Multidisciplinary management of the airway in a trauma-induced brain injury patient

Sleep & Breathing = Schlaf & Atmung
Jacques R Conaway, Steven C Scherr

Abstract

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 c...Continue Reading

References

Apr 1, 1992·The Annals of Otology, Rhinology, and Laryngology·P Woo
Apr 22, 1999·The Journal of Laryngology and Otology·F J CatalfumoD Goldenberg
Feb 28, 2002·Sleep & Breathing = Schlaf & Atmung·Yuehua LiuJohn A. Fleetham
Jun 21, 2002·Sleep & Breathing = Schlaf & Atmung·Anette M C FranssonGöran Isacsson
Sep 24, 2002·Sleep & Breathing = Schlaf & Atmung·Margot A SkinnerD Robin Taylor
May 7, 2004·The Journal of Trauma·Samir M FakhryUNKNOWN IRTC Neurotrauma Task Force

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brain injury after impact to the head is due to both immediate mechanical effects and delayed responses of neural tissues.

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