Sleep Breath 2004; 8(3): 165-170
DOI: 10.1055/s-2004-834488
CASE REPORT

Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Multidisciplinary Management of the Airway in a Trauma-Induced Brain Injury Patient

Jacques R. Conaway1 , Steven C. Scherr2
  • 1Franklin Square Hospital Sleep Disorders Center, Baltimore, Maryland
  • 2private practice, Owings Mills, Maryland
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Publikationsverlauf

Publikationsdatum:
24. September 2004 (online)

Laryngomalacia occurs in some brain injury patients secondary to global muscle hypotonia. Surgical therapies for epiglottis prolapse have centered around removal or reshaping of the epiglottis. This approach has brought mixed success and frequent complications. We present a case that demonstrates successful nonsurgical treatment of a 33-year-old male brain injury patient with moderate obstructive sleep apnea that is believed to be a consequence of post-brain injury nocturnal epiglottis prolapse. The presence of a tracheostomy performed at the time of emergency surgery had become an emotional and physical barrier to our patient’s recovery. The tracheostomy could only be reversed if the obstructive sleep apnea disorder could be managed in an alternative fashion. A titratable mandibular repositioning appliance was prescribed and its effectiveness was demonstrated with nasolaryngoscopy and polysomnography.

After initially fitting the oral appliance, a period of accommodation and gradual protrusive adjustments was allowed. Subsequent confirmation polysomnography demonstrated improvement, but not suitable resolution, of disordered breathing events. However, an additional 1.25-mm protrusive titration of the oral appliance during the course of the confirmation polysomnogram led to therapeutic success. The patient’s tracheostomy was subsequently reversed with significant quality of life benefits.

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Steven C ScherrD.D.S. 

21 Crossroads Dr., Ste. 240

Owings Mills, MD 21117

eMail: thesmiledoc@comcast.net