Robert W. Riley's research while affiliated with Stanford University and other places

Publications (129)

Article
Background: Rate of corrective nasal surgery after maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA) has been reported to be 18.7% for functional and aesthetic indications. Objective: Describe a comprehensive strategy to optimize nasal outcomes with MMA for OSA. Methods: A retrospective review of patients undergoing MMA for OSA...
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There are many ways to categorize surgery for obstructive sleep apnea (OSA), one of which is to distinguish between intrapharyngeal and extrapharyngeal procedures. While the general otolaryngologist treating OSA is familiar with intrapharyngeal procedures, such as uvulopalatopharyngoplasty and tongue base reduction, extrapharyngeal sleep operations...
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Sleep surgery is part of a continuum of care for OSA that involves medical, pharmacologic, and behavioral therapy. Upper airway surgery for OSA can significantly improve stability by way of modulating the critical negative closing pressure. This is the same mechanism of action as PAP or oral appliance therapy (OAT). The updated surgical algorithm i...
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Objectives Maxillomandibular advancement (MMA) confers consistent and high rates of surgical success for obstructive sleep apnea (OSA). In the era of value-based medicine, identifying factors that affect the stability of rigid fixation and allow rapid return to function are important targets for improvement. The aim of this study was to identify pa...
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Background: To systematically review the literature for methods to localize the genial tubercle as a means for performing an advancement of the genioglossus muscle. Methods: PubMed, Google Scholar, CRISP, EMBASE, CINAHL, and Scopus were searched from inception through June 16, 2015. Results: One hundred fifty-two articles were screened, and th...
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Whereas the original Stanford protocol relied on a tiered approach to care to avoid unnecessary surgery, it did not address the issue of surgical relapse, a common concern among sleep medicine specialists. With 3 decades of experience since the original 2-tiered Powell-Riley protocol was introduced and the role of evolving skeletal techniques and u...
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Maxillomandibular advancement (MMA) for the treatment of obstructive sleep apnea (OSA) has remained a reliable and highly effective surgical intervention since its introduction in 1989. Modifications have been made to maximize skeletal movement and upper airway stability without compromising facial balance. Contemporary indications of recommending...
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While effects of maxillomandibular advancement (MMA) on respiratory parameters for patients with obstructive sleep apnea (OSA) are well described, effects on sleep architecture before and after MMA are not. A retrospective cohort analysis on sleep architecture was examined in 10 OSA patients who underwent MMA surgery between July 2013 and November...
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Objective Efficacy of maxillomandibular advancement (MMA) in the treatment of obstructive sleep apnea (OSA) is associated with degree of maxillary advancement. Large maxillary advancement leads to profound changes of the nasolabial region. We present the incidence and indications of post-MMA corrective nasal surgery in a large cohort. Study Design...
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In 1993, a surgical protocol for dynamic upper airway reconstruction in patients with obstructive sleep apnea (OSA) was published, and it became commonly known as the Stanford phase 1 and 2 sleep surgery protocol. It served as a platform on which research and clinical studies have continued to perfect the surgical care of patients with OSA. However...
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Objective The objective of this study was to systematically review the international literature for studies providing a preoperative checklist for medical disorders to be evaluated or treated before performing sleep surgery. If no checklist exists, then the identified studies would be used to develop a checklist de novo. Study design Systematic...
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There is too much individual patient variation in mandibular anatomy for any single described genioglossus advancement technique to be used consistently. Virtual surgical planning allows surgeons to design genioglossus osteotomy that captures the structures of interest. Intraoperative osteotomy and positioning guides mitigate known risks of the pro...
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Objectives To use drug-induced sedation endoscopy (DISE) and computational fluid dynamics (CFD) modeling to study dynamic airway and airflow changes after maxillomandibular advancement (MMA), and how the changes correlate with surgical success based on polysomnography parameters. Study Design Retrospective cohort study. Setting University medical...
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Importance Maxillomandibular advancement (MMA) is an invasive yet effective surgical option for obstructive sleep apnea (OSA) that achieves enlargement of the upper airway by physically expanding the facial skeletal framework.Objective To identify criteria associated with surgical outcomes of MMA using aggregated individual patient data from mult...
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Objective: Obstructive sleep apnea (OSA) can be a challenging disorder to treat. Maxillomandibular advancements (MMAs) generally have high success rates; however, larger advancements have higher success and cure rates. Our aim is to present and to describe the current technique used by the senior authors, which has been successful for performing la...
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The efficacy of maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA) with anatomic airway changes has previously been studied using static imaging and endoscopy in awake subjects. The aim of the present study was to use drug-induced sleep endoscopy (DISE) to evaluate the dynamic upper airway changes in sleeping subjects before and...
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Obstructive sleep-disordered breathing (OSDB) is defined by total or partial collapse of the upper airway during sleep (obstructive sleep apnea and obstructive sleep hypopnea, respectively). In the presence of specific anatomic features, OSDB is potentially amenable to surgical intervention. Initially, the only treatment available for these patient...
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Objective: To assess the outcomes of maxillomandibular advancement (MMA) for the treatment of persistent obstructive sleep apnea syndrome (OSA) after phase I reconstruction in patients who do not have maxillomandibular deficiency. Methods: From January 1997 to September 1998, 25 patients previously treated with phase I reconstruction (uvulopalat...
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To examine the association between sleep disordered breathing severity and resting energy expenditure (REE). Cross-sectional. University-based academic medical center. Two hundred twelve adults with signs or symptoms of sleep disordered breathing underwent medical history, physical examination, level I attended polysomnography, and determination of...
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Obstructive sleep apnea (OSA) remains a significant public health problem because of its neurocognitive sequelae. Additionally, with persistent obstruction, it has an impact on the cardiovascular system, leading to hypertension and cardiac failure as one of its causative or comorbid factors. For the surgeon managing OSA, there is a stepwise sequenc...
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To quantify the prevalence of self-reported near-miss sleepy driving accidents and their association with self-reported actual driving accidents. A prospective cross-sectional internet-linked survey on driving behaviors. Dateline NBC News website. Results are given on 35,217 (88% of sample) individuals with a mean age of 37.2 +/- 13 years, 54.8% wo...
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Although standard treatment of pediatric sleep apnea has been directed at the nasal and retropalatal levels, some patients will have persistent obstruction at the base of the tongue. Surgical approaches that treat this area, many of which have been proven effective in the adult population, can be considered to treat these patients.
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To investigate the incidence of complications after temperature-controlled radiofrequency (TCRF) treatment of the inferior turbinates, palate, and tongue. To compare these complication rates with those reported in the literature. Prospective, observational study. All patients treated with TCRF to the inferior turbinates, palate, and tongues during...
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Objectives: Temperature-controlled radiofrequency (TCRF) is commonly used to treat patients with sleep-disordered breathing and/or nasal obstruction. The incidence of complications reported in the literature is higher than our experience would suggest. The objective of this study was to determine the incidence of complications after TCRF within our...
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Temperature-controlled radiofrequency volumetric reduction (TCRF), a minimally invasive procedure, has been used to treat tongue base obstruction in Obstructive Sleep Apnea Syndrome (OSAS). An adjunctive method was objectively evaluated. A prospective, nonrandomized clinical study was undertaken on 20 consecutive OSAS patients with isolated tongue...
Article
Our goal was to evaluate the long-term outcomes of temperature-controlled radiofrequency reduction of the tongue base in sleep-disordered breathing. The 18 patients from our initial pilot study were reevaluated. Clinical examinations, polysomnography (PSG), questionnaires, visual analog scales, and a comparative SF-36 were used to assess long-term...
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Although the data available for RF thermal ablation for the treatment of sleep-disordered breathing is limited, the available data does support the continual investigation of this novel treatment approach. It should be emphasized, however, that despite the minimally invasive nature of this outpatient treatment technique, severe complications such a...
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Distraction osteogenesis has been widely applied in maxillofacial surgery for the treatment of skeletal deformities. Distraction osteogenesis can also be applied in sleep apnea surgery to improve airway obstruction by expanding the maxillofacial skeleton. This article describes the techniques currently used by the primary author for the treatment o...
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The study aim was to evaluate the resultant changes in the upper airway after maxillomandibular advancement (MMA) for obstructive sleep apnea. Twelve patients were evaluated before and after MMA using fiberoptic nasopharyngoscopy (NPG) with Müller maneuver. An inspiratory force meter was used to ensure the consistency of the inspiratory efforts bet...
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Surgical treatment of obstructive sleep apnea syndrome may, in many cases, need to address obstruction at the level of the palate and the base of tongue. By careful evaluation and a stepwise surgical approach, those individuals who require more aggressive advancement of the hypopharyngeal airway may be identified. Maxillary-mandibular advancement i...
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The study goals were to evaluate the associated risks of driving and to assess predictors of accidents and injury due to sleepiness. A cross-sectional Internet-linked survey was designed to elicit data on driving habits, sleepiness, accidents, and injuries during the preceding 3 years. Statistical analysis included logistic models with covariate-ad...
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This study evaluated the potential application of distraction osteogenesis (DO) for skeletal expansion in the management of adult patients with obstructive sleep apnea syndrome (OSAS). Five consecutive adult patients (3 male, 2 female) underwent a DO procedure with intraoral distraction devices for the management of OSAS. The surgical procedures we...
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Objectives: To estimate the treatment effect of temperature-controlled radiofrequency (TCRF) reduction of turbinate hypertrophy in patients with sleep-disordered breathing (SDB) treated with nasal continuous positive airway pressure (CPAP), and to assess the impact of study design on this estimate. Study design: Prospective, randomized, double-b...
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This study evaluated the accuracy of a genioglossus advancement (GA) technique (rectangular window) to incorporate the genial tubercle/genioglossus muscle complex (GGC) in patients with obstructive sleep apnea. This prospective study consisted of 38 consecutive patients who underwent GA. Preoperative localization of the GGC was based on the cephalo...
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To evaluate the presence of velopharyngeal insufficiency (VPI) symptoms and the associated changes of the velopharyngeal anatomy in patients who underwent maxillomandibular advancement (MMA) for persistent obstructive sleep apnea (OSA) after uvulopalatopharyngoplasty (UPPP). Preoperative and postoperative cephalometric radiographs were analyzed to...
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The goal of this study was to evaluate the patient's perception of the facial appearance after maxillomandibular advancement (MMA) surgery for obstructive sleep apnea syndrome (OSAS). During a 14-month period, 58 patients underwent MMA for OSAS. All of the patients underwent preoperative and postoperative cephalometric analysis. Between 6 and 12 mo...
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Objectives/hypothesis: A large sector of the population of the United States has sleep deprivation directly leading to excessive daytime sleepiness. The prevalence of excessive daytime sleepiness in this population ranges from 0.3% to 13.3%. The consequences of even 1 to 2 hours of sleep loss nightly may result in decrements in daytime functions r...
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This study evaluated the upper airway characteristics in the early postoperative period after reconstructive surgery for obstructive sleep apnea (OSA). During a 24-month period, the upper airway of patients who underwent uvulopalatopharyngoplasty (UPPP) with genioglossus advancement (GA) or hyoid myotomy (HM) or maxillomandibular advancement (MMA)...
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The goal of this study was to assess the outcomes of obstructive sleep apnea (OSA) surgery based on the patient perspective and polysomnographic data. Fifty-six patients with severe OSA completed the 2-phase reconstructive protocol. A minimum of 6 months after the phase II surgery and after the postoperative polysomnography, questionnaires with vis...
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To investigate the possible differences between Far-East Asian men and white men in obstructive sleep apnea syndrome (OSAS). Prospective nonrandomized controlled study. This study compared consecutive Far-East Asian men with OSAS (n = 50) with two selected groups of White men with OSAS (n = 50 in each group). One group of white men was controlled f...
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To evaluate the outcomes of airway reconstructive surgery for the treatment of severe obstructive sleep apnea in the morbidly obese patient. Retrospective review of consecutively treated patients. Variables examined include age, sex, body mass index (BMI), respiratory disturbance index (RDI), lowest oxygen saturation (LSAT), cephalometric data, and...
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This study compares the posttreatment discomfort between laser-assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP), and radiofrequency volumetric tissue reduction (RFVTR) of the palate through the use of visual analog pain scales and a quantitative assessment of the analgesic medication taken. In one group, LAUP (n = 10) or UPPP (n...
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We report the case of a 15-year-old boy with obstructive sleep apnea and obesity who was treated since the age of 5 with nasal continuous positive airway pressure. Due to the long-term use of a nasal mask, the child developed a mid-face hypoplasia. Chronic use of a nasal mask for home ventilation in children should always be associated with regular...
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Outcome data on the surgical treatment of obstructive sleep apnea are, in general, based on short-term follow-up (<6-9 months). This examination was undertaken to assess long-term results. Forty patients who underwent soft tissue and skeletal surgery were the subjects of this review. Methods of evaluation included polysomnographic variables (respir...
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To evaluate the upper airway characteristics in the early postoperative period after maxilomandibular advancement for obstructive sleep apnea syndrome. Nasopharyngolaryngoscopy was performed before and 48 hours after surgery on 70 consecutive patients who underwent maxillomandibular advancement for obstructive sleep apnea syndrome. The preoperative...
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A new operative technique to improve nasal valve collapse by placement of cartilage struts along the alar rim was compared with the standard nasal valve cartilage graft (NVG) technique. Methods And Patients: A retrospective study of consecutive patients with nasal valve collapse was performed at Stanford University Medical Center. Seventy-nine pati...
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Inferior turbinate hypertrophy is a common cause of nasal obstruction. Although topical corticosteroid sprays, antihistamines, and allergic desensitization are usually the first-line treatments of inferior turbinate hypertrophy, these therapies often are ineffective. This article describes the authors' treatment philosophy and technique of radiofre...
Article
OBJECTIVES This study compares the posttreatment discomfort between laser-assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP), and radiofrequency volumetric tissue reduction (RFVTR) of the palate through the use of visual analog pain scales and a quantitative assessment of the analgesic medication taken. METHODS In one group, LAUP...
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The goal was to evaluate the effect of radiofrequency (RF) of the palate on speech, swallowing, taste, sleep, and snoring 12 to 18 months after treatment. Twenty-two patients were evaluated by clinical examination, questionnaires, and visual analog scales. The patients with relapse of snoring were offered further RF treatment. After a mean follow-u...
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Radiofrequency has been an evolving technology in volumetric reduction of tissues in the upper airway, including the nasal turbinates, soft palate, and tongue. Radiofrequency tongue base reduction is an alternative technique of improving upper airway patency by reducing the size of the tongue in sleep-disordered breathing. This modality is a multip...
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Soft palatal radiofrequency reduces the volume of palatal soft tissue and produces scar tissue to alleviate velopharyngeal vibration and collapse in snoring and mild sleep-disordered breathing. This innovative alternative to laser-assisted uvulopalatoplasty or uvulopalatopharyngoplasty is performed in an outpatient setting under local anesthesia wi...
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Surgery is a major modality in the treatment of obstructive sleep apnea syndrome (OSAS), and maxillomandibular advancement (MMA) has been shown to be the most effective surgical option. However, despite the successful short-term (6-9 months) results reported by various investigators, little is known of the long-term clinical outcomes. A review of o...
Article
Objective: To evaluate the possible differences between Asian and white patients with obstructive sleep apnea syndrome. Methods: A retrospective review of Asian and white patients during a 12-month period was conducted. Patients with respiratory disturbance index (RDI) > or = 15 based on polysomnography were included in the study. Variables exam...
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It is well established that obstructive sleep apnea syndrome is associated with increased morbidity and mortality. Surgical therapy has been demonstrated to be a viable treatment option for cure. Thorough presurgical evaluation with the identification of the type of airway abnormality is mandatory to allow for the utilization of a surgical protocol...
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It is well established that obstructive sleep apnea syndrome is associated with increased morbidity and mortality. Surgical therapy has been demonstrated to be a viable treatment option for cure. Thorough presurgical evaluation with the identification of the type of airway abnormality is mandatory to allow for the utilization of a surgical protocol...
Article
Objectives/hypothesis: Patients with sleep-disordered breathing have reaction time deficits that may lead to catastrophic accidents and loss of life. Although safety guidelines do not exist for unsafe levels of sleepiness, they have been established for unsafe levels of alcohol consumption. Since reaction time performance is altered in both, we pr...
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This pilot study investigates the new technology of radiofrequency energy (RFe), as applied to the tongue base, for the purpose of assessing feasibility, safety, and possible efficacy in the treatment of sleep-disordered breathing (SDB). Eighteen patients with SDB, in whom at least palatopharyngoplasty had failed, were entered in this study. The me...
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Ideal treatment for nasal obstruction caused by turbinate hypertrophy remains in question. Medical therapy is often ineffective. Surgical procedures have associated morbidity including pain, bleeding, crusting, adhesion, infection, and dryness. Radiofrequency has recently been shown to be safe and effective in volumetric tissue reduction of the ton...
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The etiology of sleep disordered breathing is collapse or obstruction of the upper airway during sleep. This obstruction may be localized to one or two areas or may encompass the entire upper airway passages to include the nasal cavity, nasopharynx, oropharynx, hypopharynx, and larynx. The presurgical evaluation, which includes polysomnography, a c...
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The etiology of sleep disordered breathing (SDB), which includes upper airway resistance syndrome (UARS) and obstructive sleep apnea syndrome (OSAS), is collapse or obstruction of the upper airway during sleep. Surgical management was the first treatment modality available for SDB. Since the introduction of the tracheotomy to treat OSAS, there have...
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Full-text available
To evaluate pain, swallowing, speech, edematous response, tissue shrinkage, sleep, snoring, and safety (energy limits and adverse effects) following radiofrequency (RF) treatment to the palate in 22 subjects with sleep-disordered breathing. This investigation is a prospective nonrandomized study. Polysomnography, radiographic imaging, and infrared...
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Sleep-related breathing disorders (SRBD) encompass a spectrum of disease severity that includes simple snoring, upper airway resistance syndrome (UARS), obstructive sleep apnea (OSA), and obesity-hypoventilation syndrome. Treatment is instituted to avoid the cardiovascular sequelae and behavioral derangements of sleep-related upper airway collapse....
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This article discusses the history of operative management of obstructive sleep apnea syndrome and reviews a protocol for surgical intervention. An overview of diagnostic procedures and evaluation is also presented, and emerging technology for the management of this disorder is touched on.
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Hypoxemia, hypertension, airway obstruction, and death have been associated with surgery for obstructive sleep apnea syndrome (OSAS). Patient analysis was undertaken to identify potential factors that could affect risk-management outcome. One hundred eighty-two consecutively treated patients with OSAS undergoing 210 procedures were evaluated. Fifty...