed prior UPPP N=60 Responder N=145 Nonresponder N=94 Skeletal deformity N=7 Refused further surg N=70 Proceed to phase II N=24 Phase II Surgery N=91 Responder N=89 Nonresponder N=2

Powell-Riley Phase I – Soft Tissue ,[object Object],[object Object],[object Object],Sleep 2007; 30:461-7

Powell-Riley Phase I – Soft Tissue ,[object Object],[object Object],[object Object],[object Object]

Diagnostic Modalities ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],General Head & Neck Examination

General Head & Neck Examination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

General Head & Neck Examination ,[object Object],[object Object],[object Object],[object Object],[object Object]

Friedman Clinical Staging ,[object Object],< 40 < 40 3, 4 3, 4 I II BMI Tonsil Size Friedman Tongue Position

Friedman Clinical Staging ,[object Object],< 40 < 40 0, 1, 2 0, 1, 2 III IV BMI Tonsil Size Friedman Tongue Position

Friedman Clinical Staging ,[object Object],< 40 < 40 0, 1, 2 3, 4 I, II III, IV BMI Tonsil Size Friedman Tongue Position

Friedman Clinical Staging ,[object Object],All patients with significant craniofacial or other anatomic deformities  40 0, 1, 2, 3, or 4 1, 2, 3, or 4 BMI Tonsil Size Friedman Tongue Position

Successful Treatment of OSAHS with UP3 % Successful Treatment Friedman et al. Otolaryngol Head Neck Surg 2003;129:611-21.

Distribution of Patients with OSAHS by Stage Percentage of Patients Friedman et al. Otolaryngol Head Neck Surg 2003;129:611-21.

Successful Treatment of OSAHS with UP3 vs. UP3 + TBRF % Successful Treatment * * * Different from UP3 only ( P < .001) Friedman et al. Otolaryngol Head Neck Surg 2003;129:611-21.

Modified Muller Maneuver ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Lateral Cephalometric Analysis SNB SNB < 72o Severe mandibular deficiency BOT obstruction PNS-P > 40 velopharyngeal obstruction PAS < 7 mm BOT obstruction MP-H > 20 BOT obstruction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Fluoroscopy and Somnofluoroscopy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pharyngeal Pressure Measurement ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cine CT Scan ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

MRI ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Sleep Endoscopy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Palatal Level: Posterior Collapse of Soft Palate

Palatal Level: Circumferential Narrowing

Oropharyngeal Level : Posterior Collapse of BOT

Oropharyngeal Level : Collapse of Lateral OP Wall

Oropharyngeal Level: Circumferential Narrowing

Supraglottic Level: Collapse of Epiglottis

Summary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Preoperative Considerations: Selection of Surgical Candidates ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Preoperative Considerations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Intraoperative Considerations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Postoperative Considerations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Postoperative Considerations

Preop Assessment Periop Management

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