obstructive sleep apnea C D A J O U R N A L , V O L 4 9 , Nº 3
Contemporary Sleep Surgery: From Reconstruction To Restoration Stanley Yung-Chuan Liu, MD, DDS, and Rishi Jay Gupta, DDS, MD, MBA
abstract Obstructive sleep apnea (OSA) is a prevalent condition that affects people of all ages. Surgical management has improved with growing understanding of OSA pathophysiology, new methods of airway phenotyping and precision in operative techniques. The classic Stanford phased approach serves as a foundation for the updated algorithm, which places surgery on a continuum with medical and dental care. The last 40 years have seen a burgeoning of effort focused on individual surgical or dental procedural success rates. What lies ahead should be a focus on improving overall treatment success, usually achievable only with multimodal interventions. The goal of treatment success for the OSA patient will foster collaboration across disciplines. Key words: Snoring, obstructive sleep apnea, maxillomandibular advancement, hypoglossal nerve stimulation, temporomandibular disorders, tonsillectomy, UPPP, DOME
AUTHORS Stanley Yung-Chuan Liu, MD, DDS, is an assistant professor of otolaryngology and, by courtesy, of plastic and reconstructive surgery at the Stanford University School of Medicine. He is director of the Stanford sleep surgery fellowship and preceptor to the oculoplastic surgery fellowship. Dr. Liu is a Stanford biodesign faculty fellow alumnus, a diplomate of the American Board of Oral and Maxillofacial Surgery, a fellow of the American College of Surgeons and a consultant member of sleep medicine for the American Academy of Otolaryngology.
Rishi Jay Gupta, DDS, MD, MBA, is the section chief, oral and maxillofacial surgery, dental service, at the San Francisco VA Health Care System. He also serves as the regional sleep surgical and dental director for the VA Health Care System. He is assistant professor, department of oral and maxillofacial surgery, at the University of California, San Francisco and practices in a private practice. Dr. Gupta is a fellow of the American College of Surgeons. Conflict of Interest Disclosure for both authors: None reported.
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he origin of sleep surgery is rooted in medicine and dentistry. The late William Dement, MD, PhD, is recognized as the father of sleep medicine. He launched the world’s first sleep disorders clinic at Stanford University Medical Center in 1970. He recruited Christian Guilleminault, MD, DM, DBiol, who is credited with describing obstructive sleep apnea (OSA) as a clinical entity. OSA is characterized by repetitive episodes of complete or partial upper airway obstruction during sleep resulting in disruptions of normal sleep architecture and is associated with arterial desaturations.1 The prevalence is approximately 11.1% in men and 4.9% in women based on the Sleep Heart Health
Study.2 The sequelae of OSA includes metabolic syndrome, cardiovascular morbidities, neurocognitive deficits, psychosocial consequences and cancer.3 Nelson Powell, MD, DDS, a pioneer of sleep surgery, once recounted: In 1979, Dr. Guilleminault and Dr. Dement were interested in Bob Riley and I since we both had maxillofacial and dental experience. They were convinced that children and adults needed a more aggressive approach to obstructive sleep apnea than weight loss or tracheotomy. At a time when continuous positive airway pressure (CPAP) and oral appliance therapy (OAT) were not yet introduced and tracheostomy was the only surgical solution,4 Drs. Riley and Powell’s recognition of soft tissue and skeletal targets for OSA treatment was M ARC H 2 0 2 1
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