Aadsm Annual Meeting San Antonio: June 7-919
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Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome
Medical Policy Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome Table of Contents Policy: Commercial Coding Information Information Pertaining to All Policies Policy: Medicare Description References Authorization Information Policy History Policy Number: 130 BCBSA Reference Number: 7.01.101 Related Policies None Policy Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity Medicare HMO BlueSM and Medicare PPO BlueSM Members Uvulopalatopharyngoplasty (UPPP) may be MEDICALLY NECESSARY for the treatment of clinically significant obstructive sleep apnea syndrome (OSAS) in appropriately selected adult patients who have failed an adequate trial of continuous positive airway pressure (CPAP) or failed an adequate trial of an oral appliance (OA). Clinically significant OSA is defined as those patients who have: Apnea/hypopnea Index (AHI) or Respiratory Disturbance Index (RDI) 15 or more events per hour, or AHI or RDI 5 or more events and 14 or less events per hour with documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke. Hyoid suspension, surgical modification of the tongue, and/or maxillofacial surgery, including mandibular- maxillary advancement (MMA), may be MEDICALLY NECESSARY in appropriately selected adult patients with clinically significant OSA and objective documentation of hypopharyngeal obstruction who have failed an adequate trial of continuous positive airway pressure (CPAP) or failed an adequate trial of an oral appliance (OA). Clinically significant OSA is defined as those patients who have: AHI or RDI 15 or more events per hour, or AHI or RDI 5 or more events and 14 or less events per hour with documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke. -
Management of Ankylogossia by Frenectomy- a Case Report
British Journal of Medicine & Medical Research 18(8): 1-5, 2016, Article no.BJMMR.28162 ISSN: 2231-0614, NLM ID: 101570965 SCIENCEDOMAIN international www.sciencedomain.org Management of Ankylogossia by Frenectomy- A Case Report Meghna Singh1, Ashish Saini2*, Pranav Kumar Singh2, Charu Tandon2, Snehlata Verma3 and Tanu Tewari4 1Department of Pedodontics, BBD College of Dental Sciences, Lucknow, India. 2Department of Periodontics, BBD College of Dental Sciences, Lucknow, India. 3Department of Orthodontics and Dentofacial Orthopedics, BBD College of Dental Sciences, Lucknow, India. 4Department of Conservative Denstistry and Endodontics, BBD College of Dental Sciences, Lucknow, India. Authors’ contributions This surgery was carried out by authors MS and AS. Author PKS wrote the first draft of the manuscript. Authors CT and SV managed the literature searches. Author TT managed the final draft. All authors read and approved the final manuscript. Article Information DOI: 10.9734/BJMMR/2016/28162 Editor(s): (1) Joao Paulo Steffens, Department of Stomatology, Universidade Federal do Parana, Brazil. (2) Emad Tawfik Mahmoud Daif, Professor of Oral & Maxillofacial Surgery, Cairo University, Egypt. (3) James Anthony Giglio, Adjunct Clinical Professor of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Virginia, USA. (4) Philippe E. Spiess, Department of Genitourinary Oncology, Moffitt Cancer Center, USA and Department of Urology and Department of Oncologic Sciences (Joint Appointment), College of Medicine, University of South Florida, Tampa, FL, USA. Reviewers: (1) Kritika Jangid, Saveetha Dental College, India. (2) Jaspreet Singh Gill, Desh BhagatDental College & Hospital, Muktsar, Punjab. Baba Farid University of Health Sciences, Faridkot, Punjab, India. (3) Vishal Mehrotra, Rama University of Health Scemces, Kanpur, India. -
Surgical Treatments for Obstructive Sleep Apnea (OSA) Policy Number: PG0056 ADVANTAGE | ELITE | HMO Last Review: 06/01/2021
Surgical Treatments for Obstructive Sleep Apnea (OSA) Policy Number: PG0056 ADVANTAGE | ELITE | HMO Last Review: 06/01/2021 INDIVIDUAL MARKETPLACE | PROMEDICA MEDICARE PLAN | PPO GUIDELINES This policy does not certify benefits or authorization of benefits, which is designated by each individual policyholder terms, conditions, exclusions and limitations contract. It does not constitute a contract or guarantee regarding coverage or reimbursement/payment. Self-Insured group specific policy will supersede this general policy when group supplementary plan document or individual plan decision directs otherwise. Paramount applies coding edits to all medical claims through coding logic software to evaluate the accuracy and adherence to accepted national standards. This medical policy is solely for guiding medical necessity and explaining correct procedure reporting used to assist in making coverage decisions and administering benefits. SCOPE X Professional _ Facility DESCRIPTION Sleep apnea is a disorder where breathing nearly or completely stops for periods of time during sleep. In obstructive sleep apnea (OSA), the brain sends the message to breathe, but there is a blockage to air flowing into the chest. It is a condition in which repetitive episodes of upper airway obstruction occur during sleep. The obstruction may be localized to one or two areas, or may encompass the entire upper airway passages to include the nasal cavity (nose), oropharynx (palate, tonsils, tonsillar pillars) and hypopharynx (tongue base). The hallmark symptom of OSA is excessive daytime sleepiness, and the typical clinical sign of OSA is snoring, which can abruptly cease and be followed by gasping associated with a brief arousal from sleep. The snoring resumes when the patient falls back to sleep, and the cycle of snoring/apnea/arousal may be repeated as frequently as every minute throughout the night. -
32 Surgical Treatment of Sleep-Related Breathing Disorders Donald M
32 Surgical Treatment of Sleep-Related Breathing Disorders Donald M. Sesso Department of Otolaryngology/Head and Neck Surgery, Stanford University Medical Center, Stanford, California, U.S.A. Nelson B. Powell and Robert W. Riley Department of Otolaryngology/Head and Neck Surgery, Stanford University Medical Center and Department of Behavioral Sciences, Division of Sleep Medicine, Stanford University School of Medicine, Stanford, California, U.S.A. INTRODUCTION Snoring, upper airway resistance syndrome (UARS), obstructive sleep apnea (OSA), and obstructive sleep apnea-hypopnea syndrome (OSAHS) are collectively referred to as sleep- related breathing disorders (SRBD). These terms describe a partial or complete obstruction of the upper airway during sleep. Patency of the pharyngeal airway is maintained by two opposing forces: negative intraluminal pressure and the activity of the upper airway musculature. Anatomical or central neural abnormalities can disrupt this delicate balance and result in compromise of the upper airway. This reduction of airway caliber may cause sleep fragmentation and subsequent behavioral derangements, such as excessive daytime sleepiness (EDS) (1–3). The goal of medical and surgical therapy is to alleviate this obstruction and increase airway patency. The first therapeutic modality employed to treat SRBD was surgery. Kuhlo described placement of a tracheotomy tube in an attempt to bypass upper airway obstruction in Pickwickian patients (4). Although effective, tracheotomy does not address the specific sites of pharyngeal collapse and is not readily accepted by most patients. These sites include the nasal cavity/nasopharynx, oropharynx, and hypopharynx. Often, multilevel obstruction is present. Consequently, the surgical armamentarium has evolved to create techniques that correct the specific anatomical sites of obstruction. -
Stanford University
STANFORD UNIVERSITY CURRICULUM VITAE Updated September 2019 NAME Stanley Yung-Chuan Liu, MD, DDS POSITION Assistant Professor of Otolaryngology Stanford University School of Medicine Co-Director, Sleep Surgery Fellowship EDUCATION Date Attended Institution Degree, Title Major 9/25/96 - 6/11/00 Stanford University B.S. Biology 8/28/02 - 6/17/07 University of California – San D.D.S. Dentistry Francisco (UCSF), School of Dentistry 9/12/07 - 6/10/11 University of California – San M.D. Medicine Francisco (UCSF), School of Medicine ACADEMIC APPOINTMENTS 6/2013 – 6/2014 Clinical Instructor Department of Otolaryngology, Stanford University School of Medicine Stanford, CA, USA 9/2014 – Present Assistant Professor (Medical Center Line) Department of Otolaryngology, Stanford University School of Medicine Stanford, CA, USA 9/2015 – Present Preceptor Department of Ophthalmology, Stanford University School of Medicine Stanford, CA, USA HOSPITAL APPOINTMENTS/AFFILIATIONS 6/2013 – Present Stanford Hospital and Clinics, Stanford, CA, USA 9/2015 – Present San Francisco Veterans Affairs Hospital, Palo Alto, CA, USA CERTIFICATION 4/2018 – Present Diplomate, American Board of Oral & Maxillofacial Surgery 4/2018 – Present Candidate, American College of Surgeons LICENSURE 2010 – Present California Dental License #59319 2012 – Present California Medical License # A122495 HONORS AND AWARDS 2004 Howard Hughes Medical Institute – NIH Research Scholarship (Cloister Program) 2009 Advanced Training Clinical Research Fellowship, UCSF School of Medicine, 2010 Lightowler -
Treatments for Ankyloglossia and Ankyloglossia with Concomitant Lip-Tie Comparative Effectiveness Review Number 149
Comparative Effectiveness Review Number 149 Treatments for Ankyloglossia and Ankyloglossia With Concomitant Lip-Tie Comparative Effectiveness Review Number 149 Treatments for Ankyloglossia and Ankyloglossia With Concomitant Lip-Tie Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. 290-2012-00009-I Prepared by: Vanderbilt Evidence-based Practice Center Nashville, TN Investigators: David O. Francis, M.D., M.S. Sivakumar Chinnadurai, M.D., M.P.H. Anna Morad, M.D. Richard A. Epstein, Ph.D., M.P.H. Sahar Kohanim, M.D. Shanthi Krishnaswami, M.B.B.S., M.P.H. Nila A. Sathe, M.A., M.L.I.S. Melissa L. McPheeters, Ph.D., M.P.H. AHRQ Publication No. 15-EHC011-EF May 2015 This report is based on research conducted by the Vanderbilt Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2012-00009-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. -
Icd-9-Cm (2010)
ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular -
Obstructive Sleep Apnea and the Role of Tongue Reduction Surgery in Children with Beckwith-Wiedemann Syndrome (2018)
RESEARCH INSTITUTE Obstructive sleep apnea and the role of tongue reduction surgery in children with Beckwith-Wiedemann syndrome (2018) Christopher M. Cielo, Kelly A. Duffy, Aesha Vyas, Jesse A. Taylor, Jennifer M. Kalish Background Patients with Beckwith-Wiedemann syndrome (BWS) can be affected by a large tongue (macroglossia). Similar to other features of BWS, macroglossia can vary in severity between patients. Studies suggest that children with macroglossia are at an increased risk for obstructive sleep apnea (OSA), a condition that is also highly variable, ranging from mild sleep obstruction to severe respiratory distress. No recommendations regarding OSA management in patients with BWS and macroglossia exist. Purpose This article reviews all available evidence regarding children with Beckwith-Wiedemann Syndrome (BWS) and macroglossia. The prevalence of obstructive sleep apnea (OSA) and management strategies in this population are discussed. Findings Evaluations Children suspected of having BWS and macroglossia should receive the following evaluations. No clear guidelines exist for at what age children should be evaluated. • Clinical Genetics: Any child with a feature suggestive of BWS should be referred to a clinical geneticist, who can evaluate the patient and determine whether the patient meets criteria for a clinical diagnosis of BWS. • Plastic Surgery: Patients with macroglossia should be referred to a plastic surgeon, who can evaluate the size of the tongue to determine whether a tongue reduction surgery is necessary. • Pulmonology: A pulmonologist can evaluate the degree to which the large tongue affects breathing, as an increased tongue size can narrow the airway and cause upper airway obstruction. o Polysomnography (sleep study) is used for evaluation of OSA in children and has been used in certain studies of BWS children to detect the following: moderate- severe OSA, upper airway obstruction, apnea, upper airway resistance, severe desaturation, sleep-disordered breathing, and snoring. -
The Efficacy of Lingual Laser Frenectomy in Pediatric OSAS
International Journal of Environmental Research and Public Health Study Protocol The Efficacy of Lingual Laser Frenectomy in Pediatric OSAS: A Randomized Double-Blinded and Controlled Clinical Study Miriam Fioravanti * , Francesca Zara , Iole Vozza , Antonella Polimeni and Gian Luca Sfasciotti Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; [email protected] (F.Z.); [email protected] (I.V.); [email protected] (A.P.); [email protected] (G.L.S.) * Correspondence: miriam.fi[email protected] Abstract: This randomized, double-blind and controlled clinical trial investigates how a diode laser lingual frenectomy can improve obstructive sleep apnea syndrome (OSAS) in pediatric patients. Background: Several authors have shown that a short lingual frenulum causes a reduction in incoming air flow and the relationship between OSAS and a short lingual frenulum. Methods: Thirty-two pediatric patients were equally randomly divided into a Study Group (SG) and a Control Group (CG). On each SG patient a polysomnography 1 (PSG1) and a lingual frenectomy were performed using a diode laser via Doctor Smile Wiser technology, power 7 W. After three months, a new polysomnography (PSG2) was performed to evaluate the lingual frenectomy efficacy in pediatric patients. The pain was assessed by a numerical rating scale (NRS) before and after surgery. The CG followed the same protocol without a lingual frenectomy but myofunctional and speech therapy were conducted to qualitatively and quantitatively improve the lingual functionality. In the SG, eight Citation: Fioravanti, M.; Zara, F.; subjects (50%) had severe OSAS and eight had moderate (50%) while in the CG, three subjects had Vozza, I.; Polimeni, A.; Sfasciotti, G.L. -
Inventory #: 01 Page 1 of 3
Inventory #: 01 Page 1 of 3 CDT CODE ACTION REQUEST Part 1 – Submitter Information A. Contact Information (Action Requestor) Date Submitted: 10/17/2019 Name: DentalCodeology Consortium B. Does this request represent the official position of either a dental organization or a recognized dental specialty, or a third-party payer or administrator, or the manufacturer/supplier of a product? Yes > ☒ If Yes, The Oral Cancer Foundation Name: No > ☐ Part 2 – Submission Details 1. Action Affected Code New ☒ Revise ☐ Delete ☐ (Mark one only) (Revise or Delete only) 2. Full nomenclature and descriptor (For “Revise” mark-up as follows: added text – blue underline; deleted text – red strike-through; unchanged text – black) Nomenclature an enhanced oral cancer examination to include a comprehensive risk Required for all assessment, visual and tactile, intra/extra oral and oropharyngeal screening to “New” identify abnormalities Descriptor This procedure involves a detailed risk assessment to include a verbal inquiry, and/or an updated or new written health history, with a visual inspection using operatory Optional for “New”; enter “None” if no lighting/loupes, and palpation, which are the necessary techniques used in oral and descriptor oropharyngeal cancer evaluations. NOTICE TO PREPARER AND SUBMITTER: All requested information in Parts 1-3 is required; limited exceptions are noted. Cells where information is entered have white backgrounds and will automatically expand as needed. Mark cells with “check boxes” (☐) by moving the cursor over the box and making a “left-click”. Completed Request must be submitted in unprotected MSWord® format via email to [email protected]. A submission will be returned for correction if it is: a) not an unprotected MS Word document; b) not on the current Action Request format; or c) it is missing “Required” information. -
Lingual Frenectomy
G. Olivi, A. Signore, M. Olivi*, M.D. Genovese malformation that usually affects males more than females in a 3:1 ratio. It occurs in newborns with an University of Genoa, Department of Surgical Science (DISC) incidence of about 5%, more frequently as an isolated Master Course Laser in Dentistry, Genoa, Italy event and sometimes associated to malformative *Undergratuated student, Faculty of Dental Medicine syndromes (Simpson-Golabi-Behemel Syndrome, Optiz University "Victor Babes", Timisoara, Romania Syndrome, Beckwitz-Wiedemann Syndrome, Oro- facial-digital Syndrome; cleft palate) [Kloars, 2007]. e-mail: [email protected] If the anomaly is relatively severe and generates mechanical limitations and functional challenges, surgical reduction of the frenum is indicated, followed by speech therapy for an immediate rehabilitation of the lingual muscle [Campan, 1996]. Lingual Frenectomy: Furthermore, it should be also emphasised that a short frenum is not always tight or fibrotic; in fact, functional evaluation despite the reduced length of the lingual frenum, the elasticity of the floor of the mouth may still allow and new therapeutical a normal mobility of the tongue thus making the approach frenectomy unnecessary. Functional problems of ankyloglossia › Breastfeeding difficulty is caused by the lingual hypomobility and the resulting inability of the ABSTRACT nursing infant to squeeze the nipple against the upper arch and hard palate during suction; Aim When ankyloglossia is relatively severe and furthermore, the lateral margins of the tongue raise generates mechanical limitations and functional to form a U-shaped channel that wraps around the challenges, surgical reduction of the frenum is indicated. nipple to avoid the milk leaking into the vestibule of Materials and methods Laser technique is an the mouth. -
Preliminary Programme
PRELIMINARY PROGRAMME You can register online now CLICK HERE OPPortUNITIES AND CHALLENGES ANNUAL SCIENTIFIC MEETING 28 – 30 June 2017 ICC BIRMINGHAM PLATINUM SPONSOR British Association of Oral and Maxillofacial Surgeons The Royal College Surgeons, 35-43 Lincoln’s Inn Fields, London WC2A 3PE Email: [email protected] Website: www.baoms.org.uk Plan ahead Contact us at: [email protected] +44 1635 262 400 BAOMS Flyer.1.indd 3 3/21/17 2:33 PM BIRMINGHAM 2017 PRELIMINARY PROGRAMME 3 CONTINUING ProFESSIONAL DEVELOPMENT (CPD) CONTENTS This scientific meeting aims to provide attendees with the opportunity to gain up to date knowledge on the latest developments in research, audit, education, surgical techniques, INtroDUCTION clinical patient management and outcomes in the field of oral and maxillofacial surgery. from ThE BAOMS PRESIDEnT This is delivered through seminars led by experts in their field, masterclasses and short papers presenting the latest research and developments. Participants should verify their own attendance record out of the maximum hours 4 available, which have been calculated as follows: Wednesday 28 June CPD hours 5.25 BAOMS COunCIL 2017 Thursday 29 June CPD hours 6.25 Friday 30 June CPD hours 6.25 4 CERTIFicaTES OF ATTENdaNCE Certificates of attendance indicating the CPD hours for the elements of the meeting ExhIBITIOn PLAn & LISTIngS booked by the attendee will be sent by email after the conference. SIGNING THE ATTENdaNCE REGISTER 5 In order to meet the requirements of verifiable CPD attendees should sign in at the Registration Desk on each day that they attend the conference. BAOMS is required to SCIENTIFIC ProGRAMME keep this attendance record on file in order for CPD hours to be considered verifiable.