THE ESSENTIAL ROLE OF THE COM IN THE MANAGEMENT OF SLEEP-DISORDERED BREATHING: A LITERATURE REVIEW AND DISCUSSION.

The origins of Orofacial Myofunctional Therapy began in the early 1960's by orthodontists who recognized the importance of functional nasal breathing, proper swallowing, and more ideal oral rest postures. Re-patterning these functions through myofunctional therapy assisted with better orthodontic outcomes and improved stability. Experts in orofacial myology have concluded that improper oral rest postures and tongue thrusting may be the result of hypertrophy of the lymphatic tissues in the upper airway. Orthodontists are aware of the deleterious effects these habits have on the developing face and dentition. Sleep disordered breathing is a major health concern that affects people from infancy into adulthood. Physicians who treat sleep disorders are now referring patients for orofacial myofunctional therapy. Researchers have concluded that removal of tonsils and adenoids, along with expansion orthodontics, may not fully resolve the upper airway issues that continue to plague patients' health. Sleep researchers report that the presence of mouth breathing, along with hypotonia of the orofacial muscular complex, has been a persistent problem in the treatment of sleep disordered breathing. Orofacial myofunctional disorders (OMDs) coexist in a large population of people with sleep disordered breathing and sleep apnea. Advances in 3D Cone Beam Computed Tomography (CBCT) imaging offer the dental and medical communities the opportunity to identify, assess, and treat patients with abnormal growth patterns. These undesirable changes in oral structures can involve the upper airway, as well as functional breathing, chewing and swallowing. Leading researchers have advocated a multidisciplinary team approach. Sleep physicians, otolaryngologists, dentists, myofunctional therapists, and other healthcare professionals are working together to achieve these goals. The authors have compiled research articles that support incorporating the necessary education on sleep disordered breathing for healthcare professionals seeking education in orofacial myology.

The Armed Services Blood Program: blood support to combat casualty care 2001 to 2011.

BACKGROUND: The Armed Services Blood Program (ASBP) provides the farthest-reaching blood supply in the world. This article provides statistics and a review of blood operations in support of combat casualty care during the last 10 years. It also outlines changes in blood doctrine in support of combat casualty care. METHODS: This is a descriptive overview and review of blood product use and transfusions used by ASBP personnel to support combat operations in Iraq and Afghanistan between October 2001 and November 2011. RESULTS: The ASBP initiated major changes in blood availability and age of blood in theater. In support of data published by physicians in theater, showing improved patient survival when a higher ratio of fresh frozen plasma and red blood cells (RBCs) is achieved, plus the use of platelets, the ASBP increased availability of plasma and established platelet collection facilities in theater. New capabilities included emergency collection of apheresis platelets in the battlefield, availability and transfusion of deglycerolized red cells, rapid diagnostic donor screening, and a new modular blood detachment. Forward surgical facilities that were at one time limited to a blood inventory consisting of RBCs now have a complete arsenal of products at their fingertips that may include fresher RBCs, fresh frozen plasma, cryoprecipitate, and platelets. A number of clinical practice guidelines are in place to address these processes. Changes in blood doctrine were made to support new combat casualty care and damage-control resuscitation initiatives. CONCLUSION: Despite the challenges of war in two theaters of operation, a number of improvements and changes to blood policy have been developed during the last 10 years to support combat casualty care. The nature of medical care in combat operations will continue to be dynamic and constantly evolving. The ASBP needs to be prepared to meet future challenges. LEVEL OF EVIDENCE: Epidemiologic study, level IV.