Veidlapa Nr. M-3 (8)

Study Course Description

Diagnosis and Treatment of Obstructive Sleep Apnea, Laser Surgery, Ultrasound Surgery, Radiofrequency Surgery and Cryosurgery

Main Study Course Information

Course Code

RMS_050

Branch of Science

Clinical medicine

ECTS

11.00

Target Audience

Medicine

LQF

Level 8

Study Course Implementer

Course Supervisor

Ģirts Šalms

Residency Speciality

Speciality

Maxillofacial Surgeon

Supervisor of Medical Speciality

Ģirts Šalms

Contacts

About Study Course

Objective

To acquaint doctors - maxillofacial surgeons with the clinical signs and symptoms, diagnosis, and treatment methods of OSA, emphasizing their connection with craniofacial development disorders. Residents should be familiar with surgical treatment methods and techniques for OSA within the practice of ENT and maxillofacial surgeons. Ensure that maxillofacial surgeons knows the clinic, diagnosis, and treatment of OSA, as two of the three main treatment methods defined in the guidelines are relevant to their specialty. Residents must know modern oral, facial and jaw surgical treatment methods, such as ultrasound, laser, radiofrequency and cryo surgery.

Learning Outcomes

Knowledge

1.Knows the causative factors of OSA, the mechanism of the development of complications and health risks; can clinically recognize the risk factors of OSA, knows diagnostic techniques, and main treatment methods. Knows the use of modern technology: ultrasound, laser, radiofrequency and cryosurgery in maxillofacial surgery.

Skills

1.IS able to recognize patients with increased risk of OSA. Can choose the appropriate diagnostic and treatment strategy according to patient`s clinical situation and needs. Able to choose the right type of bimaxillary surgery, decide on the right soft palate reduction method, tongue reduction or advancement method. Able to diagnose and treat OMA in patients with congenital and acquired craniofacial deformities. Able to apply the necessary surgical method in the treatment of pathologies of the MSŽĶK.

Competences

1.Is able to recognize OSA risk, can manage high-risk OSA patients, and select appropriate diagnostic and treatment options for maxillofacial surgery patients, including OSA.

Assessment

Individual work

Title	% from total grade	Grade
1. Individual work	-	-
Read the literature on the pathogenesis, clinical manifestations, diagnosis, and treatment methods of OSA. Read the guidelines of professional associations for the diagnosis and treatment of OSA. Get to know the equipment and use it in the treatment of patients.

Examination

Title	% from total grade	Grade
1. Examination	-	-
In the form of a discussion, demonstrating understanding of the issues discussed in the seminars.
2. Examination	-	-
Theoretical knowledge and practical skills are assessed.

Study Course Theme Plan

FULL-TIME

Part 1

Seminar

Modality	Location
On site	Auditorium

Topics

Causes of obstructive sleep apnea (OSA). Pathogenesis of OSA syndrome and the most frequent cardiometabolic and cognitive complications.

Description

Annotation: In the seminar, the predisposing factors of OSA and the mechanisms of development of complications areanalyzedd. Topics covered during the class: Craniomorphological developmental abnormalities of the facial skeleton acquired in childhood, which may predispose the development of OSA. The influence of overweight and obesity types on the development of OSA. OSA-induced mechanisms predisposing development of cardiometabolic and cognitive impairment.

Seminar

Modality	Location
On site	Auditorium

Topics

The most characteristic clinical signs and symptoms of obstructive sleep apnea (OSA). Clinical and instrumental diagnostic techniques.

Description

Annotation: Physical risk factors, anatomical features, and symptoms that indicate risk for OSA. Topics covered during the class: Physical risk factors, anatomical features, and symptoms indicating the risk of OSA. The most common night symptoms, daytime symptoms and side effects. Patient questionnaires for the determination of increased risk of OSA. Clinical signs of OSA and types of examinations (polysomnography, respiratory polygraphy).

Seminar

Modality	Location
On site	Auditorium

Topics

Non-surgical treatment methods for obstructive sleep apnea (OSA).

Description

Annotation: The main non-surgical treatment techniques for (OSA) defined in the guidelines are reviewed: positive airway pressure therapy (CPAP) and oral appliances. Topics covered during the class: The choice of the individual treatment method is guided by the specific clinical situation: severity of sleep apnea, age, gender, features of the craniofacial skeleton, excess weight.

Seminar

Modality	Location
On site	Auditorium

Topics

Surgical treatment methods for obstructive sleep apnea (OSA).

Description

Annotation: The main (OSA) surgical treatment techniques mentioned in the guidelines are discussed: types of ENT surgery, bimaxillary surgery, chin surgery, and craniofacial approach. Topics covered during the class: Soft palate surgery, nasal surgery methods for airway expansion, types of tongue resection, operations to push the tongue forward, nasal conchal surgery, FES (functional endoscopic nasal surgery), Spreader grafts, orthognathic operations to advance both jaws and widen the jaws, chin operations to enlarge the airway, Le Fort II and Le Fort III osteotomies in patients with OSA.

Seminar

Modality	Location
On site	Auditorium

Topics

Modern technologies in oral, facial, and jaw surgery. Laser surgery and ultrasound surgery.

Description

Annotation: Knowledge of modern additional surgical methods for the treatment of pathologies of the mouth, face, and jaws is acquired. Laser surgery and ultrasound surgery. Topics covered during the class: Laser surgery: types of lasers, their physical characteristics, application, in maxillofacial dermatosurgery, oral surgery, periodontology, cariology. Application of ultrasound in oral, and maxillofacial surgery: physical characteristics and application of ultrasound in medicine, use for determining the primary stability of implants. The ultrasound-assisted incision in the jaws, application in orthognathic and oncosurgery.

Seminar

Modality	Location
On site	Auditorium

Topics

Modern technologies in oral, facial, and jaw surgery. Radiofrequency surgery and cryosurgery.

Description

Annotation: Knowledge of modern additional surgical methods for the treatment of pathologies of the mouth, face, and jaws is acquired. Radiofrequency and cryosurgery. Topics covered during the class: Radiofrequency surgery: physical characteristics, application in medicine, dermatosurgery, nose and mouth surgery. Cryosurgery: physical characteristics, application in medicine, facial and maxillofacial dermatosurgery.

Total ECTS (Creditpoints):

11.00

Number of Residency Seminars:

Length (weeks):

Final Examination:

Residency exam (Theory and practice)

Bibliography

Required Reading

Nolan, J. P., I. Maconochie, J. Soar, T. M. Olasveengen, et all. (2020). "Executive Summary 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations." Resuscitation 156: A1-A22; Elsevier Public Health Emergency Collection

Olasveengen, T. M., F. Semeraro, G. Ristagno, et all. (2021). "European Resuscitation Council Guidelines 2021: Basic Life Support." Resuscitation 161: 98-114

Collange, O., A. Bildstein, J. Samin, R. Schaeffer, et all. (2010). "Prevalence of medical emergencies in dental practice." Resuscitation 81(7): 915-916

Liu, C.-T., C.-Y. Lai, et all. (2020). "A Population-Based Retrospective Analysis of Post-In-Hospital Cardiac Arrest Survival after Modification of the Chain of Survival." The Journal of Emergency Medicine 59(2): 246-253.

"Practice Guidelines For Intravenous Conscious Sedation In Dentistry (2nd Edition, 2017)". 2018. Anesthesia Progress 65 (4): e1-e18. doi:10.2344/anpr-65-04-15w.

Weaver, Joel M. “The History of the Specialty of Dental Anesthesiology.” Anesthesia Progress, vol. 66, no. 2, 2019, pp. 61–68

Profesionālo asociāciju vadlīnijas: Merchant, R. M., A. A. Topjian, A. R. Panchal, et all. (2020). "Part 1: Executive Summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care." Circulation 142 (16_suppl_2): S337-s357

Kapur V.K., Auckley D.H., Chowdhuri S., et all. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2017;13(3):479e504.

Susheel P. Patil, MD, PhD, Indu A. Ayappa, PhD, et all. Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of Clinical Sleep MedicineVolume 15, Issue 02

10.

Danny J. Eckert and Atul Malhotra. Pathophysiology of Adult Obstructive Sleep Apnea. Proc Am Thorac Soc. 2008 Feb 15; 5(2): 144–153. doi: 10.1513/pats.200707-114MG

11.

Modern Management of Obstructive Sleep Apnea. 1st Edition. 2019, by Salam O. Salman (Editor), Springer

12.

Advanced Surgical Techniques in Snoring and Obstructive Sleep Apnea. 1st Edition. Kenny P. Pang, Brian Rotenberg, B. Tucker Woodson

13.

Profesionālo asociāciju vadlīnijas: Olasveengen, T. M., F. Semeraro, G. Ristagno, et all. (2021). "European Resuscitation Council Guidelines 2021: Basic Life Support." Resuscitation 161: 98-114

Additional Reading

Abelsson, A. and L. Lundberg. (2018). "Cardiopulmonary resuscitation quality during CPR practice versus during a simulated life-saving event." International journal of occupational safety and ergonomics : JOSE 24(4): 652-655.

Ali, D. M., B. Hisam, N. Shaukat, N. Baig, et all. (2021). "Cardiopulmonary resuscitation (CPR) training strategies in the times of COVID-19: a systematic literature review comparing different training methodologies." Scandinavian journal of trauma, resuscitation and emergency medicine 29(1): 53.

Viljoen, Andre, et all. “Analysis of Oxygen Saturations Recorded during Dental Intravenous Sedations: A Retrospective Quality Assurance of 3500 Cases.” Anesthesia Progress, vol. 58, no. 3, 2011, pp. 113–120

Yusufoğlu, K., M. Erdoğan, İ. Tayfur, M. A. Afacan and Ş. Çolak (2018). "CPR-related thoracic injuries: comparison of CPR guidelines between 2010 and 2015." Turk J Med Sci 48(1): 24-27

Inverso, Gino, et all. “Complications of Moderate Sedation versus Deep Sedation/General Anesthesia for Adolescent Patients Undergoing Third Molar Extraction.” Journal of Oral and Maxillofacial Surgery, vol.74, no. 3, 2016, pp.474–47.

Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med 2019;7(8):687e98. https://doi.org/10.1016/S2213-2600(19) 30198-5.

Bruyneel M. Telemedicine in the diagnosis and treatment of sleep apnoea. Eur Respir Rev 2019;28:180093. https://doi.org/10.1183/16000617.0093-2018.

Spicuzza L, Caruso D, Di Maria G. Obstructive sleep apnoea syndrome and its management. Therapeutic Advances in Chronic Disease. 2015;6(5):273-285. DOI:10.1177/2040622315590318

Sistla SK, Paramasivan VK, Agrawal V. Anatomic and Pathophysiologic Considerations in Surgical Treatment of Obstructive Sleep Apnea. Sleep Med Clin. 2019 Mar;14(1):21-31

10.

Slowik JM, Collen JF. Obstructive Sleep Apnea. StatPearls. Treasure Island (FL) 2019.

11.

Deckers K, Schievink SHJ, et al. Coronary heart disease and risk for cognitive impairment or dementia: Systematic review and meta-analysis. PLoS One. 2017;12(9):e0184244.