Selected Papers:

The nose and its impact on snoring and obstructive sleep apnea 
Kerry Olson, M.D. Otolaryngologist/Mayo Clinic…This is a classic that, unfortunately most ENT’s are ignorant of. When nasal obstruction is coupled with flaccid, redundant pharyngeal musculature, snoring, and then later, obstructive sleep apnea occurs.

Inferior Partial Turbinectomy: An effective procedure for chronic rhinitis
Steven Mucci, M.D. Otolaryngologist/Richmond, Va. … Correction of nasal obstruction 92%. Snoring 75%. Obstructive Sleep Apnea 33% (without any UPPP)

Letter to the editor of the Ear, Nose and Throat Journal
George Meredith, MD…Partial resection of the inferior turbinates provides for results that are superior to electrocautery, outfracture, steroid injection and (now) R.F. (radiofrequency) "ablation”. Furthermore, the success rate with UPPP is literally more than doubled when inferior turbinate trim is combined with reasonable palatal surgery

Letter to the editor American Journal of Orthodontics
George Meredith, M.D. …Children who are chronic mouth breathers often go on to develop long narrow faces and have long term nasal obstruction. Because of maxillary compression. A concept that most ORL and allergists have yet to grasp.

The Influence of Nasal Obstruction and Chronic Mouth Breathing on Dentofacial Aesthetics.
George Meredith, M.D. - Perspectives in Plastic Surgery: Volume 7, Number 1 - 1993. Quality Medical Publishing, Inc., St. Louis, Missouri.

Snoring: An overview with Historical Perspectives, Snoring and Obstructive Sleep Apnea; Raven Press, New York
David Fairbanks, M.D., et al, Washington, D.C. …Hypertension, cor pulmonale (right heart hypertrophy), excessive daytime somnolence, strokes and myocardial infarctions are frequent occurrences in patients who are nasally obstructed, (usually) overweight, snore loudly and have obstructive sleep apnea. Hallmarks include the recussitative snort, myoclonus (twitching and jerking of the arms and, especially, the legs during deep sleep). Correction can be achieved either with CPAP machine or with corrective inferior turbinate surgery combined with conservative palatal surgery.

Diagnosis and Treatment of Nasal Obstruction; Daniel’s Rhinoplasty
George Meredith, M.D. …Nasal physiology. Nasal anatomy. Maxillary compression. The twelve tooth smile. CAT Scans to aid in the diagnosis of nasal obstruction. Nasal allergies debunked. The technique for inferior turbinate trim. Use of the nasal water pik for postoperative nasal toilet. Atrophic rhinitis in postmenopausal women. Comprehensive reference list.

The November 1999 issue of Ear, Nose and Throat Journal was devoted to the diagnosis of obstructive sleep apnea and it’s surgical correction. A comprehensive look at some fairly sophisticated operative techniques involving the tongue, the palate, the mandible and the hyoid. Unfortunately little attention is given to (imperative) inferior turbinate manicure except to mention in passing that R.F. (radiofrequency ablation) of the inferior turbinate would probably improve overall results in some cases. Which it won’t (long-term). And there’s nothing contained herein re: rapid palatal expansion in children or alar rotation in adults with maxillary compression/long face syndrome (the cottle tension nose).

Changes of the Soft Palate after laser UPPP; Archives of Otolaryngology.
Gerald Berger, M.D., et al…Tel-Aviv. This paper confirms what I’ve maintained for over a decade. Palatal scarring and fibrosis and dysfunction are long term sequel of any thermal procedure designed to “stiffen” the soft palate. And this will, in time, I predict include those “high tech” R.F. (radiofrequency) palatal procedures. “The best is cold steel” *The morbidity of laser, electrocautery (and R.F.) UPPP is significant. the failure rate in clinically significant obstructive sleep apnea cases is about 65%. And these thermal procedures, despite their popularity on the Internet and in the otolaryngology literature should be abandoned for the above mentioned reasons.

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