Issue: Spring/Summer 2013
Life Saving Sleep
Jeff Prinsell '75
“I went to dental school thinking I was going to become an orthodontist,” reflects Jeff Prinsell ’75. Now, Prinsell is a world-renowned innovator in sleep medicine surgery. His unmistakable passion seeps through in the work he does to help people suffering from Obstructive Sleep Apnea (OSA).
After graduating from Houghton, Prinsell went to Tufts Dental School, followed by a dental residency where he discovered his passion – surgery. This led him to Vanderbilt for medical school, a general surgery internship, and an oral and maxillofacial surgery residency. His private practice (www.drprinsell.com) is in Atlanta. Among a limited number of board-certified oral and maxillofacial surgeons licensed in both dentistry and medicine, Prinsell explains that the dual education and training gave him a more complete picture of OSA. “It really worked hand-in-hand, being able to converse with different medical specialties as well as the dental community, as both disciplines work with the airway,” said Prinsell.
What is OSA ?
OSA is a medical disorder in which the upper airway obstructs during sleep, triggering pauses in breathing. The brain is oxygen deprived, resulting in daytime sleepiness, irritability, depression, shortterm memory loss, reduced libido, and impaired concentration. Left untreated long-term, OSA can lead to high blood pressure, heart problems, stroke, and death during sleep. Many industrial and motor vehicle accidents, which also place the public at risk, are caused by the daytime sleepiness from untreated OSA.
People suffering with OSA often live their daily lives as though in a fog, without realizing why. “It’s a severe medical problem, thought to be under-diagnosed,” said Prinsell. “There are thousands of people that do not know they have OSA and, therefore, are not being treated.”’
Diagnosis and Treatment
Snoring, usually reported by a spouse, often drives the person to seek treatment. Treatments can include weight loss, dental appliances, and continuous positive airway pressure (CPAP). When these are intolerable or ineffective, surgery may be an option.
Maxillomandibular advancement (MMA) surgery advances the upper and lower jaws through controlled jawbone cuts to pull forward the soft palate and tongue base, which opens the entire upper airway. Once considered a last resort for severe cases of OSA, MMA surgery, through the work of Prinsell and others, has become a primary operation, even for mild cases of OSA.
Prinsell’s innovations include refinements in diagnostic and surgical techniques. Years ago, the main indication for MMA was a lower facial skeletal deformity, such as a retruded lower jaw. Both jaws were typically advanced the same amount, often resulting in an unaesthetic result. Prinsell showed that the primary anatomic criterion was hypopharyngeal airway (behind the tongue base) narrowing, rather than a skeletal deformity. His counterclockwise rotational advancement allows more lower jaw advancement that results in greater hypopharyngeal airway opening to enhance MMA effectiveness, and a more aesthetically pleasing facial appearance.
Prinsell also established goals and guidelines for OSA surgery. In earlier methodical protocols, MMA was typically performed only after stages of less effective and often painful dysfunctional surgery failed. Prinsell demonstrated what adjunctive procedures can be performed safely together with MMA in a “site-specific” approach — on the correctly identified anatomic sites of airway obstruction, which varies between different patients — as a comprehensive, definitive, single-staged operation.
Prinsell’s MMA innovations have produced extraordinary results. In a five-year clinical study of MMA surgery in 50 consecutive OSA patients, he reported a 100% success rate (Chest 116:1519-1529,1999) – highest worldwide (Chapter 114 in textbook Current Therapy in Oral and Maxillofacial Surgery, Elsevier, 2011). He continues to publish and lecture, nationally and internationally (eg.,World Congress on OSA in Rome, Italy, this past fall), on MMA for OSA.
The impact of Prinsell’s innovations expands beyond the surgical arena to his committed service in leadership positions (eg., founding president of the American Board of Dental Sleep Medicine, past president of the American Academy of Dental Sleep Medicine, and president-elect of the Georgia Society of Oral and Maxillofacial Surgeons), which helps increase awareness of OSA to healthcare providers and the public through education, establishing standards of practice, and influencing legislation, such as regulation of drowsy driving to reduce motor vehicle accidents.
“I learned the importance of a loving, Christian family at an early age while living in Sierra Leone, West Africa, where my parents served as medical missionaries,” recalls Prinsell. “The biggest influence in my life and work is the love and support of my family,” said Prinsell, who has been married to Kim for 31 years, and with whom he has two sons, Jeffrey and Eric. “Our loving family bonds continue to strengthen over time.”
Medicine is a multi-generational calling in the Prinsell family. His son, Jeffrey, is a physician. His father, Gustave ’48, is a physician, and his mother, Louise, a nurse. Now retired, his parents lead active lives in the Houghton community.
Despite many achievements and accolades throughout his career, Prinsell continues to focus on the lives his work impacts. “Years later, I’ll hear from patients who say ‘this saved my life,’” reflects Prinsell, who cites that relieving others from suffering is the most rewarding aspect of his career.