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Al-Somairi MAA, Zheng B, Almaqrami BS, Al-Worafi NA, Alyafrusee ES, Al-Tayar B, Al-Rokhami RK, Al-Warafi LA, Liu Y, Alhammadi MS. Correlation between the three-dimensional hyoid bone parameters and pharyngeal airway dimensions in different sagittal and vertical malocclusions. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101994. [PMID: 39084559 DOI: 10.1016/j.jormas.2024.101994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/20/2024] [Accepted: 07/28/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVE This study aimed to explore the relationship between three-dimensional (3D) measurements of the hyoid bone (HB) and pharyngeal airway space (PAS) in relation to sagittal and vertical malocclusion. METHODS A total of 368 cone-beam computed tomography (CBCT) scans were classified into three skeletal groups (Class I, II, and III) and subdivided by vertical growth patterns (hypodivergent, normodivergent, and hyperdivergent). PAS dimensions, including nasopharyngeal, oropharyngeal, hypopharyngeal, and total airway spaces, were measured in surface area, volume, minimum constricted area (MCA), length, and width, HB position and dimension were analyzed in 3D using InVivo 6.0.3 and Dolphin 11.8 software. Data were analyzed using two-way ANOVA, and Bonferroni post-hoc tests, with P ≤ 0.05 considered significant. RESULTS The study found that patients with skeletal Class III and hypodivergent growth pattern had the highest sagittal position of the hyoid bone, while those with skeletal Class II and hyperdivergent pattern had the lowest hyoid length. Nasopharyngeal airway space width was significantly lower in skeletal Class III patients, while volume and area were lower in hyperdivergent patients. Oropharyngeal and hypopharyngeal dimensions were also affected by skeletal class and growth pattern, with hyperdivergent patients having the lowest values. Total pharyngeal volume, area, and minimum constricted area were also affected, with hyperdivergent patients having the lowest values and skeletal Class II patients having the lowest minimum constricted area. CONCLUSION Pharyngeal airway dimensions and hyoid bone parameters vary with malocclusions. The hyoid bone's position influences the airway, identifying patients at risk for airway obstruction and sleep-disordered breathing.
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Affiliation(s)
- Majedh Abdo Ali Al-Somairi
- Department of Orthodontics, School of Stomatology, China Medical University, Liaoning, Shenyang 110002, China; Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, China; Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Ibb University, Republic of Yemen
| | - Bowen Zheng
- Department of Orthodontics, School of Stomatology, China Medical University, Liaoning, Shenyang 110002, China
| | - Bushra S Almaqrami
- Department of Orthodontics, School of Stomatology, China Medical University, Liaoning, Shenyang 110002, China; Department of Orthodontics, Ningbo Dental Hospital, Ningbo, Zhejiang, China
| | - Naseem A Al-Worafi
- Department of Orthodontics, School of Stomatology, China Medical University, Liaoning, Shenyang 110002, China
| | - Enas Senan Alyafrusee
- Department of Orthodontics, School of Stomatology, China Medical University, Liaoning, Shenyang 110002, China
| | - Barakat Al-Tayar
- Department of Orthodontics, School of Stomatology, China Medical University, Liaoning, Shenyang 110002, China
| | - Remsh K Al-Rokhami
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, China
| | - Leena A Al-Warafi
- Department of Orthodontics, First Affiliated Hospital of Zhengzhou University, China
| | - Yi Liu
- Department of Orthodontics, School of Stomatology, China Medical University, Liaoning, Shenyang 110002, China.
| | - Maged S Alhammadi
- Orthodontics and Dentofacial Orthopedics, Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Saudi Arabia; Postgraduate Orthodontic Program, Department of Orthodontics, Pedodontics and Preventive Dentistry, Faculty of Dentistry, Sana'a University, Republic of Yemen
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Kurbanova A, Aksoy S, Nalça Andrieu M, Öz U, Orhan K. Evaluation of the influence of hyoid bone position, volume, and types on pharyngeal airway volume and cephalometric measurements. Oral Radiol 2023; 39:731-742. [PMID: 37330936 DOI: 10.1007/s11282-023-00691-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 06/09/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES We aimed to explore the position, morphological, and morphometric properties of the hyoid bone (HB) and to investigate the effect of HB on the pharyngeal airway (PA) volume and cephalometric measurements. METHODS A total of 305 patients with CT images were included in the study. DICOM images were transferred to the InVivoDental three-dimensional imaging software. The position of the HB was determined based on the cervical vertebra level and in volume render tab, the bone was classified into six types after all structures around the HB were removed. Also, final bone volume was recorded. In the same tab, the pharyngeal airway volume was divided and measured in three groups (nasopharynx-oropharynx-hypopharynx). The linear and angular measurements were performed on the 3D cephalometric analysis tab. RESULTS HB was most commonly located in C3 vertebra level (80.3%). While B-type was found to be the most frequent (34%), V-type was the least frequent (8%). The volume of the HB was found to be significantly higher in male (3205 mm3) than female (2606 mm3) patients. Also, it was significantly higher in the C4 vertebra group. The vertical height of the face was positively correlated with the HB volume, C4 level position, and increased oro-nasopharyngeal airway volume. CONCLUSION The volume of the HB is found to differ significantly between genders and can potentially serve as a valuable diagnostic tool for understanding respiratory disorders. Its morphometric features are associated with increased face height and airway volume; however, are not related with the skeletal malocclusion classes.
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Affiliation(s)
- Aida Kurbanova
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Near East University, Nicosia, Cyprus.
| | - Seçil Aksoy
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Near East University, Nicosia, Cyprus
| | - Meltem Nalça Andrieu
- Department of Radiation Oncology, Faculty of Medicine, Near East University, Nicosia, Cyprus
| | - Ulaş Öz
- Department of Orthodontics, Faculty of Dentistry, Final International University, Nicosia, Cyprus
| | - Kaan Orhan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
- Medical Design Application and Research Center (MEDITAM), Ankara University, Ankara, Turkey
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Zhang Z, Wang S, Li J, Yang Z, Zhang X, Bai X. Quantification of pharyngeal airway space changes after two-jaw orthognathic surgery in skeletal class III patients. BMC Oral Health 2023; 23:345. [PMID: 37264397 DOI: 10.1186/s12903-023-03075-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 05/25/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Skeletal class III malocclusion is a common dentofacial deformity. Orthognathic treatment changes the position of the jaws and affects the shape of the upper airway to some extent. The aim of this study was to use multislice spiral computer tomography data and orthognathic knowledge to quantify the relationship between the amount of surgical movement of the maxilla or mandible in all three spatial planes and the changes in airway volume that occurred. METHODS A retrospective study of 50 patients was conducted. Preoperative and postoperative linear changes related to skeletal movements of the maxilla and mandible were measured and compared to changes in the most constricted axial level (MCA) and its anteroposterior (MCA-AP) and transverse diameters (MCA-TV). Correlation tests and linear regression analysis were performed. RESULTS Significant interactions were observed between the anterior vertical movement of the maxilla and the MCA-AP. The anteroposterior movement distance of the mandible was significantly correlated with changes in the oropharyngeal, velopharyngeal, total airway volume, MCA, MCA-AP, and MCA-TV. The change in the mandibular plane angle was significantly correlated with the change in velopharyngeal volume, total airway volume (nasopharynx, oropharynx, velopharynx), and MCA. The linear regression model showed that oropharyngeal volume decreased by 350.04 mm3, velopharyngeal volume decreased by 311.50 mm3, total airway volume decreased by 790.46 mm3, MCA decreased by 10.96 mm2 and MCA-AP decreased by 0.73 mm2 when point B was setback by 1 mm. CONCLUSIONS Anteroposterior mandibular control is the key to successful airway management in all patients. This study provides estimates of volume change per millimeter of setback to guide surgeons in treatment planning.
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Affiliation(s)
- Ziqi Zhang
- Department of Oral and Maxillofacial SurgerySchool and Hospital of StomatologyLiaoning Provincial Key Laboratory of Oral Diseases, China Medical University, Shenyang, 110002, China
| | - Shuze Wang
- Department of Oral and Maxillofacial SurgerySchool and Hospital of StomatologyLiaoning Provincial Key Laboratory of Oral Diseases, China Medical University, Shenyang, 110002, China
| | - Jing Li
- Department of Oral and Maxillofacial SurgerySchool and Hospital of StomatologyLiaoning Provincial Key Laboratory of Oral Diseases, China Medical University, Shenyang, 110002, China
| | - Zhijie Yang
- Department of Oral and Maxillofacial SurgerySchool and Hospital of StomatologyLiaoning Provincial Key Laboratory of Oral Diseases, China Medical University, Shenyang, 110002, China
| | - Xia Zhang
- Department of Oral and Maxillofacial SurgerySchool and Hospital of StomatologyLiaoning Provincial Key Laboratory of Oral Diseases, China Medical University, Shenyang, 110002, China
| | - Xiaofeng Bai
- Department of Oral and Maxillofacial SurgerySchool and Hospital of StomatologyLiaoning Provincial Key Laboratory of Oral Diseases, China Medical University, Shenyang, 110002, China.
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Florez BM, Tagawa DT, Inoue DP, Yamashita HK, Aidar LADA, Dominguez GC. Associations between skeletal discrepancies, breathing pattern, and upper airway obstruction in Class III malocclusions. Int J Pediatr Otorhinolaryngol 2023; 166:111471. [PMID: 36764078 DOI: 10.1016/j.ijporl.2023.111471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To verify the associations between sagittal and vertical skeletal discrepancies, changes in upper airways, and breathing pattern in children and adolescents with Angle Class III and Class III subdivision malocclusions. METHODS Eighty-five children and adolescents with a mean age of 9.5 ± 1.74 years were selected. Cephalometry assessed the sagittal relationship (AO-BO measurement), facial types (Ricketts VERT index), nasopharynx, and oropharynx. An otorhinolaryngologist analyzed the breathing pattern and upper airway obstruction during anamnesis, physical examination, anterior rhinoscopy, and nasofibroscopy. Medical records were also reviewed. For statistical analysis, ordinary one-way ANOVA, Kruskal-Wallis (Tukey's post-hoc), unpaired t-test, Pearson's correlation, chi-square, and Fisher's exact tests (p < 0.05) were used. RESULTS The nasopharyngeal cephalometric dimension and pharyngeal tonsil hypertrophy were associated, whereas the oropharyngeal cephalometric dimension and palatine tonsils hypertrophy were not. Sagittal discrepancies were associated with septum deviation, while facial type was associated with inferior turbinate and palatine tonsils hypertrophy. However, facial type was not associated with breathing pattern, septum deviation, and pharyngeal tonsils hypertrophy. CONCLUSIONS Sagittal discrepancies and type of malocclusion were not associated with breathing pattern and changes in upper airways, except for the severity of septum deviation and Class III malocclusions, which were associated with large sagittal discrepancies. Although the facial types analyzed presented signs of airway obstruction, the highest prevalence of inferior turbinate and palatine tonsils hypertrophy were found in patients with dolichofacial type.
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Affiliation(s)
- Bruna Maluza Florez
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Department of Orthodontics, Universidade Santa Cecília, Santos, SP, Brazil.
| | | | - Daniel Paganini Inoue
- Department of Otorhinolaryngology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Helio Kiitiro Yamashita
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | | | - Gladys Cristina Dominguez
- Department of Orthodontics, School of Dentistry, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
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Al-Somairi MAA, Liu Y, Almashraq AA, Almaqrami BS, Alshoaibi LH, Alyafrusee ES, Al-Tayar B, An X, Alhammadi MS. Correlation between the three-dimensional maxillomandibular complex parameters and pharyngeal airway dimensions in different sagittal and vertical malocclusions. Dentomaxillofac Radiol 2023; 52:20220346. [PMID: 36695712 PMCID: PMC9944012 DOI: 10.1259/dmfr.20220346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES This study aimed to determine the three-dimensional (3D) correlation between maxillomandibular complex parameters and pharyngeal airway dimensions in different sagittal and vertical malocclusions. METHODS This retrospective cross-sectional study included the CBCT scans of 368 patients with a mean age of 23.81 ± 3.01 years. The patients were classified into three groups (skeletal Class I, II, and III). Each class group was divided into three subgroups based on vertical growth patterns (hypo-, normo-, and hyperdivergent). The maxillomandibular complex was evaluated in the three planes using 16 skeletal measurements. Naso-, oro-, hypo-, and total pharyngeal airway spaces were assessed in terms of width, volume, surface area, and minimum constricted area (MCA). Two-way ANOVA followed by the Bonferroni post-hoc test were used. RESULTS The nasopharyngeal airway space was significantly lowest regarding sagittal and lateral widths in the skeletal Class III patients, the lowest volume and surface area were in hyperdivergent patients, and MCA was the highest in Class II and hypodivergent patients. The oro- and hypopharyngeal sagittal width, volume, surface area, and MCA were the lowest in the hyperdivergent patients, and oropharyngeal lateral width and hypopharyngeal sagittal width were the highest in skeletal Class III. The total pharyngeal volume, surface area, and MCA were the lowest in the hyperdivergent patients, and skeletal Class II patients had the lowest MCA. CONCLUSIONS The pharyngeal airway dimensions differ with various sagittal and vertical malocclusions. These differences could apply to diagnosis, treatment planning, and possible changes following orthodontic/orthopedic or surgical treatment.
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Affiliation(s)
| | - Yi Liu
- Department of Orthodontics, School of Stomatology, China Medical University, Shenyang, China
| | - Abeer A. Almashraq
- Department of Pre-Clinical Oral Health Sciences, College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Lina H. Alshoaibi
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, China
| | | | - Barakat Al-Tayar
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, China
| | - Xiaoli An
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, China
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Orhan K, Shamshiev M, Ezhov M, Plaksin A, Kurbanova A, Ünsal G, Gusarev M, Golitsyna M, Aksoy S, Mısırlı M, Rasmussen F, Shumilov E, Sanders A. AI-based automatic segmentation of craniomaxillofacial anatomy from CBCT scans for automatic detection of pharyngeal airway evaluations in OSA patients. Sci Rep 2022; 12:11863. [PMID: 35831451 PMCID: PMC9279304 DOI: 10.1038/s41598-022-15920-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 07/01/2022] [Indexed: 11/21/2022] Open
Abstract
This study aims to generate and also validate an automatic detection algorithm for pharyngeal airway on CBCT data using an AI software (Diagnocat) which will procure a measurement method. The second aim is to validate the newly developed artificial intelligence system in comparison to commercially available software for 3D CBCT evaluation. A Convolutional Neural Network-based machine learning algorithm was used for the segmentation of the pharyngeal airways in OSA and non-OSA patients. Radiologists used semi-automatic software to manually determine the airway and their measurements were compared with the AI. OSA patients were classified as minimal, mild, moderate, and severe groups, and the mean airway volumes of the groups were compared. The narrowest points of the airway (mm), the field of the airway (mm2), and volume of the airway (cc) of both OSA and non-OSA patients were also compared. There was no statistically significant difference between the manual technique and Diagnocat measurements in all groups (p > 0.05). Inter-class correlation coefficients were 0.954 for manual and automatic segmentation, 0.956 for Diagnocat and automatic segmentation, 0.972 for Diagnocat and manual segmentation. Although there was no statistically significant difference in total airway volume measurements between the manual measurements, automatic measurements, and DC measurements in non-OSA and OSA patients, we evaluated the output images to understand why the mean value for the total airway was higher in DC measurement. It was seen that the DC algorithm also measures the epiglottis volume and the posterior nasal aperture volume due to the low soft-tissue contrast in CBCT images and that leads to higher values in airway volume measurement.
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Affiliation(s)
- Kaan Orhan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey. .,Medical Design Application, and Research Center (MEDITAM), Ankara University, Ankara, Turkey. .,Department of Dental and Maxillofacial Radiodiagnostics, Medical University of Lublin, Lublin, Poland.
| | | | | | | | - Aida Kurbanova
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Near East University, Nicosia, Cyprus
| | - Gürkan Ünsal
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Near East University, Nicosia, Cyprus.,Research Center of Experimental Health Science (DESAM), Near East University, Nicosia, Cyprus
| | | | | | - Seçil Aksoy
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Near East University, Nicosia, Cyprus
| | - Melis Mısırlı
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Near East University, Nicosia, Cyprus
| | - Finn Rasmussen
- Internal Medicine Department Lunge Section, SVS Esbjerg, Esbjerg, Denmark.,Life Lung Health Center, Nicosia, Cyprus
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Elagib T, Kyung HM, Hung BQ, Hong M. Assessment of pharyngeal airway in Korean adolescents according to skeletal pattern, sex, and cervical vertebral maturation: A cross-sectional CBCT study. Korean J Orthod 2022; 52:345-353. [PMID: 36148641 PMCID: PMC9512630 DOI: 10.4041/kjod21.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/18/2022] [Accepted: 05/12/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To investigate airway volumes using cone-beam computed tomography (CBCT) by skeletal patterns, sex, and cervical vertebral maturation (CVM) stages in Korean adolescents. Methods The sample consisted of pretreatment CBCT and cephalograms of 95 adolescents (aged 12–19) obtained out of 1,611 patients examined for orthodontic treatment from 2018 to 2020 in Kyungpook National University Dental Hospital. The samples were classified into two sex groups; three skeletal pattern groups, four chronological age groups and four CVM stages. Nasopharyngeal volumes (NPV), oropharyngeal volumes (OPV), total pharyngeal airway volume (TAV) and minimum cross-sectional area (MCA) measurements were taken from the CBCT. Multiple linear regression analyses to find out which one of the independent variables are good predictors for airway variables. Significant factors were analyzed by two-way multivariate analysis of variance (MANOVA) then multiple comparisons were analyzed using a t-test, and Fisher least significant difference. Results Age, sex, CVM, and Sella-Nasion-B point have significant influence on airway variable. Males and females showed similar patterns of change in chronological age groups 1–3; however, males had larger NPV, OPV, and MCA at CVM in group 4. According to CVM stages, males had larger OPV, TAV, and MCA at CVM stage 6 (p-value 0.019, 0.021, 0.015, respectively) and no sex differences at CVM stages 3, 4, and 5. Conclusions Skeletal patterns have an effect on airway volume. Sex differences were found in CVM 6.
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Affiliation(s)
- Tassneem Elagib
- Department of Orthodontics, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Hee-Moon Kyung
- Department of Orthodontics, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Bui Quang Hung
- Department of Orthodontics, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Mihee Hong
- Department of Orthodontics, School of Dentistry, Kyungpook National University, Daegu, Korea
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Orofacial myofunctional changes in skeletal Class III patients after bimaxillary orthognathic surgery. J Plast Reconstr Aesthet Surg 2022; 75:3526-3533. [DOI: 10.1016/j.bjps.2022.04.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/04/2022] [Accepted: 04/12/2022] [Indexed: 11/18/2022]
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Upper Airway Changes in Diverse Orthodontic Looms: A Systematic Review and Meta-Analysis. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Upper airway assessment is particularly important in the daily work of orthodontists, because of its close connection with the development of craniofacial structures and with other pathologies such as Obstructive Sleep Apnea Syndrome (OSAS). Three-dimensional cone-beam computed tomography images provide a more reliable and comprehensive tool for airway assessment and volumetric measurements. However, the association between upper airway dimensions and skeletal malocclusion is unclear. Therefore, the current systematic review evaluates the effects of different surgical movements on the upper airway. Materials and Methods: Medline (PubMed, OVID Medline, and EBSCO), Cochrane Library (Cochrane Review and Trails), Web of Knowledge (social science, and conference abstracts), Embase (European studies, pharmacological literature, and conference abstracts), CINAHL (nursing and allied health), PsycInfo (psychology and psychiatry), SCOPUS (conference abstracts, and scientific web pages), and ERIC (education) databases were searched. Two authors independently performed the literature search, selection, quality assessment, and data extraction. Inclusion criteria encompassed computed tomography evaluations of the upper airway spaces with retrospective, prospective, and randomised clinical trial study designs. To grade the methodological quality of the included studies a GRADE risk of bias tool was used. Results and conclusion: In total, 29 studies were included. Among these, 17 studies had a low risk of bias, whereas 10 studies had a moderate risk of bias. A meta-analysis was performed with the mean differences using a fixed-effects model. Heterogeneity was assessed with the Q-test and the I2 index. The meta-analysis revealed significant (p ≤ 0.001, 95% confidence interval) increases in upper airway volume after rapid maxillary expansion and surgical advancement for the correction of Class II.
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Correlation Analysis between Three-Dimensional Changes in Pharyngeal Airway Space and Skeletal Changes in Patients with Skeletal Class II Malocclusion following Orthognathic Surgery. BIOMED RESEARCH INTERNATIONAL 2022; 2022:3995690. [PMID: 35059461 PMCID: PMC8766181 DOI: 10.1155/2022/3995690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/10/2021] [Accepted: 12/16/2021] [Indexed: 12/02/2022]
Abstract
Introduction Studies on the pharyngeal airway space (PAS) changes using three-dimensional computed tomography (CT) have shed more light on patients with Class III than Class II malocclusion. This paper focuses on analyzing the long-term changes in the PAS and evaluating the postoperative association between these PAS and skeletal changes in patients with skeletal Class II malocclusion who have undergone orthognathic surgery. Methods The records of 21 patients with skeletal Class II malocclusion who had undergone orthognathic surgery were included. The anatomical modifications in both jaws, changes in volume, sectional area (SA), minimum sectional area (MSA), and anterior-posterior (AP) and transverse (TV) width in the airway at one month before surgery (T0), and one month (T1) and one year (T2) after surgery were analyzed using CT images. The association between the skeletal and airway changes was evaluated between T0, T1, and T2. Results After surgery, the ANS, A point, and PNS demonstrated significant posterior and superior movement. The B point and the pogonion exhibited substantial anterior and superior movement. The total and inferior oropharyngeal volumes (vol 3, vol 4) notably increased, while the nasopharyngeal volume (vol 1) decreased. The anterior-posterior movement at the ANS and PNS after surgery was significantly associated with the total volume, vol 2, vol 3, SA 1, MSA, and TV width 1, while substantial association with the total volume was found at the pogonion. Conclusion Thus, an ideal treatment plan can be formulated for patients with skeletal Class II malocclusion by considering the postoperative PAS changes.
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Hassing GJ, The V, Shaheen E, Politis C, de Llano-Pérula MC. Long-term three-dimensional effects of orthognathic surgery on the pharyngeal airways: a prospective study in 128 healthy patients. Clin Oral Investig 2021; 26:3131-3139. [PMID: 34826028 DOI: 10.1007/s00784-021-04295-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/11/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate volumetric and circumferential pharyngeal airway space (PAS) changes and stability over time as evaluated with cone beam computed tomography (CBCT) before and after orthognathic surgery 2 years postoperatively. MATERIALS AND METHODS One hundred twenty-eight patients underwent bimaxillary orthognathic surgery at the Department of Maxillofacial Surgery of University Hospitals, Leuven, Belgium, were recruited prospectively. Patients were divided into 4 groups based on the amount of mandibular advancement in 5 mm increments (< 0 mm, 0-5 mm, 5-10 mm, or > 10 mm). CBCT data was acquired preoperatively and 1-6 weeks, 6 months, 1 year, and 2 years postoperatively. Patients with a history of maxillofacial trauma or surgery, obstructive sleep apnoea syndrome, or craniofacial anomalies were excluded. Nasopharyngeal, oropharyngeal, and hypopharyngeal PAS volumes and constriction surface areas (mCSA) were measured and compared between each time point with a paired t-test. RESULTS The largest significant increase in oropharyngeal volume and mCSA were observed in the 5-10 mm (+ 13.3-21.7%, + 51.3-83.0%)) and > 10 mm (+ 23.3-44.6%, + 92.3-130.0%) mandibular advancement groups. This increase only remained stable 2 years postoperatively in the > 10 mm group. In other mandibular advancement groups, short-term oropharyngeal volume and mCSA increases were noticed, which returned to baseline levels 6 months to 1 year postoperatively. CONCLUSION Bimaxillary advancement osteotomy significantly increases oropharyngeal volume and mCSA, which remains stable between 6 months to 1 year postoperatively. CLINICAL RELEVANCE Long-term stable volumetric and mCSA enlargements were found with > 10 mm mandibular advancements over a period of 2 years. Return towards baseline levels was observed in the other mandibular advancement groups.
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Affiliation(s)
- Gert-Jan Hassing
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Vincent The
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Eman Shaheen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Oral and Facial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Oral and Facial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Maria Cadenas de Llano-Pérula
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium.
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Kim GS, Lim SH, Jeong SR, Park JH. A surgery-first approach using single-jaw rotational mandibular setback in low-angle mandibular prognathism. Am J Orthod Dentofacial Orthop 2021; 160:617-628. [PMID: 34274200 DOI: 10.1016/j.ajodo.2021.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/01/2021] [Accepted: 04/01/2021] [Indexed: 10/20/2022]
Abstract
For the treatment of low-angle mandibular prognathism, rotational mandibular setback surgery is usually performed with Le Fort I maxillary osteotomy to rotate the maxillomandibular complex simultaneously. However, this maxillary surgery can be replaced with the orthodontic intrusion of maxillary posterior teeth. Single-jaw rotational mandibular setback surgery can be done with a surgery-first approach by planning orthodontic rotation of the maxillary occlusal plane with the simulation of the postsurgical forward mandibular rotation. This case report describes this approach applied to a 19-year-old female patient with low-angle mandibular prognathism but without maxillary deficiency. A Class II open bite was formed by the rotational setback surgery. During postsurgical orthodontic treatment, the maxillary total arch was distalized with maxillary molar intrusion using palatal mini-implants and lever. This case report demonstrates that orthodontic rotation of the maxillary occlusal plane and simulation of mandibular rotation can replace maxillary surgery and enable single-jaw rotational mandibular setback surgery with a surgery-first approach.
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Affiliation(s)
- Gyeong-Su Kim
- Department of Orthodontics, College of Dentistry, Chosun University, Gwangju, South Korea
| | - Sung-Hoon Lim
- Department of Orthodontics, College of Dentistry, Chosun University, Gwangju, South Korea.
| | - Seo-Rin Jeong
- Department of Orthodontics, College of Dentistry, Chosun University, Gwangju, South Korea
| | - Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, Ariz, Graduate School of Dentistry, Kyung Hee University, Seoul, South Korea
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13
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Di Carlo G, Gili T, Caldarelli G, Polimeni A, Cattaneo PM. A community detection analysis of malocclusion classes from orthodontics and upper airway data. Orthod Craniofac Res 2021; 24 Suppl 2:172-180. [PMID: 33966341 DOI: 10.1111/ocr.12490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/19/2021] [Accepted: 05/03/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The interaction between skeletal class and upper airway has been extensively studied. Nevertheless, this relationship has not been clearly elucidated, with the heterogeneity of results suggesting the existence of different patterns for patients' classification, which has been elusive so far, probably due to oversimplified approaches. Hence, a network analysis was applied to test whether different patterns in patients' grouping exist. SETTINGS AND SAMPLE POPULATION Ninety young adult patients with no obvious signs of respiratory diseases and no previous adeno-tonsillectomy procedures, with thirty patients characterized as Class I (0 < ANB < 4); 30 Class II (ANB > 4); and 30 as Class III (ANB < 0). MATERIALS AND METHODS A community detection approach was applied on a graph obtained from a previously analysed sample: thirty-two measurements (nineteen cephalometric and thirteen upper airways data) were considered. RESULTS An airway-orthodontic complex network has been obtained by cross-correlating patients. Before entering the correlation, data were controlled for age and gender using linear regression and standardized. By including or not the upper airway measurements as independent variables, two different community structures were obtained. Each contained five modules, though with different patients' assignments. CONCLUSION The community detection algorithm found the existence of more than the three classical skeletal classifications. These results support the development of alternative tools to classify subjects according to their craniofacial morphology. This approach could offer a powerful tool for implementing novel strategies for clinical and research in orthodontics.
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Affiliation(s)
- Gabriele Di Carlo
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Tommaso Gili
- Networks Unit, IMT School for Advanced Studies Lucca, Lucca, Italy.,Department of Molecular Sciences and Nanosystems, Ca'Foscari University of Venice, Venezia Mestre, Italy
| | - Guido Caldarelli
- Department of Molecular Sciences and Nanosystems, Ca'Foscari University of Venice, Venezia Mestre, Italy.,CNR-ISC Unità Sapienza, Rome, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Paolo M Cattaneo
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic., Australia
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Sin Ç, Akkaya N, Aksoy S, Orhan K, Öz U. A deep learning algorithm proposal to automatic pharyngeal airway detection and segmentation on CBCT images. Orthod Craniofac Res 2021; 24 Suppl 2:117-123. [DOI: 10.1111/ocr.12480] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/23/2021] [Accepted: 02/17/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Çağla Sin
- Faculty of Dentistry Department of Orthodontics Near East University Mersin10 Turkey
| | - Nurullah Akkaya
- Department of Computer Engineering Applied Artificial Intelligence Research Centre Near East University Mersin10 Turkey
| | - Seçil Aksoy
- Faculty of Dentistry Department of Dentomaxillofacial Radiology Near East University Mersin10 Turkey
| | - Kaan Orhan
- Faculty of Dentistry Department of Dentomaxillofacial Radiology Ankara University Ankara Turkey
- Medical Design Application and Research Center (MEDITAM) Ankara University Ankara Turkey
| | - Ulaş Öz
- Faculty of Dentistry Department of Orthodontics Near East University Mersin10 Turkey
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Saati S, Ramezani K, Ramezani N, Alafchi B. Evaluation of pharyngeal airway volume and nasal septum deviation relation in different sagittal and vertical craniofacial patterns through cone beam computed tomography. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2021. [DOI: 10.1016/j.ajoms.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Shetty P, Shetty M, Chalapati M, Kori C, Soans CR, S. MP. Comparative Evaluation of Hard-Tissue and Soft-Tissue Changes following Fixed Functional Appliance Treatment in a Skeletal Class II Malocclusion Using Forsus and PowerScope. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2021. [DOI: 10.1055/s-0041-1722821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Introduction The purpose of this study was to evaluate and compare the skeletal, dentoalveolar and soft-tissue effects of 2 fixed functional appliance; Forsus Fatigue Resistance Device (FFRD) and PowerScope appliance in treating patients with skeletal class II division 1 malocclusion.
Materials and Methods This comparative prospective two-group study included 20 patients with a mean age of 11.2 ± 1.6 years with skeletal class II malocclusion with retrognathic mandible. One group was treated with FFRD, and second group was treated with PowerScope appliance. Lateral cephalograms were evaluated at T1 (pre-functional appliance treatment)) and at T2 (postappliance treatment). Cephalometric values were calculated and assessed to evaluate skeletal, dentoalveolar and soft-tissue changes.
Results Sagittal correction of class II malocclusion appeared to be mainly achieved by dentoalveolar changes in the PowerScope group. The FFRD was able to induce both skeletal and dentoalveolar changes. A favorable influence on facial convexity was achieved by both groups. A significant increase in upper pharynx and lower pharynx dimension was seen in the PowerScope group. A statistically significant decrease in upper lip protrusion, increase in lower lip protrusion, increased nasolabial angle, and decrease in inferior labial sulcus were noted in both the groups. Lower incisors proclined more in the PowerScope group.
Conclusion Both appliances were effective in correcting class II malocclusion. Forsus had more skeletal effects on the mandible, whereas PowerScope had less skeletal effects on the mandible and more dentoalveolar effects, contributing to class II correction. Both groups showed a significant improvement in soft-tissue profile. PowerScope group showed a significant increase in airway dimensions.
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Affiliation(s)
- Prajwal Shetty
- Department of Orthodontics and Dentofacial Orthopaedics, A.B. Shetty Memorial Institute of Dental Science, Nitte (Deemed to be) University, Deralakatte, Karnataka, India
| | - Mukul Shetty
- Department of Orthodontics and Dentofacial Orthopaedics, A.B. Shetty Memorial Institute of Dental Science, Nitte (Deemed to be) University, Deralakatte, Karnataka, India
| | - Maitreyi Chalapati
- Orthodontics and Dentofacial Orthopaedics, Private Clinic, Hyderabad, Telangana, India
| | - Chaitra Kori
- Orthodontics and Dentofacial Orthopaedics, Private Clinic, Hubli, Karnataka, India
| | - Crystal Runa Soans
- Department of Orthodontics and Dentofacial Orthopaedics, A.B. Shetty Memorial Institute of Dental Science, Nitte (Deemed to be) University, Deralakatte, Karnataka, India
| | - Murali P. S.
- Department of Orthodontics and Dentofacial Orthopaedics, A.B. Shetty Memorial Institute of Dental Science, Nitte (Deemed to be) University, Deralakatte, Karnataka, India
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von Bremen J, Lotz JH, Kater W, Bock NC, Ruf S. Upper airway changes following high oblique sagittal split osteotomy (HSSO). J Craniomaxillofac Surg 2020; 49:146-153. [PMID: 33423893 DOI: 10.1016/j.jcms.2020.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/16/2020] [Accepted: 12/25/2020] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to evaluate volumetric changes of the posterior airway space (PAS) following bimaxillary surgery using a high oblique sagittal split osteotomy (HSSO) of the mandibular ramus. The cone beam CTs of Class II and Class III patients taken before (T0) and 6-12 months after surgery (T1) were analyzed using 3D software (Mimics® Innovation Suite 18.0). The PAS was divided into three segments (superior, middle, inferior) by three planes parallel to the Frankfurt horizontal plane intersecting at the posterior nasal spine, the velum palatinum and the epiglottis. Total (TPAS) and partial volumes (SPAS = superior, MPAS = middle, IPAS = inferior) were calculated. For the 25 Class II patients, a highly significant increase (p<0.001) of the total, middle and inferior airway space (TPAS: +33.6%, MPAS: +43.1%, IPAS: +55.9%) was found, while the increase of the upper airway space was statistically not significant (+5.4%, p = 0.074). For the 28 Class III patients, the total, middle and inferior airway space increased statistically insignificantly (TPAS: +4.6%, p = 0.265, MPAS: +2.7%, p = 0.387, IPAS: +2.8%, p = 0.495), while the increase of the upper airway space was statistically significant (+9.7%, p = 0.010). Bimaxillary orthognathic surgery using the HSSO technique led to a significant increase of PAS for Class II patients and could conserve the PAS for Class III patients.
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Affiliation(s)
- Julia von Bremen
- Department of Orthodontics, University Giessen, Schlangenzahl 14, 35392, Giessen, Germany.
| | - Jan-Hendrik Lotz
- Private Practice for Maxillofacial Surgery, Zeppelinstr. 24, 61352, Bad Homburg, Germany
| | - Wolfgang Kater
- Private Practice for Maxillofacial Surgery, Zeppelinstr. 24, 61352, Bad Homburg, Germany
| | - Niko C Bock
- Department of Orthodontics, University Giessen, Schlangenzahl 14, 35392, Giessen, Germany
| | - Sabine Ruf
- Department of Orthodontics, University Giessen, Schlangenzahl 14, 35392, Giessen, Germany
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Kang JH. Associations Among Temporomandibular Joint Osteoarthritis, Airway Dimensions, and Head and Neck Posture. J Oral Maxillofac Surg 2020; 78:2183.e1-2183.e12. [PMID: 32898485 DOI: 10.1016/j.joms.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study sought to investigate associations among progressive temporomandibular joint osteoarthritis (TMJ OA), airway dimensions, and head and neck posture. MATERIALS AND METHODS In total, 114 temporomandibular disorders (TMDs) patients were enrolled. Among 114 patients, 28 had no pathologic bony changes in the TMJ condyles (TMDnoOA), 45 had progressive TMJ OA (TMJOApro), and 41 demonstrated TMJ OA which had not progressed for 12 months (TMJOAnopro). TMJ OA was diagnosed based on the Diagnostic Criteria for TMD axis I. Computed tomography (CT) images and lateral cephalograms were obtained at baseline (T0) and 12 months after treatment (T1). The head and neck posture and airway area in upright position were analyzed using lateral cephalograms whereas airway volume in supine position was determined by 3D reconstructed CT images. RESULTS The volume change of the oropharynx in supine position was more prominent in the TMJOApro than in the TMDnoOA but no significant differences in changes in the pharyngeal airway while in upright position were detected. The retrognathic facial profile became more remarkable at T1 in the TMJOApro and TMJOAnopro compared to those at T0. The forward head posture seemed to be progressed in the TMJOApro than in either the TMJOAnopro or TMDnoOA. CONCLUSION Progressive TMJ OA may have associations with retrognathia and decreased oropharyngeal airway volume in the supine position but not in the upright position. Progressive TMJ OA may be related with altered head posture in the upright position to compensate for reduced airway dimensions.
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Affiliation(s)
- Jeong-Hyun Kang
- Clinic of Oral Medicine and Orofacial Pain, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Korea (ROK).
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19
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Kim MS, Lim SH, Jeong SR, Park JH. Maxillary molar intrusion and transverse decompensation to enable mandibular single-jaw surgery with rotational setback and transverse shift for a patient with mandibular prognathism and asymmetry. Am J Orthod Dentofacial Orthop 2020; 157:818-831. [PMID: 32487312 DOI: 10.1016/j.ajodo.2019.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 10/24/2022]
Abstract
When performing single-jaw surgery for mandibular setback, the distal segment of the mandible is brought distally along the occlusal plane, leaving the relationship of the B-point and pogonion unchanged. Double-jaw surgery for rotation of the maxillomandibular complex can be considered for solving this problem. However, maxillary surgery for rotational setback of the mandible can be replaced with orthodontic intrusion of the maxillary molars. Correcting the mandibular asymmetry that frequently accompanies mandibular prognathism often requires corrections of roll, yaw, and transverse shift of the mandible. Performing these corrections in mandibular single-jaw setback surgery requires transverse decompensation and orthodontic correction of maxillary occlusal-plane canting. This case report describes the simultaneous achievement of maxillary molar intrusion, transverse decompensation, and canting correction using a palatal lever supported by 2 midpalatal mini-implants. After creating a lateral open bite, mandibular setback surgery was performed with a 13.5° clockwise rotation, 2.9° roll correction, 3.5° yaw correction, and 3.5-mm transverse shift. The application of rotational setback significantly improved the facial esthetics. This case report demonstrates that orthodontic intrusion of the maxillary molars and transverse decompensation can replace maxillary surgery in the treatment of mandibular prognathism with asymmetry.
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Affiliation(s)
- Min-Su Kim
- Department of Orthodontics, College of Dentistry, Chosun University, Gwangju, Korea
| | - Sung-Hoon Lim
- Department of Orthodontics, College of Dentistry, Chosun University, Gwangju, Korea.
| | - Seo-Rin Jeong
- Department of Orthodontics, College of Dentistry, Chosun University, Gwangju, Korea
| | - Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, Ariz; Graduate School of Dentistry, Kyung Hee University, Seoul and Seoul, Korea
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20
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Kocakara G, Buyukcavus MH, Orhan H. Evaluation of pharyngeal airway dimensions and hyoid bone position according to craniofacial growth pattern. Cranio 2020; 40:313-323. [PMID: 32692620 DOI: 10.1080/08869634.2020.1796060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare pharyngeal airway dimensions and hyoid bone position in different craniofacial growth patterns. METHODS In total, 611 patients divided into 9 subgroups were compared according to malocclusion classification and vertical growth pattern, and these subgroups were compared in terms of pharyngeal airway and hyoid measurements. A two-way ANOVA test was used to compare the findings of the subgroups. RESULTS No significant difference was found for the pharyngeal measurements between the groups (p>0.05). The vertical airway length (PNS-Ep) was significantly shorter in the Class III malocclusion group (p<0.05) and in the hypodivergent group (p<0.05). No statistically significant difference was found between any subgroups in any measurements of the position of the hyoid bone (p>0.05). CONCLUSION The pharyngeal airway dimensions and hyoid bone position are similar among individuals in the sagittal direction. The vertical airway length is significantly shorter in Class III and hypodivergent individuals.
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Affiliation(s)
- Gönül Kocakara
- Department of Orthodontics, Faculty of Dentistry, Suleyman Demirel University, Isparta, Turkey
| | | | - Hikmet Orhan
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
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Mechanical Properties of CoCr Dental-Prosthesis Restorations Made by Three Manufacturing Processes. Influence of the Microstructure and Topography. METALS 2020. [DOI: 10.3390/met10060788] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The aim of this study is to compare the mechanical properties of three different dental restorations’ manufacturing processes (CADCAM milling, casting and laser sintering) generated by only one laboratory scanner focusing on marginal fit analysis and their mechanical properties. A chrome-cobalt (Cr-Co) alloy from the same batch was used for three different methods to make an implant abutment. This simulates a maxillary right first molar that was fixed in a hemi-maxillary stone model. Five scans were performed by each tested framework. Nine frameworks were manufactured for each manufacture procedure. Field-Emission Scanning Electron Microscope (FE-SEM) direct vision was used to marginal gap measurement in five critical points for each specimen. In order to fix the samples in the microscope chamber, the restorations were submitted at a compression load of 50 N. The samples always have the same orientation and conditions. The resolution of the microscope is 4 nm and it is equipped by J image software. The microstructure of the samples was also determined with the FE-SEM equipped with EDS-microanalysis. Roughness parameters were measured using White Light Interferometry (WLI). The arithmetical mean for the Ra and Rq of each sample was calculated. The samples were mechanically characterized by means of microhardness and flexural testing. Servo-hydraulic testing machine was used with cross-head rate of 1 mm/min. Two-way ANOVA statistical analysis was performed to determine whether the marginal discrepancies and mechanical properties were significantly different between each group (significance level p < 0.05). The overall mean marginal gap values were: from 50.53 ± 10.30 µm for the samples produced by CADCAM to 85.76 ± 22.56 µm for the samples produced by the casting method. Laser sintering presents a marginal gap of 60.95 ± 20.66 µm. The results revealed a statistically significant difference (p-value < 0.005) in the mean marginal gap between the CADCAM systems studied. The higher flexure load to fracture for these restorations were for CADCAM restoration and the lower was for the casting samples. For these restorations, CADCAM Restoration yielded a higher flexure load to fracture and Casting ones yielded the lower. Porosity and microstructure play a very important role in the mechanical properties.
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Vidal-Manyari PA, Arriola-Guillén LE, Jimenez-Valdivia LM, Dias-Da Silveira HL, Boessio-Vizzotto M. Upper airways evaluation in young adults with an anterior open bite: A CBCT retrospective controlled and cross-sectional study. Int Orthod 2020; 18:276-285. [PMID: 32199748 DOI: 10.1016/j.ortho.2020.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/23/2020] [Accepted: 02/24/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the dimensions of the upper airway in young adults with anterior open bite versus matched individuals with an adequate overbite (control group) using different measurement approaches (linear, area, and volume measures). MATERIALS AND METHODS The sample included 137 cone-beam computed tomographies (CBCTs) of young adults (74 men and 63 women) divided into two groups: 47 CBCTs of individuals (mean age 27.89) with open bite (overbite depth indicator (ODI) 56.84°±9.48° and Frankfort mandibular plane angle (FMA) 31.21°±6.44°) and 90 CBCTs of individuals (mean age 26.87) without an open bite (ODI 62.24°±9.47°, FMA 26.79°±5.81°). Two trained and calibrated orthodontists made all linear, area, and volume measurements on the CBCT records of the upper airways using Planmeca Romexis software. The Mann-Whitney U-test, chi-squared test, and multiple linear regression were applied. Significance was set at P<0.05. RESULTS There were no differences in linear or volume measurements between groups, but there was a greater area in the open bite group (greater mean difference between groups 928.3 mm2) than the control group. No variable influenced nasopharyngeal airway volume, but ANB angle affected oropharyngeal airway volume (β=-623.87) and total airway volume (β=-651.48). CONCLUSIONS Orthodontists should be aware that the airways diagnosis can vary depending on the measurement approach used, the volumetric method being the gold standard. The pharyngeal airway volume was similar in individuals with vs. without an open bite and is mainly influenced by ANB angle in both groups.
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Affiliation(s)
| | | | | | | | - Mariana Boessio-Vizzotto
- Universidade Federal do Rio Grande do Sul, Division of Oral radiology, Faculty of Dentistry, Porto Alegre, Brazil
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Relationship Between Nostril, Nasal Valve and Minimal Cross-Sectional Area in Functional Upper Airway. J Craniofac Surg 2019; 30:2202-2206. [PMID: 31403514 DOI: 10.1097/scs.0000000000005791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To propose a three-dimensional cephalometric analysis of upper airway (UA) related to its functionality, defining normal reference values in healthy individuals and the relationship between nostril, nasal valve, and minimal cross-sectional area (MCS) in functional upper airway. MATERIALS AND METHODS The UAs of 20 Class I patients were analyzed with CBCT using Nemoceph 3D-OS and HOROS software, determining linear distances, volumes and cross-sectional areas, including MCS. RESULTS MCS was mostly located in the middle-upper oropharynx and high hypopharynx. MCS showed moderate correlation with the area of both nares (BNA) (r = 0.60, P = 0.004) and high correlation with the area of both internal nasal valves (BNV) (r = 0.66, P = 0.0016). BNA and BNV showed a moderate correlation (r = 0.445, P = 0.049). A total upper airway (TUA) and functional upper airway (FUA) volumes were established. TUA and FUA showed the strongest statistical correlation (r = 0.82, P = 0.00). A paired samples t test compared the measurement as absolute values of MCS with BNA (t = 0.781, P = 0.44), with BNV (t = -0.12, P = 0.90); and BNA with BNV (t = -0.76, P = 0.45), showed no significant differences. CONCLUSIONS A functional cephalometric analysis of the UA with stable parameters in cervical spine and normal reference values has been proposed. BNA and BNV could be used as reference to establish the MCS compatible with respiratory health.
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Cephalometric Evaluation of the Upper Airway in Different Skeletal Classifications of Jaws. J Craniofac Surg 2019; 30:e469-e474. [PMID: 31299819 DOI: 10.1097/scs.0000000000005637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Respiratory system is an important section in development of maxillofacial components and many studies indicated its effect on normal growth of the jaws. The aim of this study is to evaluate upper airway in different skeletal classifications of jaws in lateral cephalogram and its relation to age and gender. MATERIALS AND METHODS Study samples were 105 digital cephalometric radiographies, 72 females and 33 males. Lateral cephalograms were hand traced and based on Stainer analysis, there were 30 samples in Class I, 30 samples in Class II and 45 samples in Class III subgroup. Vertical linear measurements, horizontal linear measurements, and angular measurement, proportions and space measurements of the airway in the Cephalograms were analyzed by AutoCAD software. RESULTS Data were analyzed using SPSS software version 20. Two horizontal linear measurement (the hypo pharyngeal airway depth, the nasopharyngeal airway depth) and one space measurement (soft palate space) were significantly different in skeletal classes. Vertical and horizontal linear measurements in the 3 groups were increased significantly in men rather than women. The developmental age of groups showed some significant differences. CONCLUSION Upper airway dimension is different in different skeletal classes, developmental ages, and gender.
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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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Alhammadi MS, Almashraqi AA, Halboub E, Almahdi S, Jali T, Atafi A, Alomar F. Pharyngeal airway spaces in different skeletal malocclusions: a CBCT 3D assessment. Cranio 2019; 39:97-106. [PMID: 30821659 DOI: 10.1080/08869634.2019.1583301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: To three-dimensionally evaluate the upper pharyngeal airway spaces in adults with different anteroposterior and vertical skeletal malocclusions.Methods: In this retrospective study, three-dimensional airway volume and the minimum constricted areas of 120 adults were measured from cone beam computed tomography volume scans. The sample was divided into skeletal Class I and Class II and subdivided into average and long face malocclusions in each skeletal Class. Airway volumes of the naso-, palato-, and glossopharynx, and the minimum constricted area were measured and compared.Results: Skeletal Class II reduced glossopharyngeal airway volume and larger total minimum constricted area in average faces and more nasal minimum constricted area in long faces. Skeletal Class II with long face significantly increased palatopharyngeal and glossopharyngeal airway volumes as well as larger palatopharyngeal minimum constricted area (p < 0.05).Conclusion: This paper found a likely association between jaw skeletal classification and airway dimensions.
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Affiliation(s)
- Maged Sultan Alhammadi
- Department of Preventive Dental Sciences, Division of Orthodontics and Dentofacial Orthopedics, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Abeer Abdulkareem Almashraqi
- Department of Maxillofacial Surgery and Diagnostic Sciences, Oral and Maxillofacial Radiology Division, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Esam Halboub
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | | | - Tasneem Jali
- College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Aisha Atafi
- College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Fatima Alomar
- College of Dentistry, Jazan University, Jazan, Saudi Arabia
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Brito FC, Brunetto DP, Nojima MCG. Three-dimensional study of the upper airway in different skeletal Class II malocclusion patterns. Angle Orthod 2018; 89:93-101. [PMID: 30230378 DOI: 10.2319/112117-806.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To characterize upper airway volume and morphology in patients with different skeletal patterns of Class II malocclusion compared to Class I. MATERIALS AND METHODS A total of 197 individuals who had cone-beam computed tomography were allocated into groups according to ANB, SNA, and SNB angles (Class I, Class II maxillary protrusion, Class II mandibular retrusion), each subdivided into hypodivergent, normal, and hyperdivergent. Nasopharynx (NP), oropharynx (OP), and hypopharynx (HP) were assessed with three-dimensional image reconstruction software. RESULTS Intergroup comparison did not detect significant differences in volume and morphology of NP, OP, and HP. The males displayed larger OP and HP volume than the females. Positive correlations between age and NP, OP, HP volume and between craniocervical angle and OP and HP volume were observed. Linear regression analysis detected a tendency for OP and HP volume to increase as maxillary and mandibular length increased. CONCLUSIONS Upper airway volume and morphology were similar in different skeletal patterns of Class II malocclusion. Actual upper and lower jaw lengths were more closely related to upper airway volume and morphology than the angles that reflected their position relative to the cranial base.
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Nejaim Y, Aps JKM, Groppo FC, Haiter Neto F. Evaluation of pharyngeal space and its correlation with mandible and hyoid bone in patients with different skeletal classes and facial types. Am J Orthod Dentofacial Orthop 2018; 153:825-833. [PMID: 29853240 DOI: 10.1016/j.ajodo.2017.09.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 09/01/2017] [Accepted: 09/01/2017] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The purpose of this article was to evaluate the pharyngeal space volume, and the size and shape of the mandible and the hyoid bone, as well as their relationships, in patients with different facial types and skeletal classes. Furthermore, we estimated the volume of the pharyngeal space with a formula using only linear measurements. METHODS A total of 161 i-CAT Next Generation (Imaging Sciences International, Hatfield, Pa) cone-beam computed tomography images (80 men, 81 women; ages, 21-58 years; mean age, 27 years) were retrospectively studied. Skeletal class and facial type were determined for each patient from multiplanar reconstructions using the NemoCeph software (Nemotec, Madrid, Spain). Linear and angular measurements were performed using 3D imaging software (version 3.4.3; Carestream Health, Rochester, NY), and volumetric analysis of the pharyngeal space was carried out with ITK-SNAP (version 2.4.0; Cognitica, Philadelphia, Pa) segmentation software. For the statistics, analysis of variance and the Tukey test with a significance level of 0.05, Pearson correlation, and linear regression were used. RESULTS The pharyngeal space volume, when correlated with mandible and hyoid bone linear and angular measurements, showed significant correlations with skeletal class or facial type. The linear regression performed to estimate the volume of the pharyngeal space showed an R of 0.92 and an adjusted R2 of 0.8362. CONCLUSIONS There were significant correlations between pharyngeal space volume, and the mandible and hyoid bone measurements, suggesting that the stomatognathic system should be evaluated in an integral and nonindividualized way. Furthermore, it was possible to develop a linear regression model, resulting in a useful formula for estimating the volume of the pharyngeal space.
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Affiliation(s)
- Yuri Nejaim
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil.
| | - Johan K M Aps
- Department of Pediatric Dentistry, University of Washington, Seattle, Wash
| | - Francisco Carlos Groppo
- Department of Physiological Sciences, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Francisco Haiter Neto
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
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Kang JH, Sung J, Song YM, Kim YH. Heritability of the airway structure and head posture using twin study. J Oral Rehabil 2018; 45:378-385. [DOI: 10.1111/joor.12620] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2018] [Indexed: 11/28/2022]
Affiliation(s)
- J.-H. Kang
- Clinic of Oral Medicine and Orofacial Pain; Institute of Oral Health Science; Ajou University School of Medicine; Suwon Korea
| | - J. Sung
- Department of Epidemiology; School of Public Health; Seoul National University; Seoul Korea
| | - Y.-M. Song
- Department of Family Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Y.-H. Kim
- Department of Orthodontics; Institute of Oral Health Science; Ajou University School of Medicine; Suwon Korea
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Keum BT, Choi SH, Choi YJ, Baik HS, Lee KJ. Effects of bodily retraction of mandibular incisors versus mandibular setback surgery on pharyngeal airway space: A comparative study. Korean J Orthod 2017; 47:344-352. [PMID: 29090122 PMCID: PMC5653683 DOI: 10.4041/kjod.2017.47.6.344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 05/30/2017] [Accepted: 06/01/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The purpose of this study was to compare the changes induced in the pharyngeal airway space by orthodontic treatment with bodily retraction of the mandibular incisors and mandibular setback surgery without extraction. METHODS This retrospective study included 63 adult patients (32 men and 31 women). Thirty-three patients who had been treated via four-bicuspid extraction and bodily retraction of the mandibular incisors (incisor retraction, IR group) were compared with 30 patients who had been treated via mandibular setback surgery (MS group) without extraction. Lateral cephalograms were acquired and analyzed before (T1) and after treatment (T2). RESULTS The superior pharyngeal airway space did not change significantly in either group during treatment. The middle pharyngeal airway space decreased by 1.15 ± 1.17 mm and 1.25 ± 1.35 mm after treatment in the IR and MS groups, respectively, and the decrease was comparable between the two groups. In the MS group, the inferior pharyngeal airway space (E-IPW) decreased by 0.88 ± 1.67 mm after treatment (p < 0.01). The E-IPW was larger in the MS group than in IR group at T1, but it did not differ significantly between the two groups at T2. No significant correlation was observed between changes in the pharyngeal airway space and the skeletal and dental variables in each group. CONCLUSIONS The middle pharyngeal airway space decreased because of the posterior displacement of the mandibular incisors and/or the mandibular body. The E-IPW decreased only in the MS group because of the posterior displacement of only the mandibular body.
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Affiliation(s)
- Byeong-Tak Keum
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sung-Hwan Choi
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
- Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Yoon Jeong Choi
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
- Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyoung-Seon Baik
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kee-Joon Lee
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
- Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
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Upper airway asymmetry in skeletal Class III malocclusions with mandibular deviation. Sci Rep 2017; 7:12185. [PMID: 28939844 PMCID: PMC5610333 DOI: 10.1038/s41598-017-12076-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 09/04/2017] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to investigate the relationship between bilateral differences of upper airway and mandibular morphologic patterns in subjects with skeletal Class III mandibular deviation. 47 skeletal Class III (ANB < 0°) adult patients with and without mandibular deviation were divided into 2 groups. Bilateral differences of minimum cross-sectional area, mean cross-sectional area, volume of subdivisions (nasopharynx, palatopharynx, glossopharynx, hypopharynx) were assessed paired t test. Stepwise linear regression analysis and Pearson correlation coefficients were computed between a significant pair of upper airway variables and a pair of mandibular deviation variables to examine the quantitative relationship between the upper airway asymmetry and mandibular deviation. The mean cross-sectional area and the volume of palatopharynx on the deviated side in mandibular deviated group was significantly smaller than non-deviated side. The asymmetry index of the palatopharyngeal volume showed significant correlations with CRA asymmetry (r = 0.49) and Ramus asymmetry (r = 0.54). However, in the glossopharyngeal and hypopharyngeal segment, the mandibular deviated group showed significant asymmetry, characterized by larger mean cross-sectional area and volume in deviated side. The asymmetry index of the glossopharyngeal volume and hypopharyngeal volume showed significant correlations with CRA asymmetry (r = 0.42), Me-s (r = 0.72) and Me-s (r = 0.67) respectively.
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Upper Airway Changes After Mandibular Setback and/or Advancement Genioplasty in Obese Patients. J Oral Maxillofac Surg 2017; 75:2202-2210. [PMID: 28500875 DOI: 10.1016/j.joms.2017.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/09/2017] [Accepted: 04/10/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE Orthognathic surgeries, such as bilateral sagittal split ramus osteotomy (BSSO) and genioplasty, can influence the pharyngeal airway space (PAS) and this has been supported by previous studies. The purpose of this study was to assess changes of the PAS in patients with a high body mass index (BMI) likely to have narrow airways before and after setback BSSO with or without advancement genioplasty surgery by 3-dimensional computed tomography. MATERIALS AND METHODS Thirty-five adults with a BMI of at least 24.0 kg/m2 were treated from 2010 to 2016. Samples were grouped mandibular setback (group A; n = 11), advancement genioplasty (group B; n = 12), and mandibular setback plus advancement genioplasty (group C; n = 12). Computed tomograms were obtained 1 week preoperatively (T0), 1 week postoperatively (T1), and at least 1 year postoperatively (T2). The area of the posterior nasal spine and posterior plane (PPA), the soft palate plane (SPA), the plane of the most posterior point of the tongue base (PTA), the plane of the root of the epiglottis (EA), and the volumes of the palatopharyngeal part (VP), oropharyngeal part (VO), glossopharyngeal part (VG), and laryngeal part (VL) were measured and compared within groups using analysis of variance. The P value was set at .05. RESULTS In group A, all results showed statistically significant differences (P < .05) from T0 to T2 except for VO, VG, VL, SPA, PTA, and EA. In group B, VO, VG, VL, SPA, PTA, and EA showed statistically significant increases (P < .05) from T0 to T2. The hyoid at T2 showed significant advancement compared with T0 (P < .05). In group C, there were statistically significant decreases (P < .05) from T0 to T1 for VG, VL, PTA, and EA. CONCLUSION In adults with a high BMI, mandibular setback BSSO could decrease the PAS, whereas advancement genioplasty could enlarge the PAS, after surgery. Therefore, undergoing advancement genioplasty concurrently with mandibular setback BSSO could help in lessening the negative effects of a PAS decrease.
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Bozzini MFR, Valladares-Neto J, Paiva JBD, Rino-Neto J. Sex differences in pharyngeal airway morphology in adults with skeletal Class III malocclusion. Cranio 2017; 36:98-105. [DOI: 10.1080/08869634.2017.1300995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - José Valladares-Neto
- Department of Orthodontics, School of Dentistry, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - João Batista de Paiva
- Department of Orthodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - José Rino-Neto
- Department of Orthodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Marcussen L, Stokbro K, Aagaard E, Torkov P, Thygesen T. Changes in Upper Airway Volume Following Orthognathic Surgery. J Craniofac Surg 2016; 28:66-70. [PMID: 27893557 DOI: 10.1097/scs.0000000000003206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Reduced volume of the internal skeletal dimensions of the face is 1 of the main causes of obstructive sleep apnea, and attention to patients' airways is necessary when planning orthognathic treatment. This study aims to describe changes in upper airway volume following virtually planned orthognathic surgery.A retrospective pilot study was designed with 30 randomly selected patients (10 men and 20 women, aged 23.1 ± 6.8 years, molar-relations: 15 neutral, 8 distal, and 7 mesial). Cone-beam computed tomography scans were performed before surgery and 1 week following surgery. The authors did total upper airway volume measurements and obtained 1-mm slices at vertical levels in the velo-, oro-, and hypopharynx and at the smallest visible cross-section.Measurements before and after surgery were compared using Student t test.After orthognathic surgery, the minimum cross-sectional area at the vertical level increased from 83 mm ± 33 before surgery to 102 mm ± 36 after surgery (P = 0.019). In patients with neutral and distal occlusions, the minimum cross-sectional slice volume increased in 87% but in only 57% with mesial occlusion.The present findings suggest that orthognathic surgery increases upper airway volume parameters, but a few patients have continued impairment of the airways following orthognathic surgery. Further studies are needed to confirm an individual surgical planning approach that potentially could bring the minimum cross sectional area out of the risk zone.
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Affiliation(s)
- Lillian Marcussen
- Department of Oral and Maxillofacial Surgery, Odense University Hospital, Odense, Denmark
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Rosário HD, de Oliveira BG, Pompeo DD, de Freitas PHL, Paranhos LR. Surgical Maxillary Advancement Increases Upper Airway Volume in Skeletal Class III Patients: A Cone Beam Computed Tomography-Based Study. J Clin Sleep Med 2016; 12:1527-1533. [PMID: 27568908 DOI: 10.5664/jcsm.6282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 07/14/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Although volumetric changes of the upper airway occur following surgical advancement of the maxilla, few studies investigated these changes using three-dimensional imaging techniques. Thus, the goal of this study was to verify whether the surgical advancement of the maxilla affects the volume of the upper airway and to determine any association of these volume changes with sex and age. METHODS Preoperative and postoperative cone-beam computed tomography (CBCT) scans of 14 patients (8 male and 6 female) who underwent maxillary advancement to correct skeletal class III deformities were assessed to determine the postoperative volumetric changes in the upper airway. Preoperative and postoperative airway volume measurements were compared by means of paired t-test, which was also used to compare airway volume between genders. Pearson correlation coefficient was used to verify whether a correlation between age and upper airway volume was present. RESULTS Maxillary advancement produced significant upper airway volume increases (mean 20.94%, p < 0.05) on nearly half of our sample. However, sex and age did not seem to influence upper airway volume in our sample of skeletal class III patients. CONCLUSIONS Surgical advancement of the maxilla may produce significant volume increases in the upper airway of skeletal class III patients regardless of sex and age.
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Celikoglu M, Buyuk SK, Ekizer A, Unal T. Pharyngeal airway effects of Herbst and skeletal anchored Forsus FRD EZ appliances. Int J Pediatr Otorhinolaryngol 2016; 90:23-28. [PMID: 27729139 DOI: 10.1016/j.ijporl.2016.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 08/25/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the skeletal and pharyngeal airway effects of skeletal anchored Forsus FRD EZ appliance using bilateral miniplates inserted on mandibular symphyses and to compare the findings with a well matched control group treated using a Herbst appliance. METHODS Thirty patients with skeletal Class II malocclusion due to mandibular retrusion were divided into two groups. Group 1 consisted of 15 patients (8 females and 7 males; mean age: 13.11 ± 1.29 years) treated using the Herbst appliance and Group 2 consisted of 15 patients (9 females and 7 males; 12.84 ± 1.27 years) treated using the skeletal anchored Forsus FRD EZ appliance. Treatment changes were assessed by means of linear, angular, and area measurements. RESULTS The groups were well matched regarding to the chronological ages, gender distribution and initial cephalometric values (P > 0.05). In both groups, skeletal Class II malocclusion was corrected by decrease in SNA and increase in SNB, Co-Gn, VRL-B and VRL-Pog measurements. Those changes caused a significant correction in the maxillo-mandibular relationship. Upper and lower pharyngeal airway dimensions were increased in both group, while the increase in the lower pharyngeal dimension was found to be statistically significant in the skeletal anchored Forsus FRD EZ group (P < 0.05). Oropharyngeal area measurements significantly increased in both groups (P < 0.001 and P < 0.01, respectively). Comparison of the groups showed that both groups had similar changes with no statistically significant differences (P > 0.05). CONCLUSION Skeletal changes produced by both appliances caused significant pharyngeal airway changes.
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Affiliation(s)
- Mevlut Celikoglu
- Department of Orthodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkey.
| | | | - Abdullah Ekizer
- Department of Orthodontics, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
| | - Tuba Unal
- Privite Practice, İskenderun, Hatay, Turkey
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Manni A, Pasini M, Giuca MR, Morganti R, Cozzani M. A retrospective cephalometric study on pharyngeal airway space changes after rapid palatal expansion and Herbst appliance with or without skeletal anchorage. Prog Orthod 2016; 17:29. [PMID: 27641421 PMCID: PMC5035718 DOI: 10.1186/s40510-016-0141-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 08/24/2016] [Indexed: 11/13/2022] Open
Abstract
Background The aim of this study is to investigate the pharyngeal airway space changes in patients treated with rapid palatal expansion (RPE) and Herbst appliance with or without skeletal anchorage. Methods A 40-patient study group treated with the Herbst RME combination was included; moreover, a comparison between two subgroups based on whether miniscrews were used was evaluated. A subgroup 1 included 20 patients who were treated with RPE and an acrylic splint Herbst with miniscrews, and subgroup 2 included 20 patients who were treated with RPE and an acrylic splint Herbst. A cephalometric analysis was performed before (T1) and after (T2) treatment. The skeletal parameters of the sagittal occlusion analysis of Pancherz were utilized together with some extra measurements to evaluate the airways. Results An increased nasopharyngeal airway space was observed in group 1 (p < 0.05) from T1 to T2. Furthermore, the increase in nasopharyngeal airway space was significantly higher in subgroup 1 (p < 0.05) in comparison to the subgroup 2. Oropharyngeal (OA) and laryngopharyngeal (LA) dimensions were significantly increased in the subgroup 1 at the end of the treatment. In the subgroup 1, a significant decrease in SNA, a significant increase in SNB, and a significant decrease in ANB were observed from T1 to T2. In the subgroup 2, the treatment resulted in a significant decrease in ANB. In both groups, Pogonion increased significantly from T1 to T2. Conclusions The results suggest that the RPE and the Herbst appliance allow a slight improvement of the sagittal dimensions of the airways. The oropharyngeal dimension increased significantly more in the skeletal anchorage group.
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Affiliation(s)
| | - Marco Pasini
- Department of Surgical, Medical and Molecular Pathology and of the Critic Area, University of Pisa, Pisa, Italy. .,, Viale Roma 213, Massa, Massa-Carrara, 54100, Italy.
| | - Maria Rita Giuca
- Department of Surgical, Medical and Molecular Pathology and of the Critic Area, University of Pisa, Pisa, Italy
| | - Riccardo Morganti
- Department of Oncology, Transplants and New Technologies, University of Pisa, Pisa, Italy
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Tong Y, Udupa JK, Sin S, Liu Z, Wileyto EP, Torigian DA, Arens R. MR Image Analytics to Characterize the Upper Airway Structure in Obese Children with Obstructive Sleep Apnea Syndrome. PLoS One 2016; 11:e0159327. [PMID: 27487240 PMCID: PMC4972248 DOI: 10.1371/journal.pone.0159327] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 06/30/2016] [Indexed: 01/05/2023] Open
Abstract
Purpose Quantitative image analysis in previous research in obstructive sleep apnea syndrome (OSAS) has focused on the upper airway or several objects in its immediate vicinity and measures of object size. In this paper, we take a more general approach of considering all major objects in the upper airway region and measures pertaining to their individual morphological properties, their tissue characteristics revealed by image intensities, and the 3D architecture of the object assembly. We propose a novel methodology to select a small set of salient features from this large collection of measures and demonstrate the ability of these features to discriminate with very high prediction accuracy between obese OSAS and obese non-OSAS groups. Materials and Methods Thirty children were involved in this study with 15 in the obese OSAS group with an apnea-hypopnea index (AHI) = 14.4 ± 10.7) and 15 in the obese non-OSAS group with an AHI = 1.0 ± 1.0 (p<0.001). Subjects were between 8–17 years and underwent T1- and T2-weighted magnetic resonance imaging (MRI) of the upper airway during wakefulness. Fourteen objects in the vicinity of the upper airways were segmented in these images and a total of 159 measurements were derived from each subject image which included object size, surface area, volume, sphericity, standardized T2-weighted image intensity value, and inter-object distances. A small set of discriminating features was identified from this set in several steps. First, a subset of measures that have a low level of correlation among the measures was determined. A heat map visualization technique that allows grouping of parameters based on correlations among them was used for this purpose. Then, through T-tests, another subset of measures which are capable of separating the two groups was identified. The intersection of these subsets yielded the final feature set. The accuracy of these features to perform classification of unseen images into the two patient groups was tested by using logistic regression and multi-fold cross validation. Results A set of 16 features identified with low inter-feature correlation (< 0.36) yielded a high classification accuracy of 96% with sensitivity and specificity of 97.8% and 94.4%, respectively. In addition to the previously observed increase in linear size, surface area, and volume of adenoid, tonsils, and fat pad in OSAS, the following new markers have been found. Standardized T2-weighted image intensities differed between the two groups for the entire neck body region, pharynx, and nasopharynx, possibly indicating changes in object tissue characteristics. Fat pad and oropharynx become less round or more complex in shape in OSAS. Fat pad and tongue move closer in OSAS, and so also oropharynx and tonsils and fat pad and tonsils. In contrast, fat pad and oropharynx move farther apart from the skin object. Conclusions The study has found several new anatomic bio-markers of OSAS. Changes in standardized T2-weighted image intensities in objects may imply that intrinsic tissue composition undergoes changes in OSAS. The results on inter-object distances imply that treatment methods should respect the relationships that exist among objects and not just their size. The proposed method of analysis may lead to an improved understanding of the mechanisms underlying OSAS.
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Affiliation(s)
- Yubing Tong
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Jayaram K. Udupa
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Sanghun Sin
- Division of Respiratory and Sleep Medicine, Children’s Hospital at Montefiore, Bronx, New York, United States of America
| | - Zhengbing Liu
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - E. Paul Wileyto
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Drew A. Torigian
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Raanan Arens
- Division of Respiratory and Sleep Medicine, Children’s Hospital at Montefiore, Bronx, New York, United States of America
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Analogue simulation of pharyngeal airflow response to Twin Block treatment in growing patients with Class II(1) and mandibular retrognathia. Sci Rep 2016; 6:26012. [PMID: 27188799 PMCID: PMC4870688 DOI: 10.1038/srep26012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/25/2016] [Indexed: 11/08/2022] Open
Abstract
The flow dynamics of respiratory airflow is the basic factor that influences the ventilation function of the upper airway. This research aimed to investigate the pharyngeal flow field characteristics after Twin Block (TB) treatment in growing patients with Class II(1) and mandibular retrognathia by computation fluid dynamics (CFD) simulation. Cone beam computed tomography (CBCT) scans of patients who have completed TB treatment (n = 30) and about to accept TB treatment (n = 30) were reconstructed. After CFD simulation, correlations between the pharyngeal pressure drop and morphological parameters were further analyzed. During inspiration, we found that the pressure minimum occurred in the hypopharynx, while the maximum pressure drop and velocity was located in the oropharynx. After TB treatment, the oropharynx and hypopharynx showed significant differences in airflow features, and the most obvious change was observed in the oropharynx. A significant correlation was discovered between the change amount of oropharyngeal pressure drop and volume (r = 0.694, p = 0.001), mean cross-sectional area (r = 0.859, p = 0.000), and ratio of the minimum and mean cross-sectional area (r = 0.898, p = 0.000) of the oropharynx. Our research suggested that the pharyngeal airflow characteristics response positively to mandibular advancement with the enlargement in volume, cross-sectional area and more uniform oropharyngeal area distribution.
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Brasil DM, Kurita LM, Groppo FC, Haiter-Neto F. Relationship of craniofacial morphology in 3-dimensional analysis of the pharynx. Am J Orthod Dentofacial Orthop 2016; 149:683-691.e1. [DOI: 10.1016/j.ajodo.2015.11.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 11/01/2015] [Accepted: 11/01/2015] [Indexed: 11/28/2022]
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Christovam I, Lisboa C, Ferreira D, Cury-Saramago A, Mattos C. Upper airway dimensions in patients undergoing orthognathic surgery: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2016; 45:460-71. [DOI: 10.1016/j.ijom.2015.10.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 08/07/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
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Gurani SF, Di Carlo G, Cattaneo PM, Thorn JJ, Pinholt EM. Effect of Head and Tongue Posture on the Pharyngeal Airway Dimensions and Morphology in Three-Dimensional Imaging: a Systematic Review. J Oral Maxillofac Res 2016; 7:e1. [PMID: 27099695 PMCID: PMC4837605 DOI: 10.5037/jomr.2016.7101] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 02/25/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Natural head position is recommended to be optimal at cone-beam computed tomography acquisition. For standardization purposes in control of treatment outcome, it is clinically relevant to discuss, if a change of posture from natural head position may have an effect on the pharyngeal airway dimensions and morphology, during computed tomography, cone-beam computed tomography or magnetic resonance imaging acquisition. This was the aim of the present literature review study for purposes of valid evidence, which was hypothesized, to be present. MATERIAL AND METHODS This systematic literature review has been registered in PROSPERO database with following number: CRD42015024567. A systematic literature search performed in PubMed, Embase and Cochrane was carried out in order to evaluate if the effect of human head or tongue posture has an effect on upper airway dimensions and morphology in CT, CBCT or MRI. Study quality assessment was performed. Predictor variable was head and tongue posture. Endpoints were numerical values of upper airway dimensions and morphology. RESULTS Overall 1344 articles (Embase 1063, PubMed 269, and Cochrane 12) resulted in four included publications. Quality assessments revealed poor quality and low-level evidence by 46 - 67% of the maximum achievable score. Heterogeneous methodology made a meta-analysis impossible, consequently a narrative synthesis was performed. CONCLUSIONS Limited, poor quality and low evidence level literature is available on the effect of head posture on upper airway dimensions and morphology in three-dimensional imaging. Valid evidence requires a standardized method of head and tongue posture during image acquisition in future studies.
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Affiliation(s)
| | - Gabriele Di Carlo
- Section of Orthodontics, Department of Dentistry, Faculty of Health Science, Aarhus University, AarhusDenmark.; Department of Oral and Maxillofacial Science, Sapienza University of Rome, RomeItaly
| | - Paolo M Cattaneo
- Section of Orthodontics, Department of Dentistry, Faculty of Health Science, Aarhus University, Aarhus Denmark
| | - Jens Jørgen Thorn
- Department of Oral & Maxillofacial Surgery, Hospital of South West Denmark, Esbjerg Denmark
| | - Else Marie Pinholt
- Department of Oral & Maxillofacial Surgery, Hospital of South West Denmark, EsbjergDenmark.; Faculty of Health Sciences, Institute of Regional Health Services Sciences, University of Southern DenmarkDenmark
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Maurer JE, Sullivan SM, Currier GF, Kadioglu O, Li J. The airway implications in treatment planning two-jaw orthognathic surgery: The impact on minimum cross-sectional area. Semin Orthod 2016. [DOI: 10.1053/j.sodo.2015.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Jayaratne YSN, Zwahlen RA. The Oropharyngeal Airway in Young Adults with Skeletal Class II and Class III Deformities: A 3-D Morphometric Analysis. PLoS One 2016; 11:e0148086. [PMID: 26901313 PMCID: PMC4762707 DOI: 10.1371/journal.pone.0148086] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 01/12/2016] [Indexed: 11/18/2022] Open
Abstract
Objectives 1) To determine the accuracy and reliability of an automated anthropometric measurement software for the oropharyngeal airway and 2) To compare the anthropometric dimensions of the oropharyngeal airway in skeletal class II and III deformity patients. Methods Cone-beam CT (CBCT) scans of 62 patients with skeletal class II or III deformities were used for this study. Volumetric, linear and surface area measurements retroglossal (RG) and retropalatal (RP) compartments of the oropharyngeal airway was measured with the 3dMDVultus software. Accuracy of automated anthropometric pharyngeal airway measurements was assessed using an airway phantom. Results The software was found to be reasonably accurate for measuring dimensions of air passages. The total oropharyngeal volume was significantly greater in the skeletal class III deformity group (16.7 ± 9.04 mm3) compared with class II subjects (11.87 ± 4.01 mm3). The average surface area of both the RG and RP compartments were significantly larger in the class III deformity group. The most constricted area in the RG and RP airway was significantly larger in individuals with skeletal class III deformity. The anterior-posterior (AP) length of this constriction was significantly greater in skeletal class III individuals in both compartments, whereas the width of the constriction was not significantly different between the two groups in both compartments. The RP compartment was larger but less uniform than the RG compartment in both skeletal deformities. Conclusion Significant differences were observed in morphological characteristics of the oropharyngeal airway in individuals with skeletal class II and III deformities. This information may be valuable for surgeons in orthognathic treatment planning, especially for mandibular setback surgery that might compromise the oropharyngeal patency.
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Affiliation(s)
- Yasas Shri Nalaka Jayaratne
- Division of Orthodontics, Dept. of Craniofacial Sciences, University of Connecticut School of Dental Medicine, Farmington, Connecticut, United States of America
- Discipline of Oral & Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Sai Ying Pun, Hong Kong Special Administrative Region, Peoples Republic of China
| | - Roger Arthur Zwahlen
- Discipline of Oral & Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Sai Ying Pun, Hong Kong Special Administrative Region, Peoples Republic of China
- * E-mail:
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Kadioglu O, Hart PS, McIntyre BP, Currier GF, Sullivan SM, Li J, Shay C. Authors' response. Am J Orthod Dentofacial Orthop 2015; 148:528-9. [PMID: 26432303 DOI: 10.1016/j.ajodo.2015.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
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Hart PS, McIntyre BP, Kadioglu O, Currier GF, Sullivan SM, Li J, Shay C. Postsurgical volumetric airway changes in 2-jaw orthognathic surgery patients. Am J Orthod Dentofacial Orthop 2015; 147:536-46. [PMID: 25919099 DOI: 10.1016/j.ajodo.2014.12.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Findings from early cephalometric studies on airway changes after 2-jaw orthognathic surgery have been challenged because the previous anteroposterior interpretation of airway changes can now be evaluated in 3 dimensions. The aims of this study were to use cone-beam computed tomography to quantify the nasopharynx, oropharynx, and total airway volume changes associated with skeletal movements of the maxilla and mandible in a sample of patients undergoing 2-jaw orthognathic surgery for correction of skeletal malocclusion. METHODS Skeletal movements and airway volumes of 71 postpubertal patients (31 male, 40 female; mean age, 18.8 years) were measured. They were divided into 2 groups based on ANB angle, overjet, and occlusion (Class II: ANB, >2°; overjet, >1 mm; total, 35 subjects; and Class III: ANB, <1°; overjet, <1 mm; total, 36 subjects). Presurgical and postsurgical measurements were collected for horizontal, vertical, and transverse movements of the maxilla and the mandible, along with changes in the nasopharynx, oropharynx, and total airways. Associations between the directional movements of skeletal structures and the regional changes in airway volume were quantified. Changes in the most constricted area were also noted. RESULTS Horizontal movements of D-point were significantly associated with increases in both total airway (403.6 ± 138.6 mm(3); P <0.01) and oropharynx (383.9 ± 127.9 mm(3); P <0.01) volumes. Vertical movements of the posterior nasal spine were significantly associated with decreases in total airway volume (-459.2 ± 219.9 mm(3); P = 0.04) and oropharynx volume (-639.7 ± 195.3 mm(3); P <0.01), increases in nasopharynx (187.2 ± 47.1 mm(3); P <0.01) volume, and decreases in the most constricted area (-10.63 ± 3.69 mm(2); P <0.01). In the Class III patients only, the vertical movement of D-point was significantly associated with decreases in both total airway (-724.0 ± 284.4 mm(3); P = 0.02) and oropharynx (-648.2 ± 270.4 mm(3); P = 0.02) volumes. A similar negative association was observed for the most constricted area for the vertical movement of D-point (-15.45 ± 4.91 mm(2); P <0.01). CONCLUSIONS Optimal control of airway volume is through management of the mandible in the horizontal direction and the vertical movement of the posterior maxilla for all patients. The surgeon and the orthodontist should optimally plan these movements to control gains or losses in airway volume as a result of orthognathic surgery.
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Affiliation(s)
| | | | - Onur Kadioglu
- Assistant professor and program director, Department of Orthodontics, University of Oklahoma, Oklahoma City, Okla.
| | - G Fräns Currier
- Professor and chair, Department of Orthodontics, University of Oklahoma, Oklahoma City, Okla
| | - Steven M Sullivan
- Professor and chair, Department of Oral and Maxillofacial Surgery, University of Oklahoma, Oklahoma City, Okla
| | - Ji Li
- Biostatistician, Department of Biostatistics and Epidemiology, University of Oklahoma, Oklahoma City, Okla
| | - Christina Shay
- Assistant professor, Department of Biostatistics and Epidemiology, University of Oklahoma, Oklahoma City, Okla
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Dalmau E, Zamora N, Tarazona B, Gandia JL, Paredes V. A comparative study of the pharyngeal airway space, measured with cone beam computed tomography, between patients with different craniofacial morphologies. J Craniomaxillofac Surg 2015; 43:1438-46. [PMID: 26189145 DOI: 10.1016/j.jcms.2015.06.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 05/20/2015] [Accepted: 06/15/2015] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The present study aims to determine any existing association between airway dimensions, measured with cone beam computed tomography (CBCT), and the different patient craniofacial morphologies. MATERIAL AND METHODS Sixty CBCT (Dental Picasso Master 3D) images, from patients treated at the Orthodontics Master at Valencia University were selected. The program InVivoDental 5.1 was used to visualize sections, analyze three-dimensional images, and perform airway measurements in the three planes of the space. Intra- and interobserver error methods were recorded. After that, measurements at three different levels of the airway (upper, medium, lower) were taken, in both the anteroposterior and transversal directions of the airway space. The area (mm(2)) of the airway space at the three levels was also measured. RESULTS In the anteroposterior airway measurements, there were differences between the measurements by level. The magnitude of these differences depended on the skeletal pattern of the individual. In the transversal airway measurements and in the area airway measurements, there were no differences according to the skeletal pattern. However, in the transversal direction, measurements in the lower level were significantly higher than in the superior level in all cases. When measuring the area, significantly higher measurements in the upper level were recorded. The homogeneity between medium and lower levels decreased gradually from class I to class III subjects. CONCLUSIONS No statistically significant results were observed that related the anteroposterior and vertical skeletal craniofacial morphology with airway dimensions, although some specific associations have been detected for certain airway levels or for pattern combinations.
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Affiliation(s)
- Eva Dalmau
- Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - Natalia Zamora
- Department of Orthodontics, Faculty of Medicine and Dentistry, University of Valencia, Spain.
| | - Beatriz Tarazona
- Department of Orthodontics, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - Jose L Gandia
- Department of Orthodontics, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - Vanessa Paredes
- Department of Orthodontics, Faculty of Medicine and Dentistry, University of Valencia, Spain
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Effect of bimaxillary rotational setback surgery on upper airway structure in skeletal class III deformities. Plast Reconstr Surg 2015; 135:361e-369e. [PMID: 25626820 DOI: 10.1097/prs.0000000000000913] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Upper airway narrowing has been a concern of mandibular setback. The aims of this study were (1) to evaluate the effect of bimaxillary rotational setback surgery on upper airway structure in patients with skeletal class III deformities, and (2) to compare the preoperative and postoperative upper airways of class III patients with age- and sex-matched class I control subjects. METHODS The upper airways of 36 adults who consecutively underwent bimaxillary rotational setback surgery for skeletal class III deformities were assessed by means of cone-beam computed tomography before and at least 6 months after surgery. Results were compared with those of age- and sex-matched control subjects with skeletal class I structure. RESULTS Before surgery, the class III patients had significantly larger velopharyngeal, oropharyngeal, and hypopharyngeal volumes than did the control subjects (all p < 0.01). The velopharyngeal, oropharyngeal, and hypopharynx volumes decreased significantly after surgery (all p < 0.01). The postoperative airways of class III patients were similar with regard to velopharyngeal, oropharyngeal, and hypopharyngeal volume (all p > 0.01) compared to control subjects. The postoperative velopharyngeal and oropharyngeal airway volumes were associated with the baseline airway volume (p < 0.001) and horizontal movement of the soft palate (p < 0.01). CONCLUSION These results suggest that upper airway volume is decreased after bimaxillary rotational setback surgery for skeletal class III deformities, but is not smaller than in normal controls, and the postoperative upper airway volume is related to airway volume at baseline and changes in the surrounding structures. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Hu Z, Yin X, Liao J, Zhou C, Yang Z, Zou S. The effect of teeth extraction for orthodontic treatment on the upper airway: a systematic review. Sleep Breath 2015; 19:441-51. [PMID: 25628011 DOI: 10.1007/s11325-015-1122-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 11/21/2014] [Accepted: 01/13/2015] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the effect of teeth extraction for orthodontic treatment on the upper airway. METHODS Relevant trials assessing the effect of orthodontic extractions on the upper airway were retrieved electronically through PubMed, Embase, Medline, Web of Knowledge, and the Cochrane Library. The processes of literature search, selection, quality assessment, and data extraction were performed by two authors independently. RESULTS Seven articles were included in this systematic review. They were categorized into three groups according to their indications for extractions, namely anteroposterior discrepancy (group 1), crowding (group 2), and unspecified indications (group 3). In group 1, enrolled patients were diagnosed with class I bimaxillary protrusion and had four first premolars extracted, with a significant decrease in upper airway dimension. In group 2, increase in the upper airway dimension was reported in patients who were diagnosed with class I crowding and four first premolars extracted. In group 3, all patients were adolescents and no significant change in the upper airway dimension was observed. CONCLUSIONS Currently, it is difficult to draw evidence-based conclusions because of the exceeding heterogeneity among included studies, and more qualified trials are required to provide reliable evidence. Extractions followed by large retraction of the anterior teeth in adult bimaxillary protrusion cases could possibly lead to narrowing of the upper airway. Mesial movement of the molars appeared to increase the posterior space for the tongue and enlarge the upper airway dimensions. Although the effect of teeth extraction on upper airway dimension seems to be related to indications for extraction, accepted scientific evidence is still insufficient owing to the limited number of included studies. The relationship between the upper airway size and the respiratory function has not been demonstrated. While there may be a decrease in the upper airway volume, there is no evidence that this would turn an airway more collapsible. None of the studies assessed in this review had actual functional assessment of breathing. Additional qualified trials are necessary to verify reliability.
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Affiliation(s)
- Zhiai Hu
- Department of Orthodontics, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14#, 3rd Section of Renmin South Road, 610041, Chengdu, People's Republic of China
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Fernández-Ferrer L, Montiel-Company JM, Pinho T, Almerich-Silla JM, Bellot-Arcís C. Effects of mandibular setback surgery on upper airway dimensions and their influence on obstructive sleep apnoea - a systematic review. J Craniomaxillofac Surg 2014; 43:248-53. [PMID: 25547214 DOI: 10.1016/j.jcms.2014.11.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 11/06/2014] [Accepted: 11/17/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Mandibular setback used to be the traditional treatment of choice for correcting mandibular prognathism. Nowadays, bimaxillary surgery is preferred. Several authors have asserted that mandibular setback causes a relative narrowing of the upper airway (UA) that could trigger obstructive sleep apnoea (OSA); however, its potential role in OSA development is still much debated. Another controversial subject is whether changes in airway space caused by the procedure are permanent. OBJECTIVES To ascertain the consequences for UA size and shape of mandibular setback surgery in comparison with bimaxillary surgery (maxillary advancement with Le Fort I and mandibular setback), and to analyse the changes in oximetric indices and their relationship with OSA. SEARCH METHODS A systematic review was made of the bibliography in 4 databases: Medline, Scopus, Embase and Cochrane. SELECTION CRITERIA Systematic reviews, meta-analyses, clinical trials and cohort and case-control studies of adults published in the past 15 years were included. DATA COLLECTION AND ANALYSIS The initial search yielded 668 articles, of which 498 were eliminated because of duplication and 123 on the basis of their titles and abstracts or summaries. The remaining 47 papers were read in their entirety, and 14 were included in the final selection. RESULTS According to our observations, the nasopharyngeal space does not undergo significant changes after either of the two surgical procedures. In the oropharynx and hypopharynx, none of the measurements changed significantly with maxillary advancement; however, persistent and significant decreases in the area, horizontal linear dimensions, and volume of these spaces are encountered after mandibular setback alone. No long-term changes in oximetric indices were found. CONCLUSIONS Morphological changes are more pronounced following exclusively mandibular surgery. A decrease in the UA does take place but appears not to affect the patient's sleep quality. This study found no evidence to confirm that bimaxillary or mandibular orthognathic surgery predisposes to obstructive sleep apnoea development.
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Affiliation(s)
- Laura Fernández-Ferrer
- Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, C/ Gascó Oliag n° 1, CP: 46010, Valencia, Spain.
| | - José María Montiel-Company
- Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, C/ Gascó Oliag n° 1, CP: 46010, Valencia, Spain.
| | - Teresa Pinho
- Instituto Superior de Ciências da Saúde-Norte, Centro de Investigação Ciências da Saúde (CICS), Rua Central de Gandra, 1317 4585-116, Gandra, PRD, Portugal.
| | - José Manuel Almerich-Silla
- Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, C/ Gascó Oliag n° 1, CP: 46010, Valencia, Spain.
| | - Carlos Bellot-Arcís
- Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, C/ Gascó Oliag n° 1, CP: 46010, Valencia, Spain.
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