Photos by Ray Bryant , Bryant Studios
The nurses ' station includes three computer workstations , a built-in automatic ultrasonic instrument cleaning , ultrasonic rinsing and hot air drying unit .
The recovery room accommodates two patients and family members simultaneously , with full medical gas , vacuum and monitoring capabilities . obstructive sleep apnea for many years . “ We ’ ve known for decades that jaw deformities both result from problems with , and adversely affect , the airway . In North Texas , with rampant and chronic allergic rhinitis , we daily see the results of airway compromise during development . As the jaws grow during childhood and adolescence , allergy problems can cause developmental jaw deformities . As dentists , we know that the primary determinate of maxillary growth is the nasal septum , that its vertical limit is the dental occlusion , and that the mandibular condyle is the growth center for the mandible . Kids who can ’ t breathe through their noses breathe through their mouths . When the mouth is always open for breathing , vertical growth of the maxilla is unrestricted , creating an open bite , transverse maxillary deficiency with a high , arched palate , vertical maxillary excess with a gummy smile , a long face , and a relatively short mandible . We see this so often it ’ s actually referred to as a syndrome .
Often , allergies will lead to enlargement of the inferior turbinates , further worsening the problem . It ’ s very common for us to remove the inferior turbinates ( turbinectomy ) and correct the nasal septum ( septoplasty ) in conjunction with maxillary orthognathic surgery to improve nasal airflow after surgery . In fact , often this is the very first thing patients notice after surgery , even in the recovery room , telling us , “ Hey , I can breathe through my nose for the first time !”
Dr . Bates works closely with board-certified sleep medicine physicians in managing adults with OSA . “ Most of these patients present for treatment because their sleeping partner is concerned when the snoring progresses to apnea .” Many are unable to tolerate nasal CPAP ( continuous positive airway pressure ), usually the first line of treatment offered by physicians for OSA . But CPAP requires a bulky , noisy machine , and a mask strapped to the face — not very conducive to sleep for the patient or the partner .
It ’ s known that snoring is caused by vibration of the soft palate ( suspended from the back of the upper jaw ), and that apnea is caused by the tongue ( attached to the mandibular genial tubercles at the chin , as well as the hyoid bone ) compressing the soft palate against the back wall of the throat and obstructing the airway . Snoring is annoying , but apnea is dangerously unhealthy , causing oxygen concentration to drop and potentially leading to hypertension and heart failure .
“ We can cure sleep apnea by eliminating the obstruction ,” Dr . Bates points out . “ We can open the airway nonsurgically with oral appliances such as the TAP ( Thornton Adjustable Positioner ) device developed by our colleague Dr . Keith Thornton here in Dallas , which is very well-tolerated and indicated for many patients who aren ’ t surgical candidates for a variety of reasons .”
However , many younger healthy patients are looking for a definitive alternative that doesn ’ t require an external apparatus . These patients were in the past often managed with older ablative procedures such as the UPPP or laser-assisted uvuloplasty , which carry only about a 50 % success rate . “ After all , in obstructive sleep apnea the point of obstruction is generally the tongue , and treating the soft palate alone will not address apnea , only snoring .”
All too often , the patients seen by Dr . Bates and his staff have already unsuccessfully undergone several treatments for OSA and are seeking a once-and-for-all solution . Many of these patients are referred for telegnathic surgery , the term used for orthognathic surgery to treat sleep apnea . In this scenario , the upper and lower jaws are moved down and forward together as a unit , taking the soft palate and tongue with them , and opening the airway definitively . The success rate in eliminating apnea with MMA , or maxillomandibular advance-
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