| After exam and testing to
localize the site of obstruction, we can tell that most apneic patients
are narrow at the base of tongue region. Some of this obstruction may be
lateral-from the sides, or from anterior-from the front. Both may
co-exist. Video fiberoptic visualization of the hypopharynx allows this
determination. Mueller's maneuver duplicates the vacuum seen in the supine
nocturnal setting. Treatment of lateral motion defects requires removal of
redundant tissue with the UPPP procedure.
Base-of-tongue problems require anterior
motion of the jaw and tongue. Under video, we can access the effect of
tongue and/or jaw motion. Use of MRD's may help minor apnea due to this
collapse anteriorly. However, more serious collapse requires Hyoid
advancement.
The hyoid bone is the junction of the
tongue and larynx. Anterior neck surgery moves the hyoid bone and
base-of-tongue forward to open up the hypopharynx airway. |