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Palatal Reconstruction (Pasha Modification)

Dr. Pasha has developed his own unique approach to reconstructing the back of the throat to treat sleep apnea. His version of Palatal Reconstructive Surgery is much more minimal to better preserve function. After performing thousands of procedures to treat snorers and sleep apnea patients, Dr. Pasha believes that palatal reconstruction is a much-improved method than traditional approaches.

He describes the procedure as a “face lift” for the back of the throat.

Traditional Septoplasty

A Septoplasty allows for the septum inside your nose – which divides the right and left sides of your nasal cavity – to be straightened by removing or reshaping it.

A deviated septum occurs when the thin wall, or nasal septum, between your nostrils is displaced to one side, making one nasal passage smaller.

Partial Turbinate Reduction

The turbinates are three fleshy shelves on the side of the inside of the nose that serve to warm, moisturize, and filter inhaled air before it enters the lungs. If the turbinates become too enlarged from repeated infections, allergies, or other irritants, they can cause nasal blockage. This problem is called turbinate hypertrophy (enlarged turbinates).

If your turbinates persistently cause nasal obstruction, you may be a candidate for reducing the size of the turbinates surgically called partial turbinate reduction, which is the procedure of the removal of a small nasal bone that reduces the size of turbinate.

Nasal Valve Reconstruction

The nasal valve is the entrance of the nose just past the nostrils. The valve is made up of several components including cartilage inside the nose. For some, the cartilage of the nose becomes weak causing collapse with deep inspiration.

Dr. Pasha has a unique approach to address the nasal valve: Nasal Valve Reconstruction, in which he addresses the columella and shapes the cartilage and skin to a more normal position and shape.

Genioglossal Advancement

If the cause of your apneas (blocking of the airway) is from a collapse from the back of your tongue when you sleep, an additional procedure called a Genioglossal Advancement Procedure may be performed. The purpose of this procedure is to suspend the tongue by pulling or “slinging” the muscles that support the tongue forward to increase airway size.

Since a small bone segment is moved, this procedure does not change the appearance of the face.

Hyoid and Tongue Advancement/ Stabilization Procedures

Dr. Pasha performs many procedures that focus on severe sleep apnea, like Hyoid and Tongue Advancement. The objective of this procedure is to

prevent the tongue from blocking your airway in the deep throat by making a small incision under the neck and place sutures around the hyoid and brought forward toward your chin to give support to the muscles that support the back of the throat.

Lingual Tonsillectomy

If your lingual tonsils become too enlarged they may cause collapse of the airway at night causing snoring or sleep apnea. Dr. Pasha may consider the Lingual Tonsillectomy procedure, in which he’ll be removing your lingual tonsils if they are determined to be contributing to your snoring or sleep apnea.

 

Midline Glossectomy

This procedure is recommended for  some sleep apneic patients and snorers since the tongue may fall back during sleep causing obstruction and snoring. The objective of the procedure is to reduce the back portion of the tongue without incision, speech or swallowing impairment.

Transpalatal Advancement Pharyngoplasty

For some patients the site of obstruction that may cause blockage as well as snoring at night may be the area behind the nose and upper throat. Transpalatal Advancement Procedures create room in the upper portion of the back of the throat creating a more open airway to reduce snoring and apneas.

 

Transoral Robotic Surgery (TORS, Da Vinci Robotic Surgery)

For select patients who have collapse of the airway in the base of the tongue at night, Dr. Pasha may recommend  the da Vinci Robot to access the base of tongue. The advantage of utilizing the robot is to allow for better visualization, precision, range of motion and better access to the deeper portion of the throat.

This procedure won’t affect the way you swallow, nor will it affect how your voice sounds.

 

Hypoglossal Nerve Stimulation

A therapy for patients with sleep apnea in which Dr. Pasha will require to place a neuronal stimulator under general anesthesia. This therapy is controlled by you and the sensor continuously monitors your breathing patterns during sleep and delivers mild stimulation to key airway muscles, which keeps the airway open.

Dr. Pasha will evaluate your airway anatomy and overall health status to determine if hypoglossal nerve stimulation is appropriate for you.

Maxillomandibular Advancement (MMA) Surgery

This procedure is reserved for severe sleep apnea, and the surgery may be suggested if you continue to have severe sleep apnea after other procedures have failed. It is also performed in patients with significant jaw deformity contributing to obstructive sleep apnea.

The objective of this procedure is to move both upper and lower jaws forward to open the airway of your nose and throat using plates and screws.

Tracheotomy

In the event of life-threatening sleep apnea, Dr. Pasha can recommend a tracheotomy in which  a small hole is made in the windpipe so air can avoid potential airway obstructions.

Although this procedure is highly effective, it is a measure that is reserved for life-threatening conditions.

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