The dawn of sleep medicine began at Stanford University a little more than 50 years ago. In an auditorium filled to the brink, Professor William Dement taught his inaugural class called “Sleep and Dreams.” It was the first course of its kind, dedicated to the understanding of sleep. A sleep disorders clinic quickly followed, and for the first time, people bothered by their sleep can be treated for a medical condition.
My mentors, Dr. Nelson Powell and Dr. Robert Riley, then pioneered procedures and a protocol to treat obstructive sleep apnea (OSA) surgically. Dr. Powell and Dr. Riley were dentists, before becoming otolaryngologists. It was their interdisciplinary training that brought about success in treating OSA, and our understanding that both soft tissue and skeletal construct factor in treatment success.
Today, the intersection of medicine, surgery, and dentistry for the care of OSA patients is a hot topic. While there are real-world obstacles such as reimbursement, patient-centered and precision care is optimized by an interdisciplinary approach.
In my two lectures, I will discuss the original Stanford sleep surgical protocol, and the contemporary protocol. I use the protocol as an outline, to discuss at every step, the past, present, and precision of upper airway treatment. I will include historical perspectives, current standard of care, and ongoing research. Where there is particular interest for the dental community, I will certainly highlight and look forward to a lively Q and A.
From my perspective, the most important concept to share with you is seeing sleep-disordered breathing with a developmental view, and that care is on a continuum. Every field of dentistry has a role to play in the care of OSA patients. As dentists, we have a head start on the understanding of form and function. I look forward to sharing with you the core value of my work – Restoring Airway Health in Sleep is the Gateway to Wellness.
Associate Professor of Otolaryngology, and by courtesy, to the Division of Plastic & Reconstructive Surgery
Stanford University School of Medicine
Director, Sleep Surgery Fellowship
- Invited professorships to 5 Universities
- Keynote talks at the American, Chinese, Spanish Sleep Medicine Conferences
- Keynote talks at international ENT and Maxillofacial Conferences
- Chair to 7 World Sleep Symposiums
- Grand Rounds Speaker to 9 Universities
- 80 original scientific texts, 22 book chapters
My introduction to sleep came by way of the iconic Sleep and Dreams undergraduate course at Stanford by the late Dr. Bill Dement. Surgically, I owe my mentors who are also pioneers of our field in Dr. Nelson Powell and Dr. Robert Riley. The Powell and Riley Stanford sleep surgery approach has served as a foundation to our clinical approach. Since starting as a faculty member at Stanford after my fellowship in 2014, I have continued to update the approach to patients with sleep-disordered breathing.
Surgery for sleep apnea should aim to restore form, followed by re-training of function. The ideal facial and airway form during sleep would promote nasal breathing and upper airway dilator muscle function, both of which work best with optimal maxillofacial skeletal position.
In my talk, I will focus on:
- Surgical interventions for the internal nasal valve, including maxillary expansion
- “UPPP”, which should now be “uvulopalato-preservation-pharyngoplasty”
- How to improve treatment efficacy of hypoglossal nerve stimulation
- Instead of planning MMA with maxilla or mandible first, how about “airway first”