Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4586_Библиотеки_им_академика_М_И_Перельмана

Dear Colleague,

Thanks for choosing this book and for reading this foreword. I’ll try to explain why in my opinion you have made a good decision to study this book. As an expert in sleep medicine and sleep surgery you are aware that the epiglottis has become an area of interest in this eld. Many years ago, we used to focus in particular on the nose, the palate, the tongue, and the facial bone framework, while the epiglottis as a source of obstruction was mostly neglected. There might be several reasons for this: in the rst place, the epiglottis is not visualized by standard physical examination, as performed by pulmonologists and neurologists; it is mostly diagnosed by drug­induced sleep endoscopy. Secondly, it was until recently regarded as a rare phenom­enon. In the last place, most OSA care givers would reason that epiglottis collapse, if present anyhow, would be effectively treated by CPAP.This probably explains both the apathy in the sleep community regarding the epiglottis and the relatively low number of papers on this topic in the sleep surgery literature. This book how­ever indicates that epiglottis collapse is not rare at all, it discusses different ways to diagnose it, and that epiglottis collapse in fact might be a reason for CPAP failure. The increasing amount of worldwide clinical data seems to disclose an underevalu­ated problem, and epiglottis collapse might very well be much more prevalent than we used to think. Moreover, the pathophysiology of epiglottis instability and col­lapse, primary or secondary, may explain many challenging and not well- understood situations (e.g., unexpected and unexplained CPAP failures, residual OSA after upper airway surgery, etc.) in the daily practice. This book is intended as another contribution in helping you to build a better understanding of the role of the epiglot­tis in upper airway collapse during sleep. Most of the available basic and advanced data is organized in a logical sequence, giving you the possibility to get into the problem in a very smooth and comprehensive way. After a general introductory overview of the problem about denition, epidemiology, pathogenesis, and outcome denitions, several main sections are expanded. A rst section is devoted to the proper identication of epiglottis dysfunction during sleep. Clinical and endoscopi­cal information is discussed within a wide range of additional options (sleep studies, DISE, imaging and manometry) in order to build up a sound diagnostic approach workup. Some situations that deserve special attention are described in detail for their relative more complex prole: epiglottis collapse in childhood (laryngomala­cia), the role of obesity in epiglottis collapse, and the role of the nose as related to

hypopharyngeal obstructions. The last couple of chapters are intended to highlight the great variety of treatment options, conservative and surgical, in a comprehen­sive, detailed and critical way. CPAP therapy, myofunctional therapy, oral appli­ances, and positional therapy are described in the nonsurgical section. All the state-of-the-art updated surgical techniques are a matter of discussion in a special section. Last but not least, the long experience and competence of all authors in the eld of sleep disorders makes this book a real treasure of knowledge and an useful compass in the still dark sea of epiglottis collapse in OSA.Enjoy the lecture.

Part II Diagnosis of Epiglottis Collapse

Part III Special Section

Part V Surgical Treatment of Epiglottis Collapse