Hair has been regarded as a sign of beauty and power for as long as one can remember. Judges in olden days wore wigs as mark of authority whereas monks shave their scalp as part of their renunciation of all worldly pleasures and to render themselves unattractive to the opposite sex.
Hair loss does not affect you just cosmetically but emotionally and socially. Research reveals how deeply hair loss can impact your life.
Emotionally, a high percentage of people experiencing hair loss are known to suffer from low self esteem and depression as a result of this problem, be it men or women
However, the most important aspect of hair loss is its medical implication. Loss of hair is almost always a sign of an internal disorder. It is often first warning signal of many deep seated ailments including thyroid, Diabetes and anemia.
Causes of Hair loss & Thinning
1. Androgenetic Alopecia – male or female pattern baldness
2. Auto immune diseases – an immune reaction that attacks the hair follicles, producing
antibodies which attack these tissues as if they were foreign invaders.
Androgenic Alopecia – the body’s immune system is sensitized to increased levels of DHT in the scalp causing hair loss in these high concentrated DHT areas
Alopecia Totalis, universalis – immune sensitivity to a substance other than DHT
3. Connective tissue disease – causes scarring of skin, loss of circulation to hair follicles and an autoimmune reaction leading to temporary or permanent loss of hair.
 Lupus, Rheumatoid arthritis, Scleroderma, MCTD, Scarring alopecia
4. Exposure to toxic chemicals –Tobacco smoke contains hundreds of lethal and
damaging chemicals which can accelerate normal hair loss and retard effects of
medication and surgical restoration. This effect can result either from being a
smoker or from second hand smoke. We are exposed to other toxic chemicals
and metals through work, hobbies and environment. They can be present in our
homes (ie.: lead, aluminum, cadmium, arsenic, mercury, etc.) Exposure can be
environmental and/or ingested through food sources.
5. Radiation exposure – Irradiation therapy or exposure to radiation from any source can cause localized or total hair loss, which may be permanent if thevdose is high enough.
6. Iron deficiency anemia – very common with women but can also affect men.
7. Hormonal changes – due to pregnancy, birth control pills, other medications,
and menopause.
8. Thyroid disease – either hypothyroid or hyperthyroid disease causes hair to become brittle and break resulting in localized or generalized loss. Correction of the thyroid condition usually causes hair to re-grow.
9. Stress – usually temporary and transient. Hair may re-grow when stress levels decrease
10. Drug interactions – certain vitamins, many prescriptions and over the counter (OTC) supplements may have individual and non-specific side effects of hairloss. Usually, when the medication is discontinued, the hair re-grows.
 Excessive Vitamin A has been linked to some hair loss scenarios.
11.Others: Exposure to toxic chemicals –Tobacco smoke contains hundreds of lethal and
damaging chemicals which can accelerate normal hair loss and retard effects of medication and surgical restoration. This effect can result either from being a smoker or from second hand smoke. We are exposed to other toxic chemicals and metals through work, hobbies and environment. They can be present in our homes (ie.: lead, aluminum, cadmium, arsenic, mercury, etc.) Exposure can be
environmental and/or ingested through food sources.
Individual reaction to illness or a personal sensitivity to the environment, Chemotherapy, Fungal and bacterial infections, Cosmetic procedures like perming, crimping , straightening and colouring are enormously contributory factors, and should be avoided as far as possible.Also
• Androgenetic Alopecia- In men it is the most common cause of hair loss, In women the hormonal changes that occur at the time of menopause and post delivery are responsible.
• Alopecia Areata - In this type of hair loss, hair usually falls out, resulting in totally smooth, round patches about the size of a coin or larger. It can, rarely, result in complete loss of scalp and body hair.
• Thyroid Disease - Both an over-active thyroid and an under-active thyroid can cause hair loss.
• Low Serum Iron - Iron deficiency occasionally produces hair loss. Some people don't have enough iron in their diets or may not fully absorb iron. Women who have heavy menstrual periods may develop iron deficiency.
• Hair Pulling (Trichotillomania) - People with trichotillomania pull hair on various parts of their bodies, including the scalp, face, arms, legs and pubic areas. They may not notice the hair pulling until they need to cover up bald patches.
• Medications - Some prescription drugs used for gout, arthritis, depression, heart problems, high doses of vitamin A & birth Control Pills may cause hair loss
Other causes includes high Fever, Severe Infection, Severe Flu , Inadequate Protein in Diet ,Major Surgery/Chronic Illness ,Fungus Infection (Ringworm) of the Scalp.



Homeopathy & Hair Remedy
This is of utmost importance to understand that hair loss is almost always a sign of an internal disorder or disease. Very often patients try over the counter prescriptions or “tried and tested” beauty parlor remedy for hair & this remedy fail because they don’t identify the cause of the hair loss.
Homoeopathy is an excellent answer to hair loss. Its personalized approach is ideal for hair treatment since hair is as distinctive as fingerprints. Homeopathy is absolutely safe without any side effects, and works from within to treat the underline disorder that is causing the hair loss thus providing a permanent solution.
A consultation with a qualified homeopath will invest a great deal of time and care in asking questions to uncover your constitution. Doctors ask about not only your hair loss and heredity but also how you are affected by environmental factors such as weather and temperature, the types of foods you like or dislike and your moods and feelings; a thorough medical history will be taken in order to establish a complete picture of you. Your current symptoms are then taken into consideration in order to prescribe the correct remedy at the right strength.
In homeopathy, there are more than 100 remedies for alopecia or hair loss. The homeopath has to analyze your case systematically to choose the right medicine for you.
To help classify the hair type, the equipment like video microscope or trichoscan is usefull. These machines even alert to catch and avert impending hair loss before it actually takes place.
Hair Grow Therapy (LLLT) & HFT.

Along with homeopathic medication, use of supporting latest international machines is also useful in stimulating blood circulation and proven to help hair loss. But it has to be complimented by medication.

• LLLT (Low Level Laser Therapy): The recent developments showed that low level lasers can also be used in treating hair loss and other skin diseases that usually occurs on the scalp. Low intensity laser energy works by absorbing the lasers into the scalp which stimulates cellular activity and hair growth. Absorption of light by the hair follicle molecules is essential in order for biological reaction to be stimulated in the molecules. Laser light reactions stimulated in cytochrome c sends signals throughout cells of the hair follicle, stimulating enhanced gene activity, decreased gene-regulated cell death, and other changes that enhance cell activity and survival.
• HFT ( High Frequency Therapy): A high frequency current which stimulates the surface of the scalp by means of massaging the cells of the scalp, also supposed to improve the process of nourishment, stimulate local blood circulation, stimulate local glandular activity, supplies heat and is soothing to the nervous system of the scalp.

WILL GOD INCARNATE? DR SHRINIWAS KASHALIKAR

It is generally observed that; the believers in God; are often agitated by the events; which appear unjust; to them. The belief that God is just; is shaken. The belief that God punishes the evil is shattered. The faith in goodness weakens. In fact; the conflict torments them.

But the story of the atheists is also not different. The “convictions” of various shades of leftist ideologies such as Marxist, Maoist, Leninist; etc; also get eroded; due to the failure; to achieve the projected or anticipated results; of the revolutionary theories and struggles.

As a result; the practice of NAMASMARAN; appears to be futile and the revolutionary efforts; appear to go in vain; respectively.

It is precisely; here that we have to appreciate; that; God; or nature; does not exist and function; according our subjective imaginations, postulations, hypotheses, fantasies; or even so called logical frameworks of ideologies. In other words; God or nature; does not work in accordance with our subjectivity.

Whether we call it emancipation of mankind; or we call it; global revolution bringing about prosperity and profundity; it is essentially; an ongoing process of transformation from subjectivity to objectivity. It is an ongoing process of intellectual, emotional, instinctual and physical evolution resulting in blossoming from within; coupled with tangible manifestation in personal and social life.

Thus if we are theists, then we have to appreciate that God incarnates within us; in the form increasing accuracy, objectivity and universality; in our perspective, thinking, emotions, instincts, physical wants; and our behavior at all these planes.

If we are atheists; then we have to appreciate that our theories of revolutions; would materialize; as and when they become increasingly objective and accurate; i.e. in tune with nature.

It is however; not possible to become objective and accurate; voluntarily; and on our own; even if our ego may suggest so. The simplest way for this; is NAMASMARAN {Jap, jaap, jikra, sumiran, simaran i.e. remembering our true) self}, which reorients and reconstitutes us; in our true and objective self.
If we are agitated by personal or social ‘evils’ or ‘retrogressive forces’; then it is urgent and essential; to practice, propagate and universalize; with top priority; the “oxygen” of NAMASMARAN; amidst our day to day routine and hustle bustle; and conquer our stress, which is pandemic!

STAINED PEARLS: DR. SHRINIWAS KASHALIKAR

It is true that the technology has made life much easier for billions of people. It has progressed in transport, communication, productivity, physical fitness and so on.
This has lead to improvement in efficiency of management, administration, coordination and physical efficiency.
However; our progress; in transport, communication, productivity, physical fitness, management, administration, coordination and physical efficiency etc; are all directed to serve; our basal instincts, individualistic whims, personal fancies, petty pursuits, and trivial gains. It has divided and disrupted us; and torn us apart from one another. It has made us more lonely and miserable.
We have lost our instinct to love. We have lost zest to come together. We have lost the urge to unite. We have lost the innocence and potency to empathize. We have lost the vigor of compassion and help. We have lost the twinkling of eyes. We have lost the very ambrosia of life. We have become caricatures of ourselves; pathetic like “stained pearls”.
This has happened because; we have lost the sight of our own core. We have forgotten our souls. We have ignored our conscience. We have neglected our hearts. While gaining knowledge and smartness in business, management, administration; and amassing money and power; our souls are left helpless and moribund!
If we are aware of this and if we want to rejuvenate our souls, then what could we do? How to achieve the ecstasy of uniting? How to achieve the harmony of hearts, motivations and actions? How to engender objective universal justice?
The answer to this question is; “Practicing the ancient mega-procedure of NAMASMARAN (jap, jaap, jikra, sumiran, simaran i.e. remembering our true selves)”!
NAMASMARAN lays open the innate core of our own selves; and the universe; and gives us access to the ambrosia therein! After drinking this ambrosia; we see; and hence get inspired and empowered; to propagate; the potential of NAMASMARAN to spring the holistic perspective, policies, plans, programs; and their implementation; for global welfare.

HIS DESIRE: DR SHRINIWAS KASHALIKAR

Suddenly in the New Year celebrations the noise changed into whispers and loud discussions.
The news had taken everybody by surprise.
Someone had noticed God Himself sitting on a nearby hillock.
All of them agreed that this was a wonderful opportunity and great boon to meet Him personally.
As they were approaching Him; someone said; “We always pray and put forth our demands and desire to God! But won’t it be wiser to ask Him His desire?”
Even though it was unusual; ultimately all agreed on this point.
As they reached God; they prostrated in front of Him and saluted in their different ways!
As God asked them to tell what they wanted; all of them unanimously said; “This time; we have come to fulfill; NOT our desire; but your desire!
God laughed!
He said; “Thinking this way; is a great achievement! You have come closer to me! Actually “my desire” operates through you as “your desire”; even if you are unaware of it!! Your awareness and concern about “my desire” is also my desire! My desire is self sufficient and omnipotent! Instantly it becomes a reality!
In this New Year and the years to come; the practice of remembering me i.e. remembering your true self (called jikra, jaap, jap, sumiran, simaran, NAMASMARAN) would spread in all the continents, nations, provinces, cities, villages, homes, institutions, industries, hospitals, farms and every nook and corner.
Further; this practice would not be aimed at petty gains! It would be selfless and blossom into holistic perspective, policies, plans and programs and their implementation! The spiritualism and materialism, theism and atheism would be culminated in holistic renaissance, superliving or individual and universal blossoming! The profundity and prosperity would go hand in hand!
Individualism and socialism would be culminated in; Self realization and SAMSHTI YOGA; respectively!
The people were thrilled to hear all this!
However; one of them, who was very curious to know; how this could happen; asked; “But how would all this happen?”
God said; “Just as 75 trillion cells unite and live in unity, complementarity and harmony; where; every cell participates in its own well being and also homeostasis i.e. well being of the individual; every individual; from every nook and corner of the world; would participate simultaneously and inseparably; in his own well being as well as that of the universe!

SLEEP DISORDERED BREATHING(SDB)


Introduction:

The detrimental effects of sleep disturbance produced by abnormal breathing patterns have been extensively studies in recent times and are called as Sleep disordered breathing(SDB)
SDB constitutes a number of the major part of sleep disorders seen by sleep physicians’ world over.
With growth of Obesity, Hypertension, Diabetes,& use of Medicines, Otolaryngologists & Sleep clinicians are witnessing a large increase in such patients.

IMPACT

SDB and along with its effects is a very significant problem in the society as it can lead to
• Road traffic accidents
• Lower productivity at school and work
• Morbidity-Impaired immune function, HTN, insulin resistance, stroke, pulm HTN, poor asthma control, ventricular arrhythmias and sudden death
• Neuro-cognitive and mood dysfunction
• Impaired quality of life
• Impaired performance in surgical skills, anesthesia administration, intubations and ECG interpretation


EPIDEMIOLOGY
Recent data suggests approximately 5% of population suffer from SDB
12-15 million adult American have SDB. In Indian scenario polyssomnography proven cases of SDB is around 3.57% (Sharma et al)

SEX:
Males> Females
• Severe OSA male to female is 8:1, moderate OSA 3:1
• Sex difference reduces after menopause
The reasons for sex predilection are not clear, possibly due to
• Body fat distribution
• Craniofacial differences
• Female hormone
RISKFACTORS & ASSOCIATED MEDICAL CONDITIONS

• Obesity:

Cardiovascular disease
Increased risk of HTN

Cerebrovascular disease : This has an unclear but growing evidence
Studies reveal that the odds ratio of having a CV stroke are high but this was not significant not after adjusting for age and BMI


Metabolic syndrome :This is a term used for features related to
• Waist circumference
• Triglycerides
• Glucose level
• BP
• Insulin resistance



DEFINATIONS

Snoring: Loud upper airway breathing sounds in sleep without episodes of apnea or hypoventilation
Apnoea :Cessation of airflow at nostrils and mouth for at least 10 seconds regardless of oxygen saturation
Sleep Apnea syndrome
30 or more apnoeic episodes during 7 hrs sleep
Apnea index =/>5
Obstructive sleep apnea
Cessation of airflow in presence of continued respiratory effort
Breath holding spells
Central sleep apnea: Cessation of airflow with cessation of all respiratory effort
Mixed Apnea : Begins as a central type of apnea followed by increasingly forceful respiratory efforts till airflow clears
UARS : Increased inspiratory effort with frequent arousals but no apnea or hypopnea



PATHOPHYSIOLOGY OF SLEEP DISORDERED BREATHING :
The primary cause of SDB is collapse of the upper airway during sleep. The mechanism for this is multi-factorial, which is mainly due to interdependence of anatomical vulnerability with physiologic mechanism of ventilation.


Local Factors:
The size of lumen depends on the dilating and collapsing forces
The dilating forces include
• Dilating muscle activity
• Mechanical force on airway wall
• Intraluminal airway pressure
• Large upper airway

The collapsing forces include
• Mass lesion in nasopharynx
• Negative intraluminal pressure
• Tissue mass
• Surface adhesive forces
• Increased extra luminal pressure

Craniofacial characteristics

Increased distance of hyoid from mandibular plane
Retrognathia
Increased cervical angulations

Neck and jaw posture

Neck flexion close airway, extension opens it
Opening Jaw slightly increase size of airway
Progressive opening-- pharyngeal narrowing
Large tongue
Myxedema
Acromegaly

Oropharynx:
Tonsillar enlargement
Macroglossia
Retrognathia
Hunters/Hurlers
High arched palate
Nasopharynx
Adenoid hypertrophy

Hypopharynx
Mass/growth


Nose:

Nasal obstruction also has a role in causing severity of OSA by :
• Reduced nasal airflow affect muscle tone of upper airway
• Increase mouth opening
o Destabilize pharyngeal airway
 Reduced humidification
Causes:

Nasal polyps
DNS
Rhinitis
Choanal atresia



CLINICAL FEATURES

The patients of OSA has certain characteristic night and day time complaints
Night Time:
• Snoring
• Witnessed breath holds,Choking
• Fragmented sleep
• Restlessness
• Dry mouth mainly due to mouth breathing
• Nocturia due to Increased abd pressure, Atrial natriuretic peptide
• Esophageal reflux due to heartburn
Day time symptoms constitutes of
o Sleepiness
 Afternoon
 Meeting
 Driving
o Headache
o Fatigue, reduced alertness
o Personality changes
 Irritability
 Anxiety
 Depression








APPROACH TO PATIENT WITH SLEEP DISORDERED BREATHIN

History

Detailed history
Underestimate symptoms…leading questions help
RTA/Drifting across lanes/honked by drivers
Assocoated HTN/ DM asked and looked for.

Physical Findings

o Obesity and
 BMI calculation
• >28 kg/sq mt
o Neck circumference
 Superior border of cricothyroid membrane, upright position
Cut off level of 40-43 cms highly specific in OSA




Detailed nasal/ oropharyngeal assessment

o Macroglossia
o Uvula, soft palate – low lying/size/edema/erythema
o Retrognathia
o Tonsillar hypertrophy
o Nose –Contributory factor



INVESTIGATION


o Establish diagnosis…
o PSG, oximetry, multichannel home testing
o Estimate level of obstruction:..
o Pharyngoscopy, Radiology, manometry
o Investigate for Causes / Predisposing factors/Sequelae….
o Hematological Ix for Hypothyroidism, HTN, Diabetes mellitus


To establish Diagnosis

Overnight Polysomnography(PSG)…Gold Standard
Overnight Oximetry
Home multi channel testing

PSG(POLYSOMNOGRAPHY)

Considered gold standard in diagnosis of OSA
Can differentiate central from peripheral apnea
Not ideal but best available
– Breathing disturbance may vary from night to night
– Does not suggest the site of obstruction

o Simultaneous Recording of multiple sleep related events
o Neurophysiolgical
o Cardiopulmonary
o Other physiological parameter over course of several hours

o Parameters specified by AASM
o EEG( frontal, central, occiptal)
o B/L EOG,
o Chin EMG,Leg EMG
o Airflow,Respiratory effort( chest and abdominal)
o SpO2, ECG
o Body position, & Video monitoring
OVERNIGHT OXYMETRY
o It is a gadget sited at the end of digit with a wrist watch like device which measures oxygen saturation and pulse rates

o Standard practice:
o 4% drop in O2 saturation( resting >90%)
o ODI: Oxygen desaturation index
 Number of times O2 saturation falls >4% per hr
 >15 suggests OSA
o Advantage:
o Easily available and cost effecient
o Good specifcity
o Good +Predeictve value
o Very useful if positive

o Disadvantage
o Poor sensitivity
o Poor – pred.value
o Miss subjects OSA who don’t de-saturate

o NOTE:
o If OD!<15, but other cofactors present refer for multi-channel assessment


HOME MULTI-CHANNEL TESTING: (Multi channel: nasal/oral airflow, chest & abdominal movements, Pulse oximeter)


o Disadvantages
– Sensor failure
– Fewer channels
– Underestimate severity as EEG not available

o Advantages
– Better patient comfort
– Cost savings
– No hospital admission
– Speed of analysis


INVESTIGTION TO DETERMINE SITE OF OBSTRUCTION

MULLERS MANUVEUR
Patient performs reverse valsalva
– effort generates negative pressure in upper airway
– Nasopharyngeal sphincter is visualized with endoscope
– Compliant tissue will collapse
– Degree of collapse scored
– Used as criteria for patient selection for Surgery
Not a reliable test as
– Done in awake patient
– And surgery based on this test is unsuccessful

Soft palate Lower pharynx
3 or 4 No ideal
3 or 4 1 or 2 Sub optimal
<3 >2 Not suitable

1=minimal collapse
2=reduced area by 50%
3=reduced area by 75%
4=complete obliteration






Radiological Investigations

Lateral cephalometry
– Very accurately taken lateral head and neck Xray
– Relationship between various soft tissue and bony points measured

No study has shown significant change in normal and OSA
Not sole diagnostic procedure


CT SCAN

– Greater anatomic details
– Awake state so low predictive value for diagnosis of OSA
– 3-D scans
&#61607; Easier way to assess the caliber of upper airway
&#61607; Statistical correlation with severity of OSA lacking


MRI

– Good anatomic definition of soft tissue
– Multiplanar images
– No radiation exposure
– Dynamic images can also be obtained
– Disadvantage
&#61607; Awake patient
&#61607; Scanner noise
&#61607; Limited studies available


Manometry

Use of catheters in upper airway to measure pressure at various sites
Important for patients suspected of UARS
– No frank apnea, but snoring and arousals in sleep
Advantage:
– Sleep manometry documents obstruction site
Disadvantage
– Precise placement o probe
– Poorly tolerated


DIAGNOSTIC CRITERIA

AHI: Number of apnea and hypopnoea averaged per hour of sleep
RDI: (respiratory disturbance index)
Number of apnea hypopnea and respiratory effort related arousal, diagnosed by EEG

AHI<5: no evidence of OSA
AHI:5-15: mild OSA
AHI:15-30: moderate OSA
AHI:>30: severe OSA
No account of desaturation index nor the length of apnea and hypopnea


TREATMENT

Depends on number of factors
– Severity of disorder
– What does patient want
– Presence of any complication
– Level of obstruction
Treatment options
– Non surgical
– Surgical


NON-SURGICAL


Address co-existent, predisposing conditions
– Obesity
– Tobacco
– Sleep deprivation
– Avoiding agents affecting sleep
– Treat hypothyroidism
– Modification of body position during sleep

Mechanical devices( positive airway pressure)

Pharmacological therapy


MANAGE OBESITY

– Documented reduction in symptom after weight reduction
– Degree of improvement no linear corelation with weight
– Few may not benefit if co-existent craniofacial abnormalities

Life style modification
Dietary modification
Pharmacological
Surgical options

BODY-POSTURE MODIFICATION

– Sleeping with head and trunk elevated to 30-60 degree angle to horizontal reduces OSA
– Lateral decubitus is also effective in reducing episodes (sleep ball)

Pharmacological Therapy

Protriptyline
– Effects not proven


Agents with uncertain limited role
– Serotonin agonists
• Affects the pharyngeal dilators

Busiprone used
Data insufficient
Stimulants
Amphetamines are also used but known to have CVS complication. Insufficient data



CPAP(continous positive airway pressure)

When to use?
– mild OSA with EDS/ Co-morbidities, moderate to severe OSA
Many consider it to be mainstay of OSA treatment

Mechanism:
– Acts as pneumatic splint

Equipment:
– machine provides fixed pressure or vary pressure depending on the presence of apnoeas (Auto CPAP)
– mask is nasal or full face, kept in place by Velcro straps
– port of exhalation
– newer machine small and light so portable
– humidifier also available as an optional mode

SIDE EFFECTS

&#61607; Claustrophobia
&#61607; Nasal stuffiness
&#61607; Skin abrasions, nasal bridge abrasions
&#61607; Leaks are uncomfortable or eyes
&#61607; Air swallowing if pressure more than esophageal sphincter pressure
&#61607; Pulmonary baro trauma ( very rare)
&#61607; Treatment Failure


COMPLIANCE WITH CPAP

By 3 years 25-40% stop using CPAP mainly due to one of possible reasons:
Treatment failure
Cost factor
– Regular service and maintenance
– Change of mask
Side effects




SURGICAL TREATMENT


&#61558; Uuvuloplatopharyngoplasty(UPPP)
&#61558; Laser assisted UP(LAUP)
&#61558; Radiofrequency tissue volume reduction(RFTVR)
&#61558; Genioglossus advancement
&#61558; Other surgeries


UVULOPALATOPLASTY

First described by Ikematsu(1950), Fugita popularized in 1985
The Surgical principle:
– Stiffen the soft palate by scarring
– Increase space behind soft palate
Complications:
– Severe post op pain
– Hemorrhage
– Laryngospasm
– Polmonary edema, hypoxia
– Nasal regurgitation
– Swallowing & voice problems
– Not satisfied post surgery

&#61656; FACTS:
– 75-95% short term success
– Long term –45%
– Modification: Preserve uvula


LAUP(LASER ASSISTED UVULOPLASTY)

Described by Kamami in France in 1993
Principle
– Stiffen the soft palate
– Prevent palatal flutter
Surgery
– Local anesthesia on soft palate
– B/L vertical incision in soft palate followed by partial vaporization of uvula with CO2 Laser
– Various modification done
Complications
– Low
– Globus like symptom common
– Post operative pain
RFTVR(RADIO-FREQUENCY TISSUE VOLUME REDUCTION THERAPY


Principle
– Similar to diathermy
– Lower temperature, lower current and voltage
– Thermal injury to specific submucosal sites in soft palate causing fibrosis and contraction

Advantage
– Day care, LA
– Less post operative pain
– Significant improvement reported
– Good for multi level obstruction
– Low relapse rate

OTHER OCCASIONAL SURGICAL PROCEDURE

Palatal: Z-pharyngoplasty, palatal implants
Tongue base
– RFTVR
– Laser midline glossectomy
– Tongue suspension suture
– Hypoglossal nerve stimulation
Epiglottis
– epiglottectomy
Temporary tracheostomy
Hyoid myotomy and suspension
Maxillomandibular osteotomy and advancement


ORAL APPLIANCES
Two basic types of appliances used

Mandibular advancement devices– popular
– Positioning the lower jaw and tongue downward and forward.
– The airway passage is increased
• Comfortable
• More effective,
Tongue repositioners.
– pulling only the tongue forward and not the entire lower jaw.
– teeth, jaw muscles and joints are less affected.
• Less studied
A period of consistent nightly wear is required
Patient motivation and cooperation essential


For treatment and guidance
Dr (major) Prasun Mishra
Pune
09881676449