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Zreaqat M, Hassan R, Samsudin AR, Alforaidi S. Effects of twin-block appliance on upper airway parameters in OSA children with class II malocclusion and mandibular retrognathia: a CBCT study. Eur J Pediatr 2023; 182:5501-5510. [PMID: 37777602 DOI: 10.1007/s00431-023-05226-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/15/2023] [Accepted: 09/17/2023] [Indexed: 10/02/2023]
Abstract
Twin-block appliance had been advocated as a potential treatment option in paediatric obstructive sleep apnoea (OSA) due to their favourable effect in enhancing upper airway parameters and improving OSA symptoms. The aim of this study was to evaluate the effect of twin-block appliance therapy on upper airway parameters/dimensions and the apnoea-hypopnea indexes (AHIs) in OSA children with class II mandibular retrognathic skeletal malocclusion using cone-beam computed tomography. This prospective longitudinal study comprised 34 polysomnography-proven OSA growing children with class II mandibular retrognathic skeletal malocclusion between the ages of 8 and 12 years who had completed myofunctional twin-block therapy and matched corresponding controls. The upper airway was segmented into the nasopharynx, oropharynx, and hypopharynx, and the effect of twin-bock treatment on upper airway parameters/dimensions was assessed pre- and posttreatment using CBCT analysis, while a second standard overnight PSG was performed to determine changes in the AHI. At the nasopharynx level, minimal (nonsignificant) increases in all variables were observed within the twin-block group and between the groups (P > 0.05). At the level of the oropharynx, all variables increased significantly in the treatment group and between groups (P < 0.001), but these increases were nonsignificant in the control group. At the level of the hypopharynx, only the minimum cross-sectional area (MCA) increased significantly in the treatment group (P = 0.003). The change in MCA was also significant between the groups (P = 0.041). In addition, the upper airway length increased significantly in the twin-block group (P = 0.0154), and the AHI decreased by 74.8% (P < 0.001). CONCLUSION Correction of class II mandibular retrognathic skeletal malocclusion with twin-block appliance resulted in a significant increase in upper airway volume, MCA, anteroposterior and lateral distances of the MCA at the level of the oropharynx, MCA at the level of the hypopharynx and upper airway length, and a significant decrease in AHI, but it had no effect on nasopharynx parameters. WHAT IS KNOWN • CBCT imaging has been shown to be an effective and precise diagnostic tool for analyzing the upper airways and craniofacial structures. • Twin block appliance may be an effective treatment modality in children with OSA. WHAT IS NEW • Minimal cross-sectional area of upper ways may be the most relevant potential parameter when explaining how the upper airway anatomy plays role of in the pathogenesis of pediatric OSA. • Twin block appliance induced favorable changes in upper airway morphology (oropharynx area mainly) and respiratory parameters in OSA children with class II malocclusion.
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Affiliation(s)
- Maen Zreaqat
- Orthodontic Dep., School of Dental Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Rozita Hassan
- Orthodontic Dep., School of Dental Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.
| | - A R Samsudin
- Maxillofacial Surgery Dep., College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Sahal Alforaidi
- Pediatric and Orthodontic Dep. College of Dentistry, Taibah University, Medina, Saudi Arabia
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Correlation between Polysomnographic Parameters and Tridimensional Changes in the Upper Airway of Obstructive Sleep Apnea Patients Treated with Mandibular Advancement Devices. J Clin Med 2021; 10:jcm10225255. [PMID: 34830533 PMCID: PMC8621062 DOI: 10.3390/jcm10225255] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 12/17/2022] Open
Abstract
Background. The effectiveness of mandibular advancement devices has been solidly demonstrated in the past. They are considered a valid alternative treatment to continuous positive airway pressure for patients with obstructive sleep apnea. Nevertheless, the relationship between polysomnographic parameters and the increase in the volume of the upper airway in patients with obstructive sleep apnea syndrome has not been clearly established so far. This study aimed to determine the impact of these oral appliances upon the volume of the airway after the device titration phase and correlate it with the degree of mandibular advancement and the improvement of polysomnographic parameters. Methods. All patients were diagnosed by polysomnography and were treated with a customized, titratable mandibular advancement device. Three-dimensional volumetric measurements were performed using cone beam computed tomography. Results. The present study included 45 patients diagnosed with obstructive sleep apnea hypopnea syndrome (mild in 23 patients, moderate in 11 and severe in 11). Forty-four percent of the patients presented with an apnea hypopnea index <5/h at the end of treatment. The volume of the upper airway increased an average of 4.3 ± 5.9 cm3, this represents a percentage increase of 20.9%, which was significantly correlated with an apnea hypopnea index and a minimum oxygen saturation improvement. Conclusions. The mandibular advancement device used was found to be effective in improving polysomnographic parameters. Moreover, the oral appliance was able to significantly increase the tridimensional dimensions of the upper airway. Moreover, this finding was correlated with a reduction in the apnea hypopnea index (p = 0.007) and an increase on minimum oxygen saturation (p = 0.033).
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Alkhader M, Alrashdan MS, Abdo N, Abbas R. Usefulness of Hard Palate Measurements in Predicting Airway Dimensions in Patients Referred for Cone Beam CT. Open Dent J 2021. [DOI: 10.2174/1874210602115010505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose:
The aim of the study was to evaluate the usefulness of hard palate measurements in predicting airway dimensions in patients referred for cone-beam CT (CBCT).
Materials and Methods:
Six hundred forty-three patients (239 males and 404 females) were examined by CBCT. Using dedicated CBCT software (Kodak CS 3D imaging version 3.8.6, Carestream, Rochester, NY, USA); different hard palate (palatal interalveolar length, palatal arch depth, maxillo-palatal arch angle, and alveolar width) and airway measurements (airway volume, minimum cross-sectional area, minimum anteroposterior distance, minimum right to left distance and airway length) were obtained and correlated using Pearson’s correlation coefficients and regression analysis.
Results:
Although the correlation between hard palate and airway measurements was weak (Pearson coefficient (r) < 0.40), there were significant (P < 0.05) additive effects for hard palate measurements in predicting airway dimensions. Maxillo-palatal arch angle was the only hard palate measurement that had no effect in predicting airway dimensions.
Conclusion:
Hard palate measurements are considered useful in predicting airway dimensions in patients referred for CBCT.
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Van de Perck E, Op de Beeck S, Dieltjens M, Vroegop AV, Verbruggen AE, Willemen M, Verbraecken J, Van de Heyning PH, Braem MJ, Vanderveken OM. The relationship between specific nasopharyngoscopic features and treatment deterioration with mandibular advancement devices: a prospective study. J Clin Sleep Med 2021; 16:1189-1198. [PMID: 32267227 DOI: 10.5664/jcsm.8474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
STUDY OBJECTIVES The variable efficacy of mandibular advancement device (MAD) treatment necessitates both accessible and accurate methods for patient selection. However, the role of awake nasopharyngoscopy for this purpose remains dubious. We introduced an assessment method based on anatomical upper airway features during tidal breathing for nasopharyngoscopy. The current study aimed to relate these features to MAD treatment outcome. METHODS One hundred patients diagnosed with obstructive sleep apnea were prospectively recruited for MAD treatment in a fixed 75% degree of maximal protrusion. Nasopharyngoscopic observations during Müller's maneuver and tidal breathing were recorded both with and without MAD. Treatment outcome, confirmed by 3-month follow-up polysomnography with MAD, was classified as (1) apnea-hypopnea index reduction ≥ 50%, (2) treatment apnea-hypopnea index < 5 events/h, and (3) ≥ 10% increase in apnea-hypopnea index compared with baseline (treatment deterioration). RESULTS A complete dataset was obtained in 65 patients. After adjusting for baseline apnea-hypopnea index, body mass index, and supine dependency, the position of the soft palate (odds ratio, 4.0; 95% confidence interval, 1.3-11.8; P = .013) and crowding of the oropharynx (odds ratio, 7.7; 95% confidence interval, 1.4-41.4; P = .017) were related to treatment deterioration. Addition of both features significantly (P = .031) improved the accuracy of baseline models based on clinical measurements alone. Moreover, with the MAD in situ, a posteriorly located soft palate (odds ratio, 9.8; 95% confidence interval, 1.7-56.3; P = .010) and a posteriorly located tongue base (odds ratio, 7.4; 95% confidence interval, 1.5-35.9; P = .013) were associated with treatment deterioration. CONCLUSIONS Awake nasopharyngoscopy might be a valuable office-based examination to exclude the risk of treatment deterioration and improve patient selection for MAD treatment. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Predicting Therapeutic Outcome of Mandibular Advancement Device Treatment in Obstructive Sleep Apnea (PROMAD); URL: https://clinicaltrials.gov/ct2/show/NCT01532050; Identifier: NCT01532050.
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Affiliation(s)
- Eli Van de Perck
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Sara Op de Beeck
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Marijke Dieltjens
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Special Dentistry Care, Antwerp University Hospital, Edegem, Belgium
| | - Anneclaire V Vroegop
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Annelies E Verbruggen
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marc Willemen
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Johan Verbraecken
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium.,Department of Pulmonology, Antwerp University Hospital, Edegem, Belgium
| | - Paul H Van de Heyning
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marc J Braem
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Special Dentistry Care, Antwerp University Hospital, Edegem, Belgium
| | - Olivier M Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
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Marco-Pitarch R, García-Selva M, Plaza-Espín A, Puertas-Cuesta J, Agustín-Panadero R, Fernández-Julián E, Marco-Algarra J, Fons-Font A. Dimensional analysis of the upper airway in obstructive sleep apnoea syndrome patients treated with mandibular advancement device: A bi- and three-dimensional evaluation. J Oral Rehabil 2021; 48:927-936. [PMID: 33977548 DOI: 10.1111/joor.13176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 05/21/2020] [Accepted: 04/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The efficiency of the mandibular advancement device (MAD) in patients with obstructive sleep apnoea syndrome (OSAS) has been demonstrated. Nevertheless, the behaviour of the upper airway once MAD is placed and titrated, and its correlation with the apnoea-hypopnoea index (AHI) is still under discussion. OBJECTIVES To analyse the morphological changes of the upper airway through a bi- and three-dimensional study and correlate it with the polysomnographic variable, AHI. METHODS Patients were recruited from two different hospitals for the treatment of OSAS with a custom-made MAD. A cone-beam computer tomography and a polysomnography were performed at baseline and once the MAD was titrated. RESULTS A total of 41 patients completed the study. Treatment with MAD reduced the AHI from 22.5 ± 16.8 to 9.2 ± 11.6 (p ≤ .05). There was a significant increase of the total airway volume with MAD from 21.83 ± 7.05 cm3 to 24.19 ± 8.19 cm3 , at the expense of the oropharynx. Moreover, the correlation between the improvement of the AHI and the augmentation of the volume of the upper airway was not statistically significant. CONCLUSIONS The oral device used in this prospective study increased the mean upper pharyngeal airway volume and significantly reduced the AHI. Future studies that measure the muscular tone are needed to completely understand the association between the AHI and the physiological and anatomical response of the upper airway.
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Affiliation(s)
- Rocío Marco-Pitarch
- Department of Stomatology, Medical School of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Marina García-Selva
- Department of Stomatology, Medical School of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Andrés Plaza-Espín
- Department of Stomatology, Medical School of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | | | - Rubén Agustín-Panadero
- Department of Stomatology, Medical School of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | | | - Jaime Marco-Algarra
- Department of Otorhinolaryngology, Medical School of Medicine and Dentistry, Hospital Clínico Universitario, University of Valencia, Valencia, Spain
| | - Antonio Fons-Font
- Department of Stomatology, Medical School of Medicine and Dentistry, University of Valencia, Valencia, Spain
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Brown EC, Jugé L, Knapman FL, Burke PGR, Ngiam J, Sutherland K, Butler JE, Eckert DJ, Cistulli PA, Bilston LE. Mandibular advancement splint response is associated with the pterygomandibular raphe. Sleep 2021; 44:5955974. [PMID: 33146716 DOI: 10.1093/sleep/zsaa222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 08/05/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To investigate whether the presence of tendinous PMR could predict treatment outcome and how it affects lateral wall mechanical properties. Mandibular advancement increases the lateral dimensions of the nasopharyngeal airway via a direct connection from the airway to the ramus of the mandible. The anatomical structure in this region is the pterygomandibular raphe (PMR), but a tendinous component is not always present. Whether tendon presence influences treatment outcome is unknown. METHODS In total, 105 participants with obstructive sleep apnea completed detailed anatomical magnetic resonance imaging with and without mandibular advancement. The study design was case-control. Variables were compared between participants with and without the tendon present. RESULTS The amount of maximum mandibular advancement decreased when pterygomandibular tendon was present (4.0 ± 1.2 mm present versus 4.6 ± 1.4 mm absent, p = 0.04). PMR tendon-absent participants had a lower posttreatment apnea hypopnea index (16 ± 12 events/hour tendon present versus 9 ± 9 events/hour absent, p = 0.007) and were more likely to have complete response (63% versus 36%, p = 0.02). However, tendon-absent participants were more likely to not complete the study (χ 2 (3) = 10.578, p = 0.014). Tendon-absent participants had a greater increase in midline anteroposterior airway diameter (1.6 ± 1.7 mm versus 0.6 ± 2.3 mm, p = 0.04). CONCLUSION When PMR tendon is absent, treatment response and amount of maximum advancement improve, possibly at the expense of reduced splint tolerability. Tendon presence may help predict a group less likely to respond to mandibular advancement splint therapy.
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Affiliation(s)
- Elizabeth C Brown
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,Prince of Wales Clinical School, Sydney, New South Wales, Australia
| | - Lauriane Jugé
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona L Knapman
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Peter G R Burke
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.,Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Joachim Ngiam
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Kate Sutherland
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jane E Butler
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Danny J Eckert
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Peter A Cistulli
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,Prince of Wales Clinical School, Sydney, New South Wales, Australia
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Jugé L, Yeung J, Knapman FL, Burke PGR, Lowth AB, Gan KZC, Brown EC, Butler JE, Eckert DJ, Ngiam J, Sutherland K, Cistulli PA, Bilston LE. Influence of mandibular advancement on tongue dilatory movement during wakefulness and how this is related to oral appliance therapy outcome for obstructive sleep apnea. Sleep 2021; 44:5909314. [PMID: 32954420 DOI: 10.1093/sleep/zsaa196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/19/2020] [Indexed: 01/17/2023] Open
Abstract
STUDY OBJECTIVES To characterize how mandibular advancement splint (MAS) alters inspiratory tongue movement in people with obstructive sleep apnea (OSA) during wakefulness and whether this is associated with MAS treatment outcome. METHODS A total of 87 untreated OSA participants (20 women, apnea-hypopnea index (AHI) 7-102 events/h, aged 19-76 years) underwent a 3T MRI with a MAS in situ. Mid-sagittal tagged images quantified inspiratory tongue movement with the mandible in a neutral position and advanced to 70% of the maximum. Movement was quantified with harmonic phase methods. Treatment outcome was determined after at least 9 weeks of therapy. RESULTS A total of 72 participants completed the study: 34 were responders (AHI < 5 or AHI ≤ 10events/h with >50% reduction in AHI), 9 were partial responders (>50% reduction in AHI but AHI > 10 events/h), and 29 nonresponders (change in AHI <50% and AHI ≥ 10 events/h). About 62% (45/72) of participants had minimal inspiratory tongue movement (<1 mm) in the neutral position, and this increased to 72% (52/72) after advancing the mandible. Mandibular advancement altered inspiratory tongue movement pattern for 40% (29/72) of participants. When tongue dilatory patterns altered with advancement, 80% (4/5) of those who changed to a counterproductive movement pattern (posterior movement >1 mm) were nonresponders and 71% (5/7) of those who changed to beneficial (anterior movement >1 mm) were partial or complete responders. CONCLUSIONS The mandibular advancement action on upper airway dilator muscles differs between individuals. When mandibular advancement alters inspiratory tongue movement, therapeutic response to MAS therapy was more common among those who convert to a beneficial movement pattern.
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Affiliation(s)
- Lauriane Jugé
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Jade Yeung
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Fiona L Knapman
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Peter G R Burke
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Aimee B Lowth
- Respiratory and Sleep Medicine Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Ken Z C Gan
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Elizabeth C Brown
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Respiratory and Sleep Medicine Department, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Danny J Eckert
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Joachim Ngiam
- Respiratory and Sleep Medicine Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Kate Sutherland
- Respiratory and Sleep Medicine Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Peter A Cistulli
- Respiratory and Sleep Medicine Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Mouhanna-Fattal C, Papadopoulos M, Bouserhal J, Tauk A, Bassil-Nassif N, Athanasiou A. Evaluation of upper airway volume and craniofacial volumetric structures in obstructive sleep apnoea adults: A descriptive CBCT study. Int Orthod 2019; 17:678-686. [PMID: 31488344 DOI: 10.1016/j.ortho.2019.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this investigation was to assess, with a descriptive three-dimensional evaluation, the volume of upper airway (UAWV) and the volume of craniofacial structures in adult patients suffering from obstructive sleep apnoea (OSA) and compare them to the corresponding findings in adults with no sleep disorders. MATERIALS AND METHODS The sample consisted of 54 adult males, 27 suffering from OSA diagnosed by means of the Apnoea Hypopnea Index and 27 with no history of sleep disorders. All subjects had a cone beam computerized tomography scan performed with the same head position. UAWV was assessed with the Amira® software, and craniofacial volumes by means of a specially developed data-processing program, which allowed the construction of tetrahedrons using anatomical landmarks. Assessed volumes were naso-maxillary, cranium upper anterior, oral cavity, post-oral cavity, hyoid to mandible, and post-hyoid. SPSS (version 19.0) was used for the statistical analysis. The Levene's test for Equality of Variance, the t-test for Equality of Means and the Mann-Whitney test were used to evaluate the variables. The level of significance was set at P ≤ 0.05. RESULTS The mean value of UAWV was smaller in the OSA group. The post-hyoid volume, the calculated posterior volume, and the ratio of posterior to total volume showed differences between the groups. CONCLUSIONS Craniofacial structures did not show significant differences between the groups, but in the OSA group the posterior space released for upper airway was significantly bigger and UAWV was significantly smaller.
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Affiliation(s)
| | - Moschos Papadopoulos
- Aristotle University of Thessaloniki, Department of Orthodontics, Faculty of Dentistry, School of Health Sciences, 54124 Thessaloniki, Greece
| | - Joseph Bouserhal
- Saint Joseph University, Department of Orthodontics, Beirut, Lebanon; Boston University, Department of Orthodontics and Dentofacial Orthopedics, Boston, USA.
| | - Alain Tauk
- Saint Joseph University, Department of Orthodontics, Beirut, Lebanon
| | | | - Athanasios Athanasiou
- European University Cyprus, School of Medicine, Department of Dentistry, P.O. Box 22006, Nicosia, Cyprus
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Pharyngeal Airway Space Changes After Condylar Replacement and Mandibular Advancement Surgery. J Oral Maxillofac Surg 2018; 76:1165-1174. [PMID: 29373821 DOI: 10.1016/j.joms.2017.12.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE The aim of this study was to examine the total volume and cross-sectional areas of the pharyngeal airway after bilateral condylar replacement and mandibular advancement surgery. MATERIALS AND METHODS A total of 137 patients (126 women and 11 men) underwent bilateral temporomandibular joint total joint replacement performed by 1 surgeon. A subsample of 30 patients who underwent condylar replacement and only mandibular advancement were evaluated for impact on the airway. Measurements were taken preoperatively, postoperatively, and at a follow-up 1 year after surgery on cone beam computed tomography scans. InVivoDental 3-dimensional imaging (Anatomage, San Jose, CA) was used to measure airway space regarding total volume (in cubic centimeters); minimum cross-sectional area (in square millimeters); minimum cross sections of the first, second, and third cervical vertebrae; and whether the patient had mandibular retrognathia before surgery. A second operator was used to test for interoperator error. Descriptive and bivariate statistics were computed, and the P value was set at .05. RESULTS There was a significant increase in all measurements at the follow-up visit compared with the preoperative visit. There were no significant differences between groups based on simultaneous Le Fort I surgery, mandibular retrognathia, and gender. However, there were statistically significant differences in cross sections 1 and 2, as well as minimum cross-sectional area, regarding age. Condylar replacement and mandibular advancement have a significant association with an increase in airway space. The intraclass correlation coefficient showed excellent agreement between interoperator measurements. CONCLUSIONS Patients undergoing bilateral temporomandibular joint replacement and mandibular advancement surgery showed an increase in pharyngeal airway space at a 1-year follow-up. In this study, age was significantly associated with the cross-sectional areas of the airway, with older patients having smaller values.
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10
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Shete CS, Bhad WA. Three-dimensional upper airway changes with mandibular advancement device in patients with obstructive sleep apnea. Am J Orthod Dentofacial Orthop 2017; 151:941-948. [DOI: 10.1016/j.ajodo.2016.09.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 09/01/2016] [Accepted: 09/01/2016] [Indexed: 11/29/2022]
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Luo H, Tang X, Xiong Y, Meng L, Yi H, Yin S. Efficacy and mechanism of mandibular advancement devices for persistent sleep apnea after surgery: a prospective study. J Otolaryngol Head Neck Surg 2016; 45:56. [PMID: 27809898 PMCID: PMC5096336 DOI: 10.1186/s40463-016-0167-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 10/18/2016] [Indexed: 11/24/2022] Open
Abstract
Background To explore the feasibility, the efficacy, and the mechanism of mandibular advancement devices (MAD) in the treatment of persistent sleep apnea after surgery. Methods Nineteen patients who failed uvulopalatopharyngoplasty (UPPP) or UPPP plus genioglossus advancement and hyoid myotomy (GAHM) were given a non-adjustable MAD for treatment. All patients had polysomnography (PSG) at least 6 months post-UPPP with and without the MAD. Seventeen patients had computed tomography (CT) examinations. Results After the application of MAD, the apnea hypopnea index (AHI) decreased significantly from 41.2 ± 13.1/h to 10.1 ± 5.6/h in the responder group. The response rate was 57.9 % (11/19). During sleep apnea/hypopnea acquired from sedated sleep, the cross-sectional area and anterior-posterior and lateral diameters of the velopharynx enlarged significantly from 4.2 ± 6.0 mm2 to 17.5 ± 15.3 mm2, 1.9 ± 2.3 mm to 6.5 ± 4.1 mm, and 1.1 ± 1.3 mm to 2.6 ± 2.1 mm, respectively (P < 0.01) in the responder group with MAD. The velopharyngeal collapsibility also decreased significantly from 83.3 ± 21.8 % to 46.5 ± 27.1 %. The glossopharyngeal collapsibility decreased from 39.8 ± 39.1 % to −22.9 ± 73.2 % (P < 0.05). Conclusion MAD can be an effective alternative treatment for patients with moderate and severe OSAHS after surgery. The principal mechanisms underlying the effect of MAD are expansion of the lateral diameter of the velopharynx, the enlargement of the velopharyngeal area, the reduction of velopharyngeal and glossopharyngeal collapsibility, and the stabilization of the upper airway.
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Affiliation(s)
- Huiping Luo
- Department of Otolaryngology, the Affiliated Sixth People's Hospital of Shanghai Jiao Tong University, Shanghai, China
| | - Xulan Tang
- Department of Otolaryngology, the Affiliated Sixth People's Hospital of Shanghai Jiao Tong University, Shanghai, China
| | - Yuanping Xiong
- Department of Otolaryngology, the Affiliated Sixth People's Hospital of Shanghai Jiao Tong University, Shanghai, China
| | - Lili Meng
- Department of Otolaryngology, the Affiliated Sixth People's Hospital of Shanghai Jiao Tong University, Shanghai, China
| | - Hongliang Yi
- Department of Otolaryngology, the Affiliated Sixth People's Hospital of Shanghai Jiao Tong University, Shanghai, China.
| | - Shankai Yin
- Department of Otolaryngology, the Affiliated Sixth People's Hospital of Shanghai Jiao Tong University, Shanghai, China
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Ma MA, Kumar R, Macey PM, Yan-Go FL, Harper RM. Epiglottis cross-sectional area and oropharyngeal airway length in male and female obstructive sleep apnea patients. Nat Sci Sleep 2016; 8:297-304. [PMID: 27757056 PMCID: PMC5055050 DOI: 10.2147/nss.s113709] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is a male-predominant condition, characterized by repeated upper-airway collapse with continued diaphragmatic efforts during sleep, and is accompanied by severe physiological consequences. Multiple morphological aspects, including epiglottis cross-sectional area (CSA) and oropharyngeal airway length (OPAL), can contribute to airway collapsibility in the condition. This study focused on the effects of OSA severity, sex, and race on OPA dimensions. MATERIALS AND METHODS Two high-resolution T1-weighted image series were collected from 40 mild-to-severe OSA subjects (age 46.9±9 years, body mass index 30.4±5.4 kg/m2, Apnea-Hypopnea Index score 32.8±22.5, 28 males) and 54 control subjects (47±9 years, 24.7±3.8 kg/m2, 32 males) using a 3 T magnetic resonance-imaging scanner. Caucasian, Asian, African-American, and "other" subjects constituted the study pool. Both image series were realigned and averaged, and reoriented to a common space. CSA and OPAL were measured, normalized for subject height, and compared between sexes and disease-severity levels in OSA and control subjects. RESULTS Significantly reduced epiglottis CSA appeared only in severe OSA vs controls (P=0.009). OPAL increased significantly with OSA severity vs controls (mild, P=0.027; moderate, P<0.001; severe, P<0.001). OSA males showed increased CSA and greater OPAL than OSA females, which may underlie the increased proportion of affected males with higher apnea-hypopnea index scores. However, no significant differences appeared between CSA and OPAL measures for male and female controls, suggesting that airway morphology may not be the sole contributor for airway collapse. No ethnic or racial differences appeared for CSA or OPAL measures. CONCLUSION Sex-based reductions in epiglottis CSA and increased OPAL in OSA subjects may enhance airway-collapse vulnerability, more so with greater disease severity, and partially underlie male vs female susceptibility to the sleep disorder.
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Affiliation(s)
| | - Rajesh Kumar
- Department of Anesthesiology
- Department of Radiological Sciences, David Geffen School of Medicine
- Brain Research Institute
| | | | - Frisca L Yan-Go
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
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Nikander K, von Hollen D, Larhrib H. The size and behavior of the human upper airway during inhalation of aerosols. Expert Opin Drug Deliv 2016; 14:621-630. [PMID: 27547842 DOI: 10.1080/17425247.2016.1227780] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The mouth, the pharynx and the larynx are potential sites of aerosol deposition in the upper airway during inhalation of aerosolized drugs. The right angle bend of the lumen at the back of the mouth, the position of the tongue, the variable size and shape of the lumen in the pharynx and the larynx, and the breathing pattern could increase aerosol deposition in the upper airway and decrease lung deposition. Areas covered: In this review, the anatomy of the upper airway from the oral cavity to the glottis and the impact of mandibular protrusion and incisal opening on the size of the upper airway are highlighted. In addition, the impact of inhalation maneuvers, inhaler mouthpiece geometries and a stepped mouthpiece on the size of the upper airway are discussed. Expert opinion: The structure of the upper airway lumen does not have a fixed cross sectional area and is susceptible to both constriction and distension during inhalation. The size of the upper airway can be enlarged through mandibular protrusion and/or incisal opening which might decrease aerosol deposition in the upper airway and increase lung deposition.
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Affiliation(s)
| | - Dirk von Hollen
- b Respironics Inc., a Philips Healthcare Company , Murrysville , PA , USA
| | - Hassan Larhrib
- c Department of Pharmacy and Pharmaceutical Sciences , University of Huddersfield , Huddersfield , UK
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Three-dimensional evaluation of upper airway in patients with obstructive sleep apnea syndrome during oral appliance therapy. J Craniofac Surg 2015; 26:745-8. [PMID: 25974784 DOI: 10.1097/scs.0000000000001538] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) represents a frequent and common respiratory disease characterized by repeated episodes of complete and/or partial obstruction of upper airways during sleep, normally associated with reduction of oxygen saturation in blood. The oral appliances (OAs) are considered to be an effective treatment modality thanks to the upper airway enlargement. Lateral cephalometry has been used for the 2-dimensional evaluation of upper airway form with several limits. We obtained an accurate 3-dimensional (3D) volume analyses with cone beam computed tomography (CBCT) scans to confirm the effects of OA on the upper airway in patients with OSAS. Ten Italian patients with moderate or severe OSA (3 males and 7 females, 53.4 ± 11.3 years of age, and BMI 24.5 ± 2.7), who cannot tolerate continuous positive air pressure therapy and rejected a surgical approach, were treated with non-adjustable customized OAs and evaluated with CBCT and polysomnography. Upper airway form was examined in the presence and absence of OA and the volume was measured and compared in 2 different areas. Specific planes have been considered to match the data and calculate the benefit obtained with therapy. Nine out of ten patients showed an improvement of total upper airway volume and an improvement in apnea-hypopnea index. Volume increased both in the posterior soft palate region and in the posterior tongue region. In the inferior area, we observed greater differences. 3D image reconstruction accurately confirmed morphological changes in the upper airway during OA therapy. The use of this 3D evaluation is expected to improve the results of OA therapy in the future.
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Marcussen L, Henriksen JE, Thygesen T. Do Mandibular Advancement Devices Influence Patients' Snoring and Obstructive Sleep Apnea? A Cone-Beam Computed Tomography Analysis of the Upper Airway Volume. J Oral Maxillofac Surg 2015; 73:1816-26. [DOI: 10.1016/j.joms.2015.02.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 02/19/2015] [Accepted: 02/20/2015] [Indexed: 01/23/2023]
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Amatoury J, Kairaitis K, Wheatley JR, Bilston LE, Amis TC. Peripharyngeal tissue deformation, stress distributions, and hyoid bone movement in response to mandibular advancement. J Appl Physiol (1985) 2015; 118:282-91. [DOI: 10.1152/japplphysiol.00668.2014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Mandibular advancement (MA) increases upper airway (UA) patency and decreases collapsibility. Furthermore, MA displaces the hyoid bone in a cranial-anterior direction, which may contribute to MA-associated UA improvements via redistribution of peripharyngeal tissue stresses (extraluminal tissue pressure, ETP). In the present study, we examined effects of MA on ETP distributions, deformation of the peripharyngeal tissue surface (UA geometry), and hyoid bone position. We studied 13 supine, anesthetized, tracheostomized, spontaneously breathing adult male New Zealand White rabbits. Graded MA was applied from 0 to ∼4.5 mm. ETP was measured at six locations distributed throughout three UA regions: tongue, hyoid, and epiglottis. Axial computed tomography images of the UA (nasal choanae to glottis) were acquired and used to measure lumen geometry (UA length; regional cross-sectional area) and hyoid displacement. MA resulted in nonuniform decreases in ETP (greatest at tongue region), ranging from −0.11 (−0.15 to −0.06) to −0.82 (−1.09 to −0.54) cmH2O/mm MA [linear mixed-effects model slope (95% confidence interval)], across all sites. UA length decreased by −0.5 (−0.8 to −0.2) %/mm accompanied by nonuniform increases in cross-sectional area (greatest at hyoid region) ranging from 7.5 (3.6–11.4) to 18.7 (14.9–22.5) %/mm. The hyoid bone was displaced in a cranial-anterior direction by 0.42 (0.36–0.44) mm/mm MA. In summary, MA results in nonuniform changes in peripharyngeal tissue pressure distributions and lumen geometry. Displacement of the hyoid bone with MA may play a pivotal role in redistributing applied MA loads, thus modifying tissue stress/deformation distributions and determining resultant UA geometry outcomes.
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Affiliation(s)
- Jason Amatoury
- Ludwig Engel Centre for Respiratory Research, Westmead Millennium Institute, Westmead, New South Wales, Australia
- University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia; and
- UNSW Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Kristina Kairaitis
- Ludwig Engel Centre for Respiratory Research, Westmead Millennium Institute, Westmead, New South Wales, Australia
- University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia
| | - John R. Wheatley
- Ludwig Engel Centre for Respiratory Research, Westmead Millennium Institute, Westmead, New South Wales, Australia
- University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia
| | - Lynne E. Bilston
- Neuroscience Research Australia, Randwick, New South Wales, Australia; and
- UNSW Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Terence C. Amis
- Ludwig Engel Centre for Respiratory Research, Westmead Millennium Institute, Westmead, New South Wales, Australia
- University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia
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Piskin B, Karakoc O, Genc H, Akay S, Sipahi C, Erdem M, Karaman B, Gorgulu S, Yetkin S, Ayyildiz S. Effects of varying mandibular protrusion and degrees of vertical opening on upper airway dimensions in apneic dentate subjects. J Orofac Orthop 2015; 76:51-65. [PMID: 25613384 DOI: 10.1007/s00056-014-0259-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 01/24/2014] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Despite numerous studies investigating the dimensional and therapeutic effects of mandibular advancement splints (MASs), data regarding the effects of differently designed individual and non-adjustable MASs on the upper airway in fully dentate apneic subjects in the sagittal plane including comparison of these effects with a placebo device are sparse. The present study aimed to determine the dimensional changes in the sagittal plane created by differently designed MASs in the upper airway in fully dentate apneic subjects and to compare these changes with the effects of a placebo device. MATERIALS AND METHODS Magnetic resonance (MR) images of 9 dentate apneic subjects with 5 differently designed MASs and without a MAS were obtained. We measured the area of the entire pharynx (velopharynx, oropharynx, hypopharynx) on these MR images and compared the dimensional changes. RESULTS The dimensional changes triggered by two specific MASs (75% of the maximum mandibular protrusion with 5 mm vertical opening, and 75% of the maximum mandibular protrusion with 10 mm of vertical opening) in the entire pharynx in the sagittal plane were statistically significant compared to the other MASs (p < 0.05). The MAS effecting 75% of the maximum mandibular protrusion and 10 mm of vertical opening created a significant dimensional increase only in the velopharyngeal area among the three pharyngeal sites (p ≤ 0.003). CONCLUSION While the degree of mandibular protrusion created by the MAS affects the dimensions of the upper airway, the degree of the vertical opening exerts no significant dimensional effect in the sagittal plane in fully dentate apneic patients. The mandibular protrusion effect is comparatively larger in the velopharyngeal region.
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Affiliation(s)
- B Piskin
- Department of Prosthodontics, Gulhane Military Medical Academy, Ankara, Turkey
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Iwasaki T, Takemoto Y, Inada E, Sato H, Saitoh I, Kakuno E, Kanomi R, Yamasaki Y. Three-dimensional cone-beam computed tomography analysis of enlargement of the pharyngeal airway by the Herbst appliance. Am J Orthod Dentofacial Orthop 2014; 146:776-85. [DOI: 10.1016/j.ajodo.2014.08.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 08/01/2014] [Accepted: 08/01/2014] [Indexed: 11/25/2022]
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Liu CY, Lu HY, Dong FS, Ma WS, Wang J, Hu XY, Wang W. Effects of a mandibular advancement device on genioglossus in obstructive sleep apnoea hypopnea syndrome. Eur J Orthod 2014; 37:290-6. [PMID: 25246607 DOI: 10.1093/ejo/cju042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate effects of mandibular advancement device (MAD) therapy for obstructive sleep apnoea hypopnea syndrome (OSAHS) on the genioglossus contractile properties and fibre-type distribution. MATERIALS AND METHODS Thirty 6-month old male New Zealand white rabbits were randomised into three groups: OSAHS, MAD, and controls. Rabbits in Group OSAHS and Group MAD were established as OSAHS models by injection, at a dose of 2 ml hydrophilic polyacrylamide gel, via the submucous muscular layer of soft palate. Spiral computed tomography (CT) showed a significant reduced retropalatal upper airway, and apnoeas happened with an increase of Apnea Hypopnea Index (AHI) and a decrease of blood oxygen saturation during polysomnography (PSG), which indicated the OSAHS model developed successfully. OSAHS rabbits in Group MAD were fitted with a MAD made from self-curing composite resin, at 30 degrees to the upper incisors, and the mandible was guided forward 3 to 4mm. Further, spiral CT and PSG suggested MAD was effective. Rabbits in 3 groups were induced to sleep for 4-6 hours per day for 8 weeks, after which the genioglossus was removed, mounted in a tissue bath, and stimulated through platinum electrodes; maximal twitch tension, contraction time, half-relaxation time, force-frequency relationship, and fatigability were recorded. The percentage of Type I and Type II fibres was quantified. RESULTS The fatigability and percentage of Type II fibres of genioglossus increased in Group OSAHS compared with controls; this abnormality was corrected by MAD. CONCLUSION MAD therapy for OSAHS could prevent genioglossus fatigue and abnormal fibre-type distribution of genioglossus in OSAHS.
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Affiliation(s)
| | | | | | | | - Jie Wang
- ***Department of Oral Pathology, College of Stomatology, Hebei Medical University, The Key Laboratory of Stomatology, Hebei Province, Shijiazhuang, Hebei, China
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Lu HY, Dong F, Liu CY, Wang J, Liu Y, Xiao W. An animal model of obstructive sleep apnoea-hypopnea syndrome corrected by mandibular advancement device. Eur J Orthod 2014; 37:284-9. [PMID: 25246606 DOI: 10.1093/ejo/cju041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of the study is to establish a stable animal model of obstructive sleep apnoea-hypopnea syndrome (OSAHS) and assess the effectiveness of a mandibular advancement device (MAD). MATERIALS AND METHODS Eighteen 6-month-old male New Zealand white rabbits were randomized into three groups according to intervention: Group OSAHS, Group MAD, and a control group (n = 6 for each group). Rabbits in Group OSAHS and Group MAD were established as OSAHS model by injection, at a dose of 2 ml hydrophilic polyacrylamide gel, in the submucous muscular layer of the soft palate. Computed tomography (CT) and polysomnography (PSG) showed that OSAHS was developed successfully, the rabbits in Group MAD were fitted with the MAD and CT of the upper airway and PSG evaluated its effectiveness. Histological observation of the injection sites was conducted. RESULTS CT scans showed the reduced sagittal space and cross-sectional areas of retropalatal upper airway in Group OSAHS were corrected by MAD (upper airway space in Group MAD was similar to that in the control group). The rabbits in Group OSAHS developed obvious sleep apnoea and hypopnea in supine position, with increased apnoea-hypopnea index and decreased oxygen saturation (SaO2). These were significantly improved by MAD and apnoea and hypopnea were not observed. Histology of the soft palate showed that the injected gel was entirely surrounded with connective tissues. CONCLUSION We primarily developed an OSAHS and MAD therapy animal model with narrow oropharynx in upper airway which could be further available for OSAHS analysis.
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Affiliation(s)
- Hai-yan Lu
- *Department of Orthodontics, College of Stomatology, Hebei Medical University, Shijiazhuang, **The Key Laboratory of Stomatology, Shijiazhuang, Hebei, Departments of
| | - Fusheng Dong
- **The Key Laboratory of Stomatology, Shijiazhuang, Hebei, Departments of ***Oral & Maxillofacial Surgery and
| | - Chun-yan Liu
- *Department of Orthodontics, College of Stomatology, Hebei Medical University, Shijiazhuang, **The Key Laboratory of Stomatology, Shijiazhuang, Hebei, Departments of
| | - Jie Wang
- **The Key Laboratory of Stomatology, Shijiazhuang, Hebei, Departments of ****Oral Pathology, College of Stomatology, Hebei Medical University, Shijiazhuang, China
| | - Ye Liu
- *Department of Orthodontics, College of Stomatology, Hebei Medical University, Shijiazhuang, **The Key Laboratory of Stomatology, Shijiazhuang, Hebei, Departments of
| | - Wei Xiao
- *Department of Orthodontics, College of Stomatology, Hebei Medical University, Shijiazhuang, ***Oral & Maxillofacial Surgery and
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Brown EC, Cheng S, McKenzie DK, Butler JE, Gandevia SC, Bilston LE. Tongue and lateral upper airway movement with mandibular advancement. Sleep 2013; 36:397-404. [PMID: 23450677 DOI: 10.5665/sleep.2458] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To characterize tongue and lateral upper airway movement and to image tongue deformation during mandibular advancement. DESIGN Dynamic imaging study of a wide range of apnea hypopnea index (AHI), body mass index (BMI) subjects. SETTING Not-for-profit research institute. PARTICIPANTS 30 subjects (aged 31-69 y, AHI 0-75 events/h, BMI 17-39 kg/m(2)). INTERVENTIONS Subjects were imaged using dynamic tagged magnetic resonance imaging during mandibular advancement. Tissue displacements were quantified with the harmonic phase technique. MEASUREMENTS AND RESULTS Mean mandibular advancement was 5.6 ± 1.8 mm (mean ± standard deviation). This produced movement through a connection from the ramus of the mandible to the pharyngeal lateral walls in all subjects. In the sagittal plane, 3 patterns of posterior tongue deformation were seen with mandibular advancement-(A) en bloc anterior movement, (B) anterior movement of the oropharyngeal region, and (C) minimal anterior movement. Subjects with lower AHI were more likely to have en bloc movement (P = 0.04) than minimal movement. Antero-posterior elongation of the tongue increased with AHI (R = 0.461, P = 0.01). Mean anterior displacements of the posterior nasopharyngeal and oropharyngeal regions of the tongue were 20% ± 13% and 31% ± 17% of mandibular advancement. The posterior tongue compressed 1.1 ± 2.2 mm supero-inferiorly. CONCLUSIONS Mandibular advancement has two mechanisms of action which increase airway size. In subjects with low AHI, the entire tongue moves forward. Mandibular advancement also produces lateral airway expansion via a direct connection between the lateral walls and the ramus of the mandible. CITATION Brown EC; Cheng S; McKenzie DK; Butler JE; Gandevia SC; Bilston LE. Tongue and lateral upper airway movement with mandibular advancement. SLEEP 2013;36(3):397-404.
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Cohen-Levy J, Pételle B, Pinguet J, Limerat E, Fleury B. Forces created by mandibular advancement devices in OSAS patients. Sleep Breath 2012; 17:781-9. [DOI: 10.1007/s11325-012-0765-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 08/11/2012] [Accepted: 08/20/2012] [Indexed: 11/28/2022]
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Zhang W, Song X, Masumi SI, Tanaka T, Zhu Q. Effects of head and body positions on 2- and 3-dimensional configuration of the oropharynx with jaw protruded: a magnetic resonance imaging study. ACTA ACUST UNITED AC 2011; 111:778-84. [DOI: 10.1016/j.tripleo.2011.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 02/07/2011] [Accepted: 02/08/2011] [Indexed: 11/29/2022]
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Lin YC, Lin HC, Tsai HH. Changes in the Pharyngeal Airway and Position of the Hyoid Bone After Treatment With a Modified Bionator in Growing Patients With Retrognathia. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.jecm.2011.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abi-Ramia LBP, Carvalho FAR, Coscarelli CT, Almeida MADO. Aparelho de avanço mandibular aumenta o volume da via aérea superior de pacientes com apneia do sono. Dental Press J Orthod 2010. [DOI: 10.1590/s2176-94512010000500020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: o diagnóstico, o tratamento e o acompanhamento de pacientes portadores da síndrome da apneia obstrutiva do sono (SAOS) são essenciais, por se tratar de um distúrbio que pode causar alterações sistêmicas. A efetividade do tratamento da SAOS com aparelhos intrabucais foi demonstrada através de estudos cefalométricos. OBJETIVO: o objetivo deste estudo foi avaliar o efeito do aparelho de avanço mandibular (Twin Block, TB) no volume das vias aéreas superiores, por meio de tomografia computadorizada Cone-Beam (CBCT). Dezesseis pacientes (6 homens e 10 mulheres) portadores de SAOS leve a moderada, idade média de 47,06 anos, utilizaram um aparelho de avanço mandibular e foram acompanhados por 7 meses, em média. MÉTODOS: foram feitas duas CBCT, sendo uma sem e outra com o aparelho em posição. A segmentação e a obtenção dos volumes das vias aéreas superiores foram realizadas e utilizado o teste t de Student pareado para análise estatística, com 5% de significância. RESULTADOS: houve aumento do volume da via aérea superior com TB quando comparado com o volume sem TB (p<0,05). CONCLUSÃO: pode-se concluir que o aumento de volume da via aérea superior observado foi associado ao aparelho de avanço mandibular.
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Park JW, Kim NK, Kim JW, Kim MJ, Chang YI. Volumetric, planar, and linear analyses of pharyngeal airway change on computed tomography and cephalometry after mandibular setback surgery. Am J Orthod Dentofacial Orthop 2010; 138:292-9. [PMID: 20816298 DOI: 10.1016/j.ajodo.2009.10.036] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Revised: 10/01/2009] [Accepted: 10/01/2009] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The purpose of this study was to use lateral cephalometry and computed tomography (CT) to examine the volumetric, planar, and linear changes in the pharyngeal airway after mandibular setback surgery. METHODS The pharyngeal airways of 12 subjects who underwent mandibular setback surgery at Seoul National University Dental Hospital were assessed linearly and volumetrically on lateral cephalometric radiographs and CT before surgery and 6 months after surgery. The pharynx, nasopharynx, and oropharynx were evaluated by volumetric analysis. Pharyngeal depth, airway space, pharyngeal soft-tissue thickness, and hyoid bone position were measured by linear analysis. The axial section area of the airway was measured by area analysis. RESULTS From the linear analysis, a significant decrease in pharyngeal depth and a significant posterior movement of the hyoid bone (P <0.05) were noted. Volumetric analysis by CT showed that the oropharynx decreased after mandibular setback surgery. However, the volume and the axial section area of the airway in the CT images did not change significantly after mandibular setback surgery (P >0.05). CONCLUSIONS Although the structures around the mandible inevitably moved backward after mandibular setback surgery on linear analysis, physiologic deformation could occur to preserve the airway capacity after sagittal compression.
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Affiliation(s)
- Jae-Woo Park
- Department of Orthodontics, Kooalldam Dental Hospital, Incheon, Korea
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Yue H, Lin CH, Guilleminault C. Upper airway changes with a mandibular advancement device. Expert Rev Respir Med 2010; 4:25-8. [DOI: 10.1586/ers.09.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Stuck B, Maurer J. Der Stellenwert bildgebender Verfahren bei der obstruktiven Schlafapnoe. SOMNOLOGIE 2009. [DOI: 10.1007/s11818-009-0415-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
29
|
Haskell JA, McCrillis J, Haskell BS, Scheetz JP, Scarfe WC, Farman AG. Effects of Mandibular Advancement Device (MAD) on Airway Dimensions Assessed With Cone-Beam Computed Tomography. Semin Orthod 2009. [DOI: 10.1053/j.sodo.2009.02.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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