Clinical Review

Areview ofsurgical treatment J.P. McDonald

Bute Medical School, University of St
Andrews, Fife, u.K.

for obstructive sleep apnoea! Correspondence to: J.P. McDonald,

Orthodontic Department, Victoria Hospital,
Hayfield Road, Kirkcaldy, Fife, u.K.
Email: jimbomcd@btinternet.com

hypopnoea syndrome
Surgical intervention and treatment of OSAHS and snoring has aconsiderable history, encompassing
a number of operations all of which have the intention of reducing or by-passing the pharyngeal
resistance that occurs during sleep. Review of the published literature presents some problems,
however, due to the ethical difficulties of undertaking randomised controlled trials in surgery.
Uncontrolled trials are less satisfactory due to the large 'regression to the mean' and placebo effects.
However, there is a considerable body of literature available relating to surgical intervention
Keywords: Ob~·tructive sleep apnoea/hypopnoea syndrome, uvulopalatopharyngoplasty
Surg J R Coli Surg Edinb Irel., I October 1003, 159-164

INTRODUCTION
Obstructive Sleep Apnoea/Hypopnoea
Syndrome (OSAHS) is a clinical condition
that occurs as a result of the repeated,
intermittent collapse of the upper airway
during sleep. This collapse can be complete
(apnoea) or partial (hypopnoea). with
apnoea being defined as a minimum of a 10
seconds pause in respiration, hypopnoea as
a minimum 10 second interval where there
is reduction of at least 50% in the baseline
ventilation, even though breathing continues.
During sleep, the muscle tone in the upper
pharyngeal airway decreases leading in turn
to some narrowing of the airway lumen.
There is a need to increase respiratory effort
in an attempt to overcome this narrowing,
which in turn leads to a transient arousal
from deep sleep to a lighter sleep phase,
allowing the normal airway muscular tone
to be re-established. This cycle can repeat
many times over the hours of sleep and leads
to a reduction in sleep quality, hence, the
symptoms of excessive daytime sleepiness
and poor concentration. The prevalence of
OSAHS in middle aged men (30-65 years) is
in the region of 1-2% and with middle aged
women it is about half that prevalence. I..'
TABLE 1. FEATURES OF OBSTRUCTIVE
SLEEP APNOEAlHYPOPNOEA SYNDROME
Snoring
Excessive daytime sleepiness
(p.m.)
Impaired concentration
Restless, unrefreshing sleep
Witnessed apnoea
Personality change - irritability
Nocturia
Decreased libido
SURGICAL TREATMENT
Tracheostomy
Once it was realised that obstruction,
predominately pharyngeal, was the main
problem, the concept of bypassing the
obstruction site by performing a tracheostomy
was attractive. This was the first successful

© 2003 Surg J R Coif Surg Edmb Irell. 5. 259-264 The Royal Colleges of Surgeons of Edinburgh and Ireland • •*1);\#0-• •
 procedure for OSAHS and was reported INTRANASAL PROCEDURES
by Gastaut et al.( 1966), and by Kuhlo et Any increase in nasal airway resistance
REFERENCES al. in 1969. 3.4 Kim et al. (1998) undertook may lead to the collapse of the pharynx
1. lradling JR. Crosby JH Predictors and a retrospective study of all patients who on inspiration, as the chest muscles
prel'alcnce of obstruclive ' leep apnoea and had received a tracheostomy and who attempt to draw air into the lungs. This
snoring 111 1001 middle aged men. Thorax had been subjected to polysomnography increase in nasal airway resistance
199 I; 46: 5-90. may be as a result of septal deviation,
since 1981 at the Johns Hopkins Sleep
2. Young T. Palla M. Dempsey J. kmrud J.
Disorder Centre. 5 They concluded turbinate hypertrophy, polyps or
Weber . Bahr . The oeeurrence of slccp-
that tracheostomy effectively treated chronic nasal congestion. There is a
disordered brealhing among middlc-aged
patients with 'uncomplicated' OSAHS, considerable variety of opinion in the
adults, EllgJ lIed 1993; 328: 1230-5.
but was considerably less effective in literature as to the efficacy of relieving
3. Galaut II. Ta Imari A. Duran B.
the treatment of patients with overlying nasal obstruction in OSAHS, with
Polygraphic study of the episodic diurnal
cardiopulmonary decompensation. Olsen and Kern (1990) concluding
and nocturnal (hypnic and respiratory)
Conway et al. (1981), published that relief of nasal obstruction does
manifeslations of the Pickwick yndrome.
BmillRes 1966; 1:167-86.
an article on the adverse effects of not resolve OSAHS whilst EI Sherif
4. Kuhlow. Doll E. Frank MD: Enfolgreiche
tracheostomy in which they highlighted and Hussein (1998) reported that 50%
behandlung eines Pickwick syndroll1 the fact that a number of patients of 96 patients in their study obtained
durch eine daucstraeheal kanule. Dm"" who had undergone tracheostomy total relief, with a further 40% gaining
Med lIochenschr 1969; 94:1286-1290. experienced tracheal granular some improvement. 8.9 Kuma and Sant'
5. Kim H. Eisele D. mith PL. hncider malformation or stomal stenosis, Ambragio (1991) recommended that
II. ehw",'!" A. An elalualion of patients necessitating revision procedures. 6 intranasal procedures were useful in
with slccp apnoea aflcr tra heoslomy. Arch This, coupled with the considerable facilitating other non-surgical treatment
O/olurYllgol Heud VecA SlIrg. 199 ; 124: social disadvantage of the operation, regimens like nasal-continuous positive
996-1000. means that tracheostomy for OSAHS airway pressure (nCPAP).1O This view
6. Conway WA. Viclor LD. 1agilligan OJ. is generally only used as a last resort, is supported by Freidmann et al. (2000)
Fujilas. Zorick FJ. Doth T.Adverse efTects never as a treatment of first choice. 7 who, in a study of 50 consecutive
of trachcostomy for sleep apnoea. ,111,1 Figure 1: Maxilla mandibular advancement patients with nasal airway obstruction
19 I: 246: 347-50.
7. Meycr JB. Knudson R The slecp apnoea
syndrome Pan II: Tremmcnt 1990; The
JOIll7lul of Pros Oem. 63: 320-324.
8. Olsen KD. Kern EB. asal influences on
snoring and obstructivc slccp apnoea. 11«\'0
Clill Proc 1990; 65; 1095-1105.
9. EI hcrif I. Hussell1 Thc efTcct of nasal
surgcry on snoring. mer J Rhinol 1998;
12: 77-79. 10.Kurna T. anl'Ambroglo
G.Pmhophysiology of uppr airway closure
during slccp. JOllrnul Ame" ,\fed A.Hoc.
1991; 266: 1384- 9.
II. Freidmann l. Tanyeri H. L,m JW.
Landsberg R. Vaidyan31han K. Caldarelli
D. EfTect of improvcd nasal breathll1g on
obstrueti\ e sleep apnoea. Otolurmgol
fleud (llld VecA IIrg 2002; 122:71-4.
12. Riley R. Powell B. MaxillofaCIal surgery
and Obslruetive leep pnoea yndrome.
O/ol(l11'IIl!.ol Clink',1 of .America 1990;
23:809-826.
13. Lowe A.A. 1I0w does the airway lend itself
to Iherapy'! Can we prediel Ihe sueces'
of dental appliances for the trealrnent of
bstru IIVC slccp apnoea based on analomic
consIderations') Sleep 1993; 16:93-95.

__4."__ The Royal Colleges of Surgeons of Edinburgh and Ireland © 2003 Surg J R Coli Surg Edinb Iref 1 5; 259-264
and OSAHS, reported that although
there was some improvement in nasal
airway resistance, nasal surgery did
not consistently improve the situation
but may have contributed to a decrease
in the required nCPAP pressure level
and hence an improvement in oxygen
saturation. I I
It would appear, therefore, from a
review of the literature that intranasal
surgical intervention is unpredictable in
its effect on OSAHS.
MAXILLARY/MANDIBULAR
ADVANCEMENT SURGERY
In those cases with a cephalometrically
measured retrognathic mandible
it is possible to use a mandibular
repositioning appliance as a diagnostic
aid, in order to establish the efficacy of
moving the mandible forward before
undertaking actual surgery. Riley
and Powell (1990) found that 65°;\1
of patients under their care improved
with mandibular forward osteostomy
surgery." Lowe (1993) agreed that
the procedure was beneficial but
only where the obstruction was in the
hypopharynx. 13 Yu (1994), however.
found mandibular advancement to be
an unpredictable procedure. 14 Waite
(1998) and Krekmanov et al. (1998)
suggested that maxillary/mandibular
advancement (MMA) using Le Fort
I and surgical splint mandibular
osteotomies, permitted greater forward
movement of the mandible whilst
preserving the occlusion (Figure I). I' 1(;
Genioplasty or geniotubercular
advancement may augment the
pharyngeal space further when
combined with maxillary/mandibular
advancement. Conradt et al. (1998)
in a controlled trial, compared nCPAP
with MMA and concluded that the
latter was successful in reducing
OSAHS severity in a high percentage
of patients selected by cephalometric
and polysomnographic investigation. I'
The success was stable over a two-
year period. In cases wherc unequal
jaw surgery advancement is necessary.
orthodontics is essential to prepare the
occlusion prior to surgery, to ensure
that profile changes are minimised
© 2003 Surg J R Coli Surg Edinb Ireli." 5 259-264
and that the post surgical occlusion is
acceptable. IX
Disadvantages of the technique are
significant, however, including both
intra and post-operative risks. The
intra-operative effects may be airway
obstruction, haemorrhage and infection;
the post-operative effects include
temporomandibular joint dysfunction
and temporary or permanent anaesthesia
due to damage to the inferior alveolar
or lingual nerves.
On the evidence available, therefore,
MMA remains largely untested.
TONGUE REDUCTION
Djuperland et al. (1992) and Midjejeig
( 1992) described an operation
termed uvulopalatopharyngoglossop
lasty (UPPGP) which incorporated a
modi fied uvu lopalatopharyngoplasty
(UPPP) with limited resection of the
tongue base.!')'" Fugita et al. (1990,
1991) and Woodson et al. (1992)
undertook midline glossectomy and
lingualplasty to create an enlarged
retrolingual airway.'I"
Chabolle et al. (1999) combined
tongue base reduction with
hyoepiglossoplasty in a small study of
°
I patients and reported considerable
improvement. '4
The intra-operative campi ications,
however. that may occur in such
procedures are those of any surgical
intervention in the oral and pharyngeal
cavity. namely that of haemorrhage,
airway obstruction and anaesthetic
risk.
BARIATRIC SURGERY
Weight loss is an effective treatment
for OSAHS, so it would follow
that bariatric surgery would be
efficacious.'5'7 Mayer et al. (1996)
noted the relationship between 8MI,
age and upper airway measurements
in snorers and sleep apnoea patients."
Charuzi et al. ( 1992) reported on a case
series of 47 morbidly obese subjects
followed-up after one year and again
after seven years following surgery.2'!
They reported a significant decrease
in the number of apnoeic episodes per
hour of sleep. due primarily to the
The Royal Colleges of Surgeons of Edinburgh and Ireland • •wlal• •
14. Yu LF. Pogrel MA, Ajayi M. Pharyngeal
airway changes associated with mandibular
ad\·ancemenl. JOII,."al 0/ Oral a"d
Matil/o/lldal IIrger)' 1994; 52:40-43.
15. Waite PD. Obstruclive sleep apnoca: a
review of the pathophy lology and surgical
managemcnt. JOIII"I/ai 0/ Oral Surgel),
1998; 85:352-361.
16. Krekmano\ L, Andersson L. RIOgquist
1, et al Anterior-interior mandibular
osteotomy 10 treatment of ob tructive
sleep apnoea syndromc. 1111 J Adllit OT/hod
OT/hog"a/hie IIrg. 199 ; 13:289-29 .
17. Conradt R. lIochban ~ , Brandenburg V,
Heitmann J, Peter JH. leep fragmentation
and daylime \"igilance in patlcnts wilh 0 A
lreated by surgical maxillomandibular
advaneemenl compared 10 CPAP Iherapy.
J leep Re. 199 ; 7:217-223.
18. Battagel JM ObstructIVe leep Apnoea:
Facts not Fiction. BJO 1996; 23: 324-345.
19. DJuperiand G. chrader H. Lybel) T.
Ref,um H. Lile s F. Godtlikscn OB. Pala
lopharyngoglosoplasty 11\ the trealmcnl of
patienls wilh obstructive sleep apnoea. Acta
OwllllJga/l992; 492:50-54.
20. Miljeleig II. Trinnereim M. \"ulopalato
pharyngoglossoplasty in the treatment of
obslructi\ e sleep apnoea syndrome. Aeta
Otolarygol 1992; 492:86- 9.
21. Fujlla . IIrgieal Trea/me,,/ o/Oh.,l/7lc/i,'e
luI' Ap"oea: UPPP a"d li"lIopllll/r (las,"
midli"e glo.Heuomy). I" ohSlnlc/II'e leep
Apnoea Syndrome: clinical researr.:h and
/rell/me'" (Guillcminaull and Pentmez)
1990; 129-151: Raven Prcs. 'elV York.
22. Fujita S. Midline laser glosscctomy \\ ith
Iinguoplasty: a treatmcnt of Jeep Apnoea
yndrome. 01' 0101"/)1:01 1991; 2: 127-
131.
23. Woodson BT. Fujila : Clinical experience
\\lth linguoplasty as part of the trealment
of scvcre sleep apnoea. O/olll"gol /lead
e k urge/)' 1992; 107;40-4 .
24_ Chabolle F, Wagner I, Blumen M. cquert
. Flcury B, Dc Dieule\ cull T. Tongue
base reducti n with hyoepiglo,soplasty.
A treatment for sc\erc obstnlelive sleep
apnoea. The LlIIJ·l1l1l1.\COpe 1999; 109:
1273-12 O.
25. Harman fF, Wynne JW. Block AJ. The
efTeel of \Velght 10 s on sleep disordered
breathing and oxygen deSaluralion in
morbIdly obese men: Ches/ 1982: 82: 291-
294.
 weight loss. It was noted that those posture. 35 ,36 Surgical intervention,
26. milh PL. Gold AR. \<leyen; DA, Haponok
individuals who subsequently gained therefore, to tense the suprahyoid
EF. B Bleeker ER. Weight loss in mildly
weight began to increase the frequency muscles (hyoid suspension) using
to modcrate obese patients with obstmctlve
of apnoeic episodes. fascia lata harvested from the thigh,
leep apnoea. AmI IlIIern Med 19 5; 103:
Sugarman et a1. (1992) reported was suggested as an efficacious way
850-855.
on 126 patients treated by bariatric forward. A randomised study of
27. urall PM. Turner BL. Wllhoil EITect
surgery over a 1O-year-period. 30 Of the this procedure, however, was halted
of inlranasal breathing during slcep. Chest
19 6; 90: 324-329.
40 patients with pre- and post-weight for, despite apparent symptomatic
2 . Mayer P, Pcpin JL. Bellaga G. Relationship
reduction sleep polysomnograms, the improvement, there was significant
bel\v~en B.M.I.. agc and upper airway
sleep apnoea index fell from 64+- 39 to worsening of sleep study indices. 37
measurements in snorers and leep apnoea 26 +·26 (P<O.OOOI), and was associated
patienlS. £lIrRe"pirJ 1996: 9: 180-189. with significant improvements in other UVULOPALATO
29. Charuzi I, Lavie P. Peiser J. Peled R. measurable sleep indices. PHARYNGOPLASTY
Bariatnc surgery in morbidly obese leep Dhabuwala et al. (2000) noted an The most widely used surgical
apnoea patients: shon and long tenn follow- improvement in co-morbidity factors treatment for OSAHS, and indeed
up. Am J Clill 'Illllr 1992; 55:594-596. following weight loss from gastric snoring, is uvulopalato-pharyngoplasty
30. Sugennan HJ. Fainnan RP. Baron PL. bypass surgery.31 (UPPP), originally undertaken by
Kivcntus JA. Long tcnn eITects of gastric There is, however, as yet no surgical excision, more commonly
surgery for trealing respiratory insufficiency controlled trial available on the efficacy now utilising a laser (LAUP),3~ The
of obesity. Am J Clill NII/r 1992: 55:597- of bariatric surgery in inducing weight original procedure was proposed by
601. loss and improvement in clinical lkematsu (1964), who reported on 152
31. Dhabuwala A. Cannon RJ. tubb R. outcomes. patients with 82% relief from snoring. 39
Improvement in co-morbidities following
The technique was then introduced
weight loss fr m gastric bypass urgery.
SUPRAHYOID TENSING into the USA by Fujita et a1. (1981)
Obes IIrg 2000; 10:42 -435.
It has long been suggested that the as an alternative to tracheostomy.4o
32. Dc Berry - Borow ieeki B. Kukwa
position of the hyoid bone vertically, The uvula, tonsils and some of the
AA. Blanks RHI. Indications for
in relation to standardised points, has soft palate, is excised, reorientating
palatopharyngoplasty'. An·1t OtolclrYlIgol
a relationship with the severity of the tonsillar pillars so as to enlarge the
19 5; 111:6-9-663.
OSAHS.32.34 Certainly, in longitudinal oropharyngeal space, hence, decreasing
33. Djuperland G. Lyberg T. Krogstad O.
studies it has been shown that changes the propensity of the pharynx to
Cephalometric analysis and urgieal
treatmcnt ofpaticnlS wilh obstructive sleep
in the hyoid position are co-ordinated collapse. (Figure 2)
apnoea. Acta Olo-LOI)'lIgologiC<l 19 7;
both with changes in the mandibular Fijita et a1. (1981) suggested that the
103:551-557. position and in head and cervical anatomical indications for UPPP were a
34. Tsuehiya M. LoweAA. Pae EK. Obstructive
sleep apnoea sublYpes by clustcr analysis.
Alii J Orlhod. Delllofuc Orthop 1992; 101:
533-542.
35. Tallgren A. olow B. Long tenn changes
in hyoid bone position and craniofacial
poslure in complctc dcnture wearcn;.
Jormral of Res/orati"e Delllis/I)' 1981; 60:
473.
36. Tallgren A, Solow B. Hyoid bone position,
2
facial morphology and head posture in
adullS. £lIrJ. OrrhodollllCS 1987: 9: 1-8.
37. Riley R. Powell • Guillcminauh
C Maxillary. mandibular and hyoid
advan cmcnt for treatmcnt of obstructive
. leep apnoea: A review of 40 patients. J.
Oral Maxillofadal Swg 1990; 48: 20-26.

3 4

Figure 2: Uvulopalatopharyngoplasty

.141"•• The Royal Colleges of Surgeons of Edinburgh and Ireland © 2003 Surg J R Coli Surg Edinb /re/l: 5; 259·264
long uvula, redundant pharyngeal wall dental appliances were more successful
tissue and/or excess tonsillar tissue. than the surgical measures.
3 . Kamam, Y . Outpatient lrealmenl of
A review of the literature relating to A recent meta-analysis review of
noring with 02 laser: Laser assi ted
UPPP reveals, perhaps not surprisingly LAUP suggested that the procedure
UPPP.OIolaryngol 1994; 23: 391-394.
given the surgical nature of the should not be used for the treatment of
39. Ikematsul T. rudy of noring 4 repon.
procedure, no randomly controlled patients with any significant OSAHS. 47
Therapy: J Jpn 0101 Rhlnol Larygol 1964:
trials. There have, however, been Battagel (1996) supported minimalist 64: 434-435.
two systematic reviews, both of which LAUP for those patients who snore 40. FUJita ,Conway W. Zonck F, Roth
concluded that there was, at best, an loudly with no symptoms of OSAHS.18 T. urgical correction of anatomical
uncontrolled case series showing a 50% It is important to differentiate, abnonnalili In obstruclive leep apnoea
improvement in 50% of the patients, when using UPPP or related surgical yndromcs. UVpp· Ololaryngol Head and
with the results being somewhat operations, between those patients '1eck urgery 19 I: 89: 923-934
unpredictable. 41 .42 Other case series who are 'simple snorers' and those 41. her E, hechtman KB, Piccirillo JF.The
studies have shown that where who exhibit clinical OSAHS. The cfficacy of . urgical modification of Ihe
indicated, tonsillectomy in its own operation is widely used on the former upper airway in adults with obslruclive
right may improve OSAHS; however, group and it is suggested that a sleep sleep apnoea yndrome. leep 1996; 19:
again no randomised controlled data study assessment to exclude OSAHS 156-157.
exists. 4344 is undertaken, given that there is 42. Bridgeman A, Dunn KM. Surgery for

Other studies have attempted to considerable evidence that UPPP ObSlnlClil'e sleep apnoea (Cochrane

control the 'regression to the mean' or has an adverse effect on the patient's RI'\·il'\l). In TIre Cochrane Library. I ue

placebo effects. Lojander et al. (1996), subsequent ability to use nCPAP, should 4.2000 Oxford: pdate Software
43. Verse T, Kroker BA, Pirsig W, Brosch .
compared patients randomly assigned to they subsequently develop OSAHS 48 49
TonJllectomy as a treatmenl of obstruclive
UPPP or to conservative management The side etfects of UPPP, both
sleep apnoea in adults with ton mar
in order to remove the regression to the immediate and in the long-term, are
mean effect 45 No significant difference
hypenrophy. Laryngoscope 2000: II 0;
considerable and should be made
1556-1559.
was shown in the measures of OSAHS clear to the patient prior to surgery. An
44. Boot H, van Wegen It. Poublon RM.
severity, only an improvement in estimation of morbidity and mortality
Bogaard JM, hmllz PL. v.n der
symptomatic assessment. Wilhelmsson has been undertaken by Haavisto et Meche FG. Long tenn re ·ults of
et al. (1999) undertook a prospective al. (1994), and Sajkov et al. (1998), uvulopalatopharygoplasty for ob trucuve
randomised trial whereby mandibular amongst others.,o.51 Immediately post- sleep apnoea yndrome. Laryngoscope
repositioning dental appliances were operatively, acute morbidity and even 2000; 110: 469-475.
compared with UPPP in patients with death has occurred due to iatrogenic 45. Logander J. Maa ilia p. Paninen M. Brander
symptomatic OSAHS.4~ Overall. the worsenll1g of the upper airway PE, almi T. Lehtonen H. asal PAP,
urgcry and con ervative management
for trcatment of obstructive sleep apmoea
TABLE 2. KEY FEATURES IN THE TREATMENT OF OSAHS ·yndrome. A randomlsed ludy: Chesl
1996: 110: 114-119.
All patients with suspected sleep apnoea/hypopnea syndrome and their partners 46. Wilhelms n B. Tegelberg A. Walker-
should complete an Epworth questionnaire to assess the degree of pre-treatment Engstrom IL. A prospeclive randomised
sleepiness,56If OSAHS is suspected, then polysomnography should be undertaken study of a denIal appliance compared
to confirm the diagnosis with uvulopalatopharyngopla ty in the
trealment of obtruclivc ·Ieep apnoea. Acta
Weight loss without resort to bariatric surgery should be encouraged where it is Ololorygo/l999; 119: 503-509.
contributing to OSAHS 47. Ve T. Pirslg W. Meta-analy i of
laser assi ted uvulopalalopharyngopla I
CPAP therapy is the first choice therapy for moderate to severe patients; intra-oral y. What i clinically relevant up to now?
devices are an appropriate therapy for snorers and mild OSAHS sufferers Laryngorhinoolologie 2000; 79: 273-284.
4. M n,mer IL, Bradley PA, 1urray JA,
Use of UPPP or LAUP for the treatment of OSAHS, as opposed to simple snoring, Dougl." J. PPP may compromise nasal
is not recommended CPAP Iherapy In leep apnoea syndrome.
AM 1. Respir Can! Med 1996: 154: 1759-
Palatal surgery can compromise later CPAP use if the patient later develops 1762.
OSAHS

© 2003 Surg J R Coli Surg Edinb Irel 1. 5; 259·264 The Royal Colleges of Surgeons of Edinburgh and Ireland __4s:.ilill_ _
 obstruction, together with ventilatory overcome some of the regression to the
49. Janson C, oges E, vedberg-Randts,
drive depression. There is a case for the mean effects. Further careful research
Lindberg E. What charnctcri patienlS
provision of nCPAP immediately post- is necessary to establish the optimum
who are unable to tolerate PAP treatment?
operatively to counter these effects, strategy for these patients.
Resp. !.fed 200(); 94: 145-149
particularly in those patients exhibiting
50. Haavi to L. uonpaa J. Complications of
comorbidity factors. 52 Copyright: 9 September 2003
uvulopalatopharygoplasry. Chin Ololal)'gol
1994; 19: 243-247.
Longer-term side effects include
51. ~kov D. Marshall R. Walker P. leep
changes in voice pattern, and a
apnoea related hypoxia I associated WIth
worsening of gastro-oesophageal reflex
cognitive di turbances in patienlS with
disease. 53 ,54
tetaplegia. Spinal Cord 199 : 36: 231-239. It is suggested by Loadsman
52. Ulnick KM, Debo RF. Po toperative et al. (200 I), that even mild to
treatmenl of the patient with obstructive moderate OSAHS patients undergoing
sleep apnoea. Ololaryngol Head Neck any surgical procedure involving
Surgery 200(); 122: 233-236. anaesthesia should be monitored with
53. Brosch ,Manhe • Pirsig W, Verse oximetry post-operatively. 55
T. U\'Ulopalalopharygoplasty changes
fundamental frequency of the voice - a CONCLUSION Royal College of
prospective study. J LorJugol 0101 200(); Any review of surgical procedures,
114: 113-11 . including all of those undertaken Surgeons in Ireland
54. Konennan et al 'feiner Medi:ini'sche for OSAHS, is handicapped by
II'ohefl,Schrift 2001; Vol 161 (5-6): 142-
the difficulty of exposing them to
146.
randomised controlled trials, given
55. Loadsman JA. Hillman DR. naesthesia
the ethical considerations that must
and leep Apnoea. Dr J Anaeslh 2001;
inevitably occur. It is suggested that
86(2): 254-266.
in an attempt to answer the relevant
56. J hns "-1W. A new method for measuring
questions on surgical efficacy that an
daytIme lcepmes: the Epworth leepm
accurate pre-operative OSAHS severity
ale. Jeep 1991; 14: 540-5.
level be ascertained, using repeated
baseline sleep studies, in an attempt to
ReSI
THE ROYAL COLLEGE OF SURGEONS OF EDINBURGH Date for
FACULTY OF DENTAL SURCERY: DENTAL COLLOQUIUM
"Research and treatment strategies to reduce the health-care burden of craniofacial anomalies"
your diary
will be held in the
SYMPOSIUM HALL OF THE COLLEGE, HILL SQUARE, EDINBURGH Millin Meeting
Thursday 4 March 2004
PROGRAMME 6th-8th November
18.15 SUPPER
Moderator: Professor Peter Mossey, Consultant in Orthodontics, Dundee Dental School
19.00 The quest for evidence-based surgical intervention in clefts and other 2003
craniofacial anomalies, Professor WC Shaw, Manchester
19.30 Does an electronic patient record for patients with cleft lip improve patient
care? Mr JD Clark, Dundee For further information please contact:
20.00 Genetic pathology of human orofacial clefts, Dr D Fitzpatrick, Edinburgh Ms Louise Loughran
20-30 Environmental factors in the aetiology of orofacial clefts, Professor J Little. Conference & Functions Officer
Royal College of Surgeons in Ireland
Aberdeen
123 St. Stephen's Green
21.00 Discussion Dublin 2
21-30 Close
This activity is recognised for 2 CPE Points Tel: + 353 1 40 22 437
Further information may be obtained from The Secretary, The Royal College of Surgeons of Fax: + 353 1 4022458
Edinburgh, 10 Hill Square, Edinburgh EH8 9DW Email: conferences@rcsLie
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41 The Royal Colleges of Surgeons of Edinburgh and Ireland © 2003 Surg J R Coif Surg Edinb Ire/1: 5; 259-264