Mandibular
Myotomy
The term mandibular means the part of the face, which is related
to the lower jawbone and myotomy means a surgery that creates a
division in the muscle. When put together we can say that mandibular
myotomy is a procedure that involves in creating a division in the
muscle of the lower jaw.
During mandibular myotomy a rectangular piece of bone is surgically
removed from the front portion of the jaw where the tongue muscles
are attached. This is then rotated ninety degrees and brought back
in place again. Mandibular myotomy results pulling the tongue forward
approximately six to ten millimeters. This clears the air passage
to a certain extent thereby resulting in removing the obstruction
of airflow during sleep.
Mandibular myotomy mainly helps in clearing the obstruction of
air as the back part of the tongue relaxes into the throat during
sleep. Mandibular myotomy has been proved to be successful in eliminating
sleep apnea due to obstruction.
This is a procedure which is recommended for those patients who
have failed to respond to other conservative traditional procedures
that are used for treating sleep apnea like UPPP,
Somnoplasty, and CPAP.
Advantages of Mandibular Myotomy
Mandibular myotomy is considered to be a newer intervention that
is being put into practice by many physicians for the treatment
of sleep apnea. The procedure was pioneered by Dr. Robert W. Riley
and Dr. Nelson Powell at Stanford University.
Mandibular myotomy is considered to be a complicated surgery and
is recommended to be performed by a skilled surgeon and only after
enough research has been done regarding the condition of the patient.
It is suggested that mandibular should only be performed by surgeons
with enough experience in both ENT surgery and maxillofacial surgery.
It should be kept in mind that the diagnosis and management of
Obstructive Sleep Apnea requires a team approach. It is not a one
person's job. It involves a good team effort put forward by the
dentist or orthodontist, an ENT or Maxillofacial surgeon (as and
when required) as well as a sleep physician
Success of Mandibular Myotomy
Today, sleep apnea has many treatment options that can be offered.
Other than Tracheostomy, mandibular myotomy is considered to be
the most invasive surgical treatments for Obstructive Sleep Apnea
along with UUUP.
Mandibular myotomy when performed in a relatively young adult population
may result in a significant reduction in OSA related health risks
like hypertension, cardiovascular problems, stroke and myocardial
infarction.
But mandibular myotomy should be used carefully as it is technically
difficult to perform and there are chances of risk associated with
it. Certain factors of this treatment are still unknown and an ongoing
research with large number of cases and long follow up periods will
surely throw more light on this treatment.
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