1
|
Mladenovic M, Freezer S, Dreyer C, Meade MJ. The orthodontic extraction of second premolars: The influence on airway volume. Am J Orthod Dentofacial Orthop 2024; 166:61-68. [PMID: 38678455 DOI: 10.1016/j.ajodo.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION The extraction of second premolars and associated changes in the volume of the airway have not been previously explored. This retrospective study aimed to compare the volumetric changes of the airway preorthodontic and postorthodontic treatment in relevant extraction and control samples and to identify variables that may influence the outcome. METHODS Cone-beam computed radiography scans of 54 patients with second premolar extraction and 59 nonextraction patients treated in a private orthodontic practice were matched for crowding. The average age for both samples was 15 years. The images were individually landmarked and measured by applying volumetric, linear, and angular parameters. The results were analyzed using repeated measures, such as variance analysis, correlation testing, and regression statistical analyses. RESULTS There was a statistically significant increase in the airway volume for both groups (P <0.05). The difference in increase between the groups was not statistically significant. Seven variables demonstrated a collectively significant effect on changes to airway volume (F[7,112] = 38.48; P <0.001; r2 = 0.701), with 70% of the variation predicted by the variables. Multiple regression analyses indicated that changes to the area of minimum constriction (B = 32.45; t = 11.95; P <0.001) and changes to airway length (B = 94.75; t = 7.79; P <0.001) had a statistically significant effect on airway volume. CONCLUSIONS The volume of the airway increased in both the extraction and nonextraction samples. The biggest contributors to the increase were an increase in airway length and an increase in the area of minimum constriction, which likely occurred as a result of natural growth.
Collapse
Affiliation(s)
- Miodrag Mladenovic
- Orthodontic Unit, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Simon Freezer
- Orthodontic Unit, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Craig Dreyer
- Orthodontic Unit, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Maurice J Meade
- Orthodontic Unit, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia.
| |
Collapse
|
2
|
Alqaryan S, Alrabiah A, Alhussinan K, Alyousef M, Alosamey F, Aljathlany Y, Aljasser A, Bukhari M, Almohizea M, Khan A, Alqahtani K, Alammar A. Measurement of the lengths of different sections of the upper airway and their predictive factors. Surg Radiol Anat 2024:10.1007/s00276-024-03345-6. [PMID: 38735016 DOI: 10.1007/s00276-024-03345-6] [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: 12/19/2023] [Accepted: 03/08/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND No studies have been conducted to define the lengths of the upper airway's different segments in normal healthy adults. AIMS/OBJECTIVES This study aimed to determine the length of the subglottis and extrathoracic trachea and the factors affecting it. MATERIAL AND METHODS This was an observational retrospective review study. Included 102 adult patients who underwent CT scan during the quiet inspiration phase of the upper airway. RESULTS The results revealed significant positive linear relationships between height and both anterior and posterior subglottic measurements (p < 0.001). Additionally, a statistically significant, moderately strong negative correlation between age and extrathoracic tracheal measurements (p > 0.001) was observed. Men exhibited longer anterior (p < 0.001) and posterior (p > 0.001) subglottic measurements. In both sexes, the average length of the anterior subglottis was 14.16 (standard deviation [SD]: 2.72) mm, posterior subglottis was 14.51 (SD: 2.85) mm and extrathoracic trachea was 66.37 (SD: 13.71) mm. CONCLUSION AND SIGNIFICANCE We concluded that a normal healthy adult's anterior subglottis length is 6.3-19.3 mm (mean: 14.16 [SD: 2.72] mm), posterior subglottis length is 6.1-20.0 mm (mean: 14.51 [SD: 2.85] mm) and extrathoracic trachea length is 25.2-98.5 mm (mean: 66.37 [SD: 13.71] mm). Age, height and sex affected the upper airway length.
Collapse
Affiliation(s)
- Saleh Alqaryan
- Department of Otolaryngology - Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, 11411, Riyadh, Saudi Arabia
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Abdulaziz Alrabiah
- Department of Otolaryngology - Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, 11411, Riyadh, Saudi Arabia
- Department of Otolaryngology - Head & Neck Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Khaled Alhussinan
- Department of Otolaryngology - Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, 11411, Riyadh, Saudi Arabia.
| | - Mohammed Alyousef
- Department of Otolaryngology - Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, 11411, Riyadh, Saudi Arabia
| | - Faisal Alosamey
- Department of Otolaryngology - Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, 11411, Riyadh, Saudi Arabia
| | - Yousef Aljathlany
- Department of Otolaryngology - Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, 11411, Riyadh, Saudi Arabia
| | - Abdullah Aljasser
- Department of Otolaryngology - Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, 11411, Riyadh, Saudi Arabia
- Otorhinolaryngology - Head and Neck Surgery, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Manal Bukhari
- Department of Otolaryngology - Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, 11411, Riyadh, Saudi Arabia
| | - Mohammed Almohizea
- Department of Otolaryngology - Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, 11411, Riyadh, Saudi Arabia
| | - Adeena Khan
- Department of Radiology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Khalid Alqahtani
- Department of Otolaryngology - Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, 11411, Riyadh, Saudi Arabia
| | - Ahmed Alammar
- Department of Otolaryngology - Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, 11411, Riyadh, Saudi Arabia
| |
Collapse
|
3
|
Meisgeier A, Dürrschnabel F, Pienkohs S, Weiser A, Neff A. Cephalometric Screening Assessment for Superior Airway Space Narrowing-Added Value of Three-Dimensional Imaging. J Clin Med 2024; 13:2685. [PMID: 38731214 PMCID: PMC11084779 DOI: 10.3390/jcm13092685] [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: 03/23/2024] [Revised: 04/19/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Assessing the morphology of the superior airway space is a crucial diagnostic step in the treatment planning of patients with obstructive sleep apnea syndrome (OSAS) or prior to orthognathic surgery. The aim of this study is to evaluate the necessary scope of a two-dimensional cephalometric assessment and the necessity of three-dimensional imaging in the identification of superior airway space narrowing (SASN). Methods: The computed tomography studies of 100 non-obese, non-OSAS patients were evaluated and analyzed retrospectively. Multiplanar reconstructions were created and underwent cephalometric evaluation. The three-dimensional superior airway morphology was segmented and measured for the minimal cross-sectional area (Amin) and volume (V0). Patients were grouped according to Amin < 80 mm2 and V0 < 12 cm3. Cephalometric parameters (CPs) were analyzed according to Amin and V0 with an unpaired t-test, Pearson correlation, and ROC-curve analysis. Results: The CPs regarding sagittal airway space dimensions (IPAS, MPAS, SPAS) and mandibular body length (GoGn) show the strongest correlation to the three-dimensional minimal cross-sectional area (Amin). The ROC-curve analysis classifying for SASN led to an AUC of 0.86 for IPAS, 0.87 for MPAS, 0.88 for SPAS, and 0.63 for GoGn. Three-dimensional imaging may further improve the diagnostic accuracy in the identification of SASN for IPAS below 13.5 mm, MPAS below 10.2 mm, SPAS below 12.5 mm, and GoGn below 90.2 mm. Conclusions: Two-dimensional cephalometric sagittal airway space diameters and mandibular body length are useful initial screening parameters in the identification of superior airway space narrowing. Nevertheless, as the correlation of two-dimensional cephalometric parameters with three-dimensional upper airway space narrowing is varying and highly dependent on acquisition circumstances, indications for three-dimensional imaging, if possible, in the supine position to evaluate upper airway space morphology should be provided generously, especially in patients with low but normal airway space parameters in two-dimensional cephalometry.
Collapse
Affiliation(s)
- Axel Meisgeier
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, 35043 Marburg, Germany; (F.D.); (S.P.); (A.W.); (A.N.)
- Faculty of Medicine, Philipps University, 35043 Marburg, Germany
| | - Florian Dürrschnabel
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, 35043 Marburg, Germany; (F.D.); (S.P.); (A.W.); (A.N.)
- Faculty of Medicine, Philipps University, 35043 Marburg, Germany
| | - Simon Pienkohs
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, 35043 Marburg, Germany; (F.D.); (S.P.); (A.W.); (A.N.)
- Faculty of Medicine, Philipps University, 35043 Marburg, Germany
| | - Annabell Weiser
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, 35043 Marburg, Germany; (F.D.); (S.P.); (A.W.); (A.N.)
- Faculty of Medicine, Philipps University, 35043 Marburg, Germany
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, 35043 Marburg, Germany; (F.D.); (S.P.); (A.W.); (A.N.)
- Faculty of Medicine, Philipps University, 35043 Marburg, Germany
| |
Collapse
|
4
|
Jessadapornchai T, Samruajbenjakun B, Chanmanee P, Chalidapongse P. 3D analysis of upper airway morphology related to obstructive sleep apnea severity. J World Fed Orthod 2024:S2212-4438(24)00016-X. [PMID: 38688739 DOI: 10.1016/j.ejwf.2024.03.003] [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: 11/09/2023] [Revised: 03/07/2024] [Accepted: 03/09/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder characterized by repetitive collapse of the upper airway during sleep. However, little evidence is available on the differences between the sub-regions of the upper airway morphology and OSA severity. Since orthodontists frequently perform cone beam computed tomography (CBCT) in the neck area, we aimed to investigate the relationship and the differences between upper airway morphology and OSA severity using CBCT. MATERIALS AND METHODS The medical records, CBCT imaging of 21 OSA patients diagnosed by polysomnography, and the apnea-hypopnea index (AHI) results were included to classify OSA severity as mild, moderate, or severe. The minimum cross-sectional areas (MCA) and volumes of the upper pharyngeal airway boundaries in four sub-regions: nasopharynx, retropalatal, retroglossal, and hypopharynx were measured. Dolphin Imaging software was used for upper airway segmentation. The correlation coefficient (r), one-way ANOVA, and the least significant difference post hoc multiple comparison test were applied to fulfill the objectives. RESULTS A statistically significant relationship was found between the MCA of the nasopharynx and the AHI (r = -0.473, P < 0.05). Furthermore, a difference was found between mild and moderate and moderate and severe OSA severity in the MCA results of the retroglossal region (P < 0.05). However, no relationship was found between the upper airway volume and OSA severity. CONCLUSIONS MCA was moderately negatively correlated to AHI only in the nasopharynx subregion. Moderate OSA presented significantly less MCA than mild and severe OSA only in the oropharynx and retroglossal subregions.
Collapse
Affiliation(s)
- Tuangporn Jessadapornchai
- Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Bancha Samruajbenjakun
- Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
| | - Pannapat Chanmanee
- Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Premthip Chalidapongse
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| |
Collapse
|
5
|
Saha S, Rattansingh A, Martino R, Viswanathan K, Saha A, Montazeri Ghahjaverestan N, Yadollahi A. A pilot observation using ultrasonography and vowel articulation to investigate the influence of suspected obstructive sleep apnea on upper airway. Sci Rep 2024; 14:6144. [PMID: 38480766 PMCID: PMC10937936 DOI: 10.1038/s41598-024-56159-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/02/2024] [Indexed: 03/17/2024] Open
Abstract
Failure to employ suitable measures before administering full anesthesia to patients with obstructive sleep apnea (OSA) who are undergoing surgery may lead to developing complications after surgery. Therefore, it is very important to screen OSA before performing a surgery, which is currently done by subjective questionnaires such as STOP-Bang, Berlin scores. These questionnaires have 10-36% specificity in detecting sleep apnea, along with no information given on anatomy of upper airway, which is important for intubation. To address these challenges, we performed a pilot study to understand the utility of ultrasonography and vowel articulation in screening OSA. Our objective was to investigate the influence of OSA risk factors in vowel articulation through ultrasonography and acoustic features analysis. To accomplish this, we recruited 18 individuals with no risk of OSA and 13 individuals with high risk of OSA and asked them to utter vowels, such as /a/ (as in "Sah"), /e/ (as in "See"). An expert ultra-sonographer measured the parasagittal anterior-posterior (PAP) and transverse diameter of the upper airway. From the recorded vowel sounds, we extracted 106 features, including power, pitch, formant, and Mel frequency cepstral coefficients (MFCC). We analyzed the variation of the PAP diameters and vowel features from "See: /i/" to "Sah /a/" between control and OSA groups by two-way repeated measures ANOVA. We found that, there was a variation of upper airway diameter from "See" to "Sah" was significantly smaller in OSA group than control group (OSA: ∆12.8 ± 5.3 mm vs. control: ∆22.5 ± 3.9 mm OSA, p < 0.01). Moreover, we found several vowel features showed the exact same or opposite trend as PAP diameter variation, which led us to build a machine learning model to estimate PAP diameter from vowel features. We found a correlation coefficient of 0.75 between the estimated and measured PAP diameter after applying four estimation models and combining their output with a random forest model, which showed the feasibility of using acoustic features of vowel sounds to monitor upper airway diameter. Overall, this study has proven the concept that ultrasonography and vowel sounds analysis may be useful as an easily accessible imaging tool of upper airway.
Collapse
Affiliation(s)
- Shumit Saha
- Department of Biomedical Data Science, School of Applied Computational Sciences, Meharry Medical College, Nashville, TN, USA
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Anand Rattansingh
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Rosemary Martino
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Keerthana Viswanathan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Anamika Saha
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Nasim Montazeri Ghahjaverestan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Electrical and Computer Engineering, Smith's Engineering, Queen's University, Kingston, Canada
| | - Azadeh Yadollahi
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
6
|
Gao W, Shi L, Xing D, Qin J, Zheng C, Li S, Wu D. Analysis of the cause of retrolingual obstruction in patients with moderate-severe obstructive sleep apnea. Eur Arch Otorhinolaryngol 2024; 281:1031-1039. [PMID: 37975910 DOI: 10.1007/s00405-023-08333-x] [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: 09/03/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To evaluate the percentage of obstructive sleep apnea (OSA) patients with retrolingual obstruction in all moderate-severe OSA patients and the proportions of different causes in all moderate-severe OSA patients with retrolingual obstruction and to discuss the accuracy of the Friedman tongue position (FTP) and retrolingual cross-sectional area (RCSA) in assessing the retrolingual obstruction. METHODS Two hundred and twenty moderate-severe OSA patients were enrolled. After retrolingual obstruction was diagnosed, the percentage of OSA patients with retrolingual obstruction in all moderate-severe OSA patients was calculated. After that, the different causes of retrolingual obstruction were diagnosed based on different diagnostic criteria, and the proportions of different causes in all moderate-severe OSA patients with retrolingual obstruction were calculated. Finally, the correlations between FTP, RCSA, and apnea-hypopnea index after nasopharyngeal tube insertion (NPT-AHI) were analyzed, and the proportions of different causes of retrolingual obstruction based on different FTP and RCSA were observed. RESULTS There were 128 patients with retrolingual obstruction, accounting for 58.2% of all moderate-severe OSA patients. In 128 patients with retrolingual obstruction, the proportions of glossoptosis (48.4%), palatal tonsil hypertrophy (28.1%), and lingual hypertrophy (8.6%) were relatively high. Both FTP and RCSA did not correlate with NPT-AHI. The proportion of lingual hypertrophy increased gradually with the increase of FTP and the proportions of glossoptosis in all FTP classifications were high. The patients with RCSA > 180 mm2 were mainly affected by glossoptosis and palatal tonsil hypertrophy, while patients with RCSA ≤ 180 mm2 were mainly affected by lingual hypertrophy. CONCLUSION The percentage of patients with retrolingual obstruction in all moderate-severe OSA patients is relatively high, mainly glossoptosis, palatal tonsil hypertrophy, and lingual hypertrophy. FTP classification and RCSA can only reflect the retrolingual anatomical stenosis, but cannot fully reflect the retrolingual functional stenosis, especially the presence of glossoptosis.
Collapse
Affiliation(s)
- Wanting Gao
- Postgraduate Training Base of Jinzhou Medical University in the General Hospital of Northern Theater Command, Jinzhou, 121013, Liaoning, China
- Department of Otolaryngology, General Hospital of Northern Theater Command, No.83, Wenhua Road, Shenhe District, Shenyang, 110016, China
| | - Lei Shi
- Outpatient Department of Fuxing Road, Jingnan Medical District, PLA General Hospital, Beijing, China
| | - Dengxiang Xing
- Department of Medical Information Center, General Hospital of Northern Theater Command, Shenyang, China
| | - Jie Qin
- Department of Otolaryngology, General Hospital of Northern Theater Command, No.83, Wenhua Road, Shenhe District, Shenyang, 110016, China
| | - Chenhai Zheng
- Department of Otolaryngology, General Hospital of Northern Theater Command, No.83, Wenhua Road, Shenhe District, Shenyang, 110016, China
| | - Shuhua Li
- Department of Otolaryngology, General Hospital of Northern Theater Command, No.83, Wenhua Road, Shenhe District, Shenyang, 110016, China
| | - Dahai Wu
- Department of Otolaryngology, General Hospital of Northern Theater Command, No.83, Wenhua Road, Shenhe District, Shenyang, 110016, China.
| |
Collapse
|
7
|
Isaac M, ElBeshlawy DM, ElSobki A, Ahmed DF, Kenawy SM. The role of cone-beam computed tomography in the radiographic evaluation of obstructive sleep apnea: A review article. Imaging Sci Dent 2023; 53:283-289. [PMID: 38174033 PMCID: PMC10761296 DOI: 10.5624/isd.20230119] [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: 06/03/2023] [Revised: 08/18/2023] [Accepted: 09/09/2023] [Indexed: 01/05/2024] Open
Abstract
The apnea-hypopnea index is widely regarded as a measure of the severity of obstructive sleep apnea (OSA), a condition characterized by recurrent episodes of apnea or hypopnea during sleep that induce airway collapse. OSA is a catastrophic problem due to the wide range of health issues it can cause, including cardiovascular disease and memory loss. This review was conducted to clarify the roles of various imaging modalities, particularly cone-beam computed tomography (CBCT), in the diagnosis of and preoperative planning for OSA. Unfortunately, 2-dimensional imaging techniques yield insufficient data for a comprehensive diagnosis, given the complex anatomy of the airway. Three-dimensional (3D) imaging is favored as it more accurately represents the patient's airway structure. Although computed tomography and magnetic resonance imaging can depict the actual 3D airway architecture, their use is limited by factors such as high radiation dose and noise associated with the scans. This review indicates that CBCT is a low-radiation imaging technique that can be used to incidentally identify patients with OSA, thereby facilitating early referral and ultimately enhancing the accuracy of surgical outcome predictions.
Collapse
Affiliation(s)
- Marco Isaac
- Department of Oral and Maxillofacial Radiology, Faculty of Oral and Dental Medicine, Delta University for Science and Technology, Gamasa, Egypt
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Dina Mohamed ElBeshlawy
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Cairo University, Cairo, Egypt
- Department of Oral and Maxillofacial Radiology, Galala University, Al Galala, Egypt
| | - Ahmed ElSobki
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Dina Fahim Ahmed
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Sarah Mohammed Kenawy
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Cairo University, Cairo, Egypt
| |
Collapse
|
8
|
Wu Q, Liu H, Zhu Z, Liu L, Luo E. Characterization of Upper Airway and Analysis of Potential Risk Factor Associated with OSA in Patients with Unilateral Temporomandibular Ankylosis and Micrognathia Deformities. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023:101708. [PMID: 38006945 DOI: 10.1016/j.jormas.2023.101708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVE To ascertain the airway characteristics in patients with unilateral temporomandibular joint ankylosis and maxilla-mandibular deformities (UTMAMD) and investigate the potential risk factors associated with obstructive sleep apnea (OSA) among UTMAMD patients. METHODS Authors conducted a retrospective single-center study to assess and compare study group consisting of a cohort of 32 patients diagnosed with UTMAMD between January 2011 and July 2022 with control group including 54 participants. The study group was further divided into two subgroups based on the presence or absence of OSA in patients. Parameters related to the upper airway were measured and analyzed using three-dimensional reconstruction of computed tomographic scans. The measurements of airway parameters were compared between study group and control group and between two subgroups. Pearson correlation analysis was used to identify the factors associated with the presence of OSA, and a multiple variable regression model was used to identify risk factors for OSA. RESULTS Airway volume (VOL), Minimum cross-section area (min CSA), mean CSA, tilt in sagittal plane (TS), and tilt in sagittal plane (TC) in velopharynx; VOL, airway length (AL), min CSA, mean CSA, TS, TC, and airway deviation (AD) in glossopharynx; min CSA, TS, and AD in hypopharynx were found difference with significance between study group and control group. Lateral dimension/anterior-posterior dimension (LAT/AP) ratio in velopharynx and min CSA, TC, and LAT/AP ratio in glossopharynx were significant different between patients with UTMAMD with OSA and without OSA. CONCLUSIONS The upper airway of patients with UTMAMD exhibits significant narrowing and distortion, rendering them susceptible to suffer from OSA. Patients with UTMAMD and OSA demonstrate more elliptical airways, and the glossopharyngeal LAT/AP ratio is a predictive indicator for the occurrence of OSA.
Collapse
Affiliation(s)
- Qionghui Wu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Hanghang Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Zhaokun Zhu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Linan Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - En Luo
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
| |
Collapse
|
9
|
Wang X, Jia L, Xu X, Guo J. The relationship between aerodynamic characteristics of the upper airway and severity of obstructive sleep apnea in adults. Cranio 2023:1-8. [PMID: 37980603 DOI: 10.1080/08869634.2023.2278958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
OBJECTIVE To investigate the relationship between aerodynamic characteristics of the upper airway and severity of obstructive sleep apnea (OSA) in adults. METHODS Ninety-seven adult OSA patients underwent polysomnography and cone beam computed tomography (CBCT). The anatomical and aerodynamic characteristics were measured based on CBCT images and computational fluid dynamics modelling of the upper airway. RESULTS After controlling for patients' gender, age, and body mass index (BMI), the maximum velocity during inspiration (In-Vmax) led to the largest increase in the explanatory power of apnea-hypopnea index (AHI) variation. The In-Vmax was closely correlated with the minimum axial area, and their relationship was represented by an inversely proportional fitted curve. CONCLUSIONS The In-Vmax was the most relevant to OSA severity, and it could be used to assist in recognizing severe OSA patients and as a primary variable to evaluate treatment outcomes of OSA. The In-Vmax was closely related to the most constricted area of the upper airway.
Collapse
Affiliation(s)
- Xiaoya Wang
- Department of Stomatology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, China
| | - Lu Jia
- Department of Orthodontics, Jinan Stomatological Hospital, Jinan, China
| | - Xin Xu
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
| | - Jing Guo
- Engineering Laboratory for Biomaterials and Tissue Regeneration, Ningbo Stomatology Hospital, Zhejiang, China
- Savaid Stomatology School, Hangzhou Medical College, Hangzhou, Zhejiang, China
- Savaid medical institute for stomatology and ENT, Ningbo, China
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
| |
Collapse
|
10
|
Zhang Z, Sun D, Jia Y, Fei N, Li Y, Han D. Facial Contour Features Measured on CT Reflects Upper Airway Morphology in Patients With OSA. J Craniofac Surg 2023; 34:2399-2404. [PMID: 37462196 DOI: 10.1097/scs.0000000000009532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 05/19/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE To determine facial contour features, measured on computed tomography (CT), related to upper airway morphology in patients with obstructive sleep apnea (OSA); certain phenotype of facial abnormalities implying restriction of craniofacial skeleton and adipose tissue nimiety has predicted the value of the severity of OSA. MATERIALS AND METHOD Sixty-four male patients with OSA [apnea-hypopnea index (AHI) ≥10/h] who had upper airway CT were randomly selected to quantitatively measure indicators of facial contour and upper airway structures. Pearson correlation analyses were performed. Partial correlation procedure was used to examine correlations while controlling body mass index (BMI). RESULTS Upper airway anatomy can nearly all be reflected in the face, except retroglossal airway. Upper face width can be measured to assess the overall skeletal structures of the airway. Lower face width can be used to represent how much adipose tissue deposited. Hard palate, retropalatal, and hypopharyngeal airways have corresponding face indicators respectively. Midface width is a better predictor of AHI severity and minimum blood oxygen even than neck circumference because it contains the most anatomical information about the airway, including RP airway condition, soft palate length, tongue volume, etc. These correlations persisted even after correction for BMI. CONCLUSIONS All anatomical features of the upper airway except retroglossal airway can be reflected in the face, and midface width is the best predictor of AHI severity and minimum blood oxygen, even better than neck circumference and BMI.
Collapse
Affiliation(s)
- Zishanbai Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University
| | - Dance Sun
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University
| | - Yajie Jia
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University
| | - Nanxi Fei
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yanru Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University
| | - Demin Han
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University
| |
Collapse
|
11
|
Augusto Bacelar de Athayde1 R, Luiz Igreja Colonna1 L, Schorr1 F, Maria Mello Santiago Gebrim2 E, Lorenzi-Filho1 G, Rodrigues Genta1 P. Tongue size matters: revisiting the Mallampati classification system in patients with obstructive sleep apnea. J Bras Pneumol 2023; 49:e20220402. [PMID: 37132703 PMCID: PMC10171301 DOI: 10.36416/1806-3756/e20220402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/28/2022] [Indexed: 02/10/2023] Open
Abstract
Objective: The Mallampati classification system has been used to predict obstructive sleep apnea (OSA). Upper airway soft tissue structures are prone to fat deposition, and the tongue is the largest of these structures. Given that a higher Mallampati score is associated with a crowded oropharynx, we hypothesized that the Mallampati score is associated with tongue volume and an imbalance between tongue and mandible volumes. Methods: Adult males underwent clinical evaluation, polysomnography, and upper airway CT scans. Tongue and mandible volumes were calculated and compared by Mallampati class. Results: Eighty patients were included (mean age, 46.8 years). On average, the study participants were overweight (BMI, 29.3 ± 4.0 kg/m2) and had moderate OSA (an apnea-hypopnea index of 26.2 ± 26.7 events/h). Mallampati class IV patients were older than Mallampati class II patients (53 ± 9 years vs. 40 ± 12 years; p < 0.01), had a larger neck circumference (43 ± 3 cm vs. 40 ± 3 cm; p < 0.05), had more severe OSA (51 ± 27 events/h vs. 24 ± 23 events/h; p < 0.01), and had a larger tongue volume (152 ± 19 cm3 vs. 135 ± 18 cm3; p < 0.01). Mallampati class IV patients also had a larger tongue volume than did Mallampati class III patients (152 ± 19 cm3 vs. 135 ± 13 cm3; p < 0.05), as well as having a higher tongue to mandible volume ratio (2.5 ± 0.5 cm3 vs. 2.1 ± 0.4 cm3; p < 0.05). The Mallampati score was associated with the apnea-hypopnea index (r = 0.431, p < 0.001), BMI (r = 0.405, p < 0.001), neck and waist circumference (r = 0.393, p < 0.001), tongue volume (r = 0.283, p < 0.001), and tongue/mandible volume (r = 0.280, p = 0.012). Conclusions: The Mallampati score appears to be influenced by obesity, tongue enlargement, and upper airway crowding.
Collapse
Affiliation(s)
- Rodolfo Augusto Bacelar de Athayde1
- 1. Laboratório do Sono – LIM 63 – Divisão de Pneumologia, Instituto do Coração – InCor – Hospital das Clínicas, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Leonardo Luiz Igreja Colonna1
- 1. Laboratório do Sono – LIM 63 – Divisão de Pneumologia, Instituto do Coração – InCor – Hospital das Clínicas, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Fabiola Schorr1
- 1. Laboratório do Sono – LIM 63 – Divisão de Pneumologia, Instituto do Coração – InCor – Hospital das Clínicas, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | - Geraldo Lorenzi-Filho1
- 1. Laboratório do Sono – LIM 63 – Divisão de Pneumologia, Instituto do Coração – InCor – Hospital das Clínicas, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Pedro Rodrigues Genta1
- 1. Laboratório do Sono – LIM 63 – Divisão de Pneumologia, Instituto do Coração – InCor – Hospital das Clínicas, Universidade de São Paulo, São Paulo (SP) Brasil
| |
Collapse
|
12
|
Kongsong W, Waite PD, Alshahrani F. Comparison of airway changes after maxillomandibular advancement with or without genial tubercle advancement in obstructive sleep apnea using cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2022; 162:616-625. [PMID: 35835704 DOI: 10.1016/j.ajodo.2021.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This study compared the airway changes of patients with obstructive sleep apnea (OSA) after maxillomandibular advancement (MMA) with or without genial tubercle advancement (GTA) using cone-beam computed tomography. METHODS The authors retrospectively studied 26 patients with moderate to severe OSA who underwent MMA with or without GTA. Airway changes were determined from preoperative and postoperative 3-dimensional reconstructed cone-beam computed tomography images. The Wilcoxon signed rank test, Mann-Whitney U tests, and Spearman correlation coefficients were used in data analysis. RESULTS Airway was changed in all dimensions significantly after MMA with or without GTA. There was no significant difference in horizontal surgical changes between MMA and MMA with the GTA group. The mean increase in total airway volume was 66.8% for MMA alone and 74.7% for MMA with GTA (P = 0.39). Patients who underwent MMA had a larger percentage change of segmented upper airway volume than patients with MMA and GTA (106.6% vs 85.3%; P = 0.65). The group with MMA and GTA had a greater percentage change of segmented lower airway volume than the MMA alone group (80.1% vs 56.3%; P = 0.42). CONCLUSIONS Differences in airway changes between MMA alone and MMA with GTA were not statistically significant. Performing the GTA concomitantly with MMA may not cause greater improvement in the pharyngeal airway in patients with OSA compared with MMA alone.
Collapse
Affiliation(s)
- Wichuda Kongsong
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
| | - Peter D Waite
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | - Faleh Alshahrani
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Ala; King Fahad Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
13
|
Zreaqat M, Hassan R, Samsudin R, Stas Y, Hanoun A. Three-dimensional analysis of upper airways in Class II malocclusion children with obstructive sleep apnea. J World Fed Orthod 2022; 11:156-163. [DOI: 10.1016/j.ejwf.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/07/2022] [Accepted: 08/09/2022] [Indexed: 10/14/2022]
|
14
|
Zhang Z, Wang H, Sun D, Fei N, Li Y, Han D. Classification of facial phenotypes in Asian patients with obstructive sleep apnea. Acta Otolaryngol 2022; 142:712-720. [PMID: 36112047 DOI: 10.1080/00016489.2022.2108552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUD The facial phenotypes of Asian obstructive sleep apnea (OSA) patients remain unclear. OBJECTIVES (1) To describe the facial features of OSA patients. (2) To develop a model based on facial contour indicators to predict OSA. (3) To classify the facial phenotypes of Asian OSA patients. MATERIALS AND METHODS 110 patients with OSA (apnea-hypopnea index [AHI] ≥ 10/h) and 50 controls (AHI< 10/h) were selected to measure facial contour indicators. Indicators were compared between OSA patients and the control group. We used multivariable linear regression analysis to predict OSA severity and K-means cluster analysis to classify OSA patients into different phenotypes. RESULTS We built a model to predict OSA which explained 49.1% of its variance and classified OSA patients into four categories. Cluster 1 (Skeletal type) had the narrowest facial width indicators with narrowing of the retroglossal airway. Cluster 2 (Obese type) had the widest face, and narrowest hard palate, retropalatal, and hypopharyngeal airways. Cluster 3 (Nose type) had the narrowest nasal cavity. Cluster 4 (Long type) had the longest airway length. CONCLUSIONS AND SIGNIFICANCE Patients with OSA were classified into four categories, each of which identified different anatomic risk factors that can be used to select the treatment.
Collapse
Affiliation(s)
- Zishanbai Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, People's Republic of China
| | - Huijun Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, People's Republic of China
| | - Dance Sun
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, People's Republic of China
| | - Nanxi Fei
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yanru Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, People's Republic of China
| | - Demin Han
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, People's Republic of China
| |
Collapse
|
15
|
Mota DA, Gregorio MG, Costa ADS, Fomin DS, Jacomelli M. Sleep endoscopy as a complementary diagnostic method for snoring and sleep apnea. EINSTEIN-SAO PAULO 2022; 20:eMD8035. [PMID: 36000614 PMCID: PMC9388198 DOI: 10.31744/einstein_journal/2022md8035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022] Open
Abstract
Obstructive sleep apnea is a disorder characterized by complete or incomplete and recurrent upper airway collapse induced by sleep. Several diagnostic methods for obstructive sleep apnea are used, but only sleep endoscopy allows an endoscopic assessment of pharyngeal collapse during sedation. It is essential to carry out sleep endoscopy following a systematic institutional protocol, in preestablished stages, to ensure better reproducibility and reliability of the results found. Sleep endoscopy has few limitations and is a safe test, with a low risk of complications.
Collapse
|
16
|
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.
Collapse
|
17
|
McNicholas WT. Obstructive Sleep Apnoea: Focus on Pathophysiology. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:31-42. [PMID: 36217077 DOI: 10.1007/978-3-031-06413-5_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Obstructive sleep apnoea (OSA) is characterized by recurring episodes of upper airway obstruction during sleep and the fundamental abnormality reflects the inability of the upper airway dilating muscles to withstand the negative forces generated within the upper airway during inspiration. Factors that result in narrowing of the oropharynx such as abnormal craniofacial anatomy, soft tissue accumulation in the neck, and rostral fluid shift in the recumbent position increase the collapsing forces within the airway. The counteracting forces of upper airway dilating muscles, especially the genioglossus, are negatively influenced by sleep onset, inadequacy of the genioglossus responsiveness, ventilatory instability, especially post arousal, and loop gain. Recent reports indicate that multiple endotypes reflecting OSA pathophysiology are present in individual patients. A detailed understanding of the complex pathophysiology of OSA encourages the development of therapies targeted at these pathophysiological endotypes and facilitates a move towards precision medicine as a potential alternative to continuous positive airway pressure therapy in selected patients.
Collapse
Affiliation(s)
- Walter T McNicholas
- School of Medicine, University College Dublin, Department of Respiratory and Sleep Medicine, St. Vincent's Hospital Group, Dublin, Ireland.
| |
Collapse
|
18
|
Airway morphology and its influence on OSA severity and surgical intervention: a retrospective study. AUSTRALASIAN ORTHODONTIC JOURNAL 2022. [DOI: 10.2478/aoj-2022-031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Introduction: The aim was to assess the relationship between airway morphology and surgical intervention in a cohort of patients presenting with increased body mass index (BMI) and a confirmed diagnosis of obstructive sleep apnoea (OSA). A secondary aim was to revisit the relationship between morphology and OSA severity.
Methods: A retrospective analysis was conducted of pre-operative maxillofacial 3D-CT scans of thirty-two patients with a confirmed diagnosis of OSA who received treatment from an ear nose and throat specialist (ENT). Lateral cephalograms were imported into Quick Ceph Studio (Quick Ceph Systems Inc, San Diego, CA, USA) after which linear and angular measurements of selected hard and soft tissues were obtained. 3D-CT images were loaded into the software program 3dMDVultus (3dMD) which permitted 3D visualisation of the airway. Measurements were repeated 3 times on the images of six patients after an interval of two weeks to establish the intraclass correlation coefficient (ICC) for intra-examiner accuracy and reliability. Logistic regression was applied to determine the relationships between morphology, OSA and surgical treatments.
Results: A positive correlation was found between age and the apnoea-hypopnea index (AHI). Morphological measurements of the airway did not exhibit a positive relationship with OSA severity. Posterior airway space at the level of the uvula and tongue, the length of the soft palate and position of the hyoid bone were significantly associated with BMI. No variables were found to be correlated with uvulopalatopharyngoplasty (UPPP) surgery. Notwithstanding, airway length and posterior airway space at the level of the uvula tip were significantly associated with tongue channelling.
Conclusions: Radiographic airway assessment is an invaluable and opportunistic tool for screening OSA but requires judicial use in its prescription and interpretation. There is little correlation between OSA severity and airway morphology and between surgical intervention and morphology. Additional factors need to be considered before a treatment modality is considered and is best managed in a multidisciplinary setting.
Collapse
|
19
|
Zhou N, Ho JPTF, Klop C, Schreurs R, Beenen LFM, Aarab G, de Lange J. Intra-individual variation of upper airway measurements based on computed tomography. PLoS One 2021; 16:e0259739. [PMID: 34739525 PMCID: PMC8570503 DOI: 10.1371/journal.pone.0259739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/25/2021] [Indexed: 11/18/2022] Open
Abstract
The aims of this study were (1) to quantify the intra-individual variation in the upper airway measurements on supine computed tomography (CT) scans at two different time points; and (2) to identify the most stable parameters of the upper airway measurements over time. Ten subjects with paired CT datasets (3-6 months interval) were studied, using computer software to segment and measure the upper airway. The minimum cross-sectional area of the total airway and all its segments (velopharynx, oropharynx, tongue base, and epiglottis) generally had the largest variation, while the length of the total airway had the lowest variation. Sphericity was the only parameter that was stable over time (relative difference <15%), both in the total airway and each subregion. There was considerable intra-individual variation in CT measurements of the upper airway, with the same patient instruction protocol for image acquisitions. The length of the total airway, and the sphericity of the total upper airway and each segment were stable over time. Hence, such intra-individual variation should be taken into account when interpreting and comparing upper airway evaluation parameters on CT in order to quantify treatment results or disease progress.
Collapse
Affiliation(s)
- Ning Zhou
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Jean-Pierre T. F. Ho
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Northwest Clinics, Alkmaar, The Netherlands
| | - Cornelis Klop
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ruud Schreurs
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Ludo F. M. Beenen
- Department of Radiology, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
20
|
Effects of Mandibular Distraction Osteogenesis on Three-Dimensional Upper Airway Anatomy in Newborns Affected by Isolated Pierre Robin Sequence. J Craniofac Surg 2021; 32:1459-1463. [PMID: 34403227 DOI: 10.1097/scs.0000000000007339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Effective airway management is critical to Pierre Robin Sequence treatment. The goal of this study is to assess the three-dimensional changes in airway size and shape in 117 newborns with isolated Pierre Robin sequence who underwent mandibular distraction osteogenesis. Methods During the study period (11/29/2016 to 11/26/2019), 117 newborns affected by isolated Pierre Robin sequence met the inclusion criteria for the present study. All 117 included patients underwent linear distraction. Demographic variables were recorded and analyzed. Cone-beam computed tomography were performed before and after mandibular distraction osteogenesis. A systemic quantitative three-dimensional analysis of size and shape of upper airway was performed. Results The mean age was 71 day (range 12 to 213). The mean weight was 3.9 kg (range 2.3-6.8). A total of 53 patients are female and 64 are male. When the distraction device was removed, the upper and lower jaws were symmetrically aligned. Pre- and post-distraction comparison clearly showed osteogenesis. For the size of the upper airway, airway volume, anteroposterior dimension of the retroglossal airway, lateral dimension of retroglossal airway, minimum retropalatal area, minimum retroglossal area, average cross-sectional area and minimum cross-sectional area increased significantly after mandibular distraction osteogenesis (P < 0.001). However, the airway length did not change significantly (P > 0.05). For the shape of the upper airway, the lateral/anteroposterior ratio in the retroglossal region and the ratio of the retropalatal airway diameter to the retroglossal airway diameter significantly decreased after mandibular distraction osteogenesis (P < 0.001). The airway uniformity significantly increased after mandibular distraction osteogenesis (P < 0.001). Conclusion Mandibular distraction osteogenesis for isolated Pierre Robin sequence improved size and shape of the upper airway, further confirming mandibular osteogenesis distraction as an effective surgical modality to address the airway obstruction in newborns affected by isolated Pierre Robin sequence. Cone-beam computed tomography scanning and analysis can serve as a safe and effective examination modality for upper airway applications of PRS newborns.
Collapse
|
21
|
Wang X, Chen H, Jia L, Xu X, Guo J. The relationship between three-dimensional craniofacial and upper airway anatomical variables and severity of obstructive sleep apnoea in adults. Eur J Orthod 2021; 44:78-85. [PMID: 34268561 DOI: 10.1093/ejo/cjab014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the relationship between three-dimensional craniofacial and upper airway anatomical variables and severity of obstructive sleep apnoea (OSA) using cone beam computed tomography (CBCT). METHODS This was a prospective observational study, consisted of 95 adult OSA whose polysomnography and CBCT were available. Three-dimensional craniofacial and upper airway anatomical analysis were performed using 12 CBCT variables, including sagittal and vertical jaw relationships, maxillary width, the volume, length and minimum axial area of upper airway. The severity of OSA was evaluated through the apnea-hypopnea index (AHI). A hierarchical regression was performed to analyze the relationship between OSA severity and craniofacial and upper airway anatomical variables after controlling patients' demographic characteristics (gender, age, and BMI). RESULTS After controlling patients' gender, age, and BMI, individual CBCT variables including MAA, V-RPA, L-RPA and Go-Me were related to AHI. The final hierarchical regression model with demographic variables in Step 1 and CBCT variables (MAA, L-RPA and Go-Me) in Step 2 indicated that CBCT variables added additional explanatory power for AHI (ΔF(3,88) = 5.176, P = 0.002). Among these variables, L-RPA and Go-Me were statistically significant (P < 0.05). LIMITATION The OSA severity was expressed by AHI alone. CONCLUSIONS Three-dimensional craniofacial and upper airway morphology played an essential role in OSA severity. The most relevant anatomical characteristic with OSA severity were the length of retropalatal airway and mandibular body, which could be used to recognize severe OSA patients and as estimators for selecting the most appropriate treatment modality for OSA patients.
Collapse
Affiliation(s)
- Xiaoya Wang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China.,Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Hui Chen
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Lu Jia
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Xin Xu
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Jing Guo
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| |
Collapse
|
22
|
Choi JW, Jeong WS, Kang MK, Lee JY, Chung YS. Counterclockwise Rotational Orthognathic Surgery for the Obstructive Sleep Apnea in Class II Dentofacial Deformity: Polysomnography and 3D Computed Tomographic Analysis. Ann Plast Surg 2021; 86:640-646. [PMID: 33346553 DOI: 10.1097/sap.0000000000002580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Traditionally, maxillomandibular advancement is an orthognathic surgical procedure that has been used to manage obstructive sleep apnea in patients not able or willing to maintain adherence to continuous positive airway pressure therapy or for patient who are not able to adhere to treatment. However, maxillomandibular advancement often leads to unsatisfactory cosmetic results.This prospective study investigated functional and esthetic outcomes using polysomnography and 3-dimensional computed tomography, after counterclockwise rotational orthognathic surgery. We enrolled 17 patients with obstructive sleep apnea, who underwent orthognathic surgery at single institution between March 2013 and December 2018.After 12 months, the patients' mean self-rated score for facial appearance, using a 10-step visual analog scale, was 7.36. The preoperative apnea-hypopnea index and respiratory disturbance index were 34.70 and 37.45, respectively; postoperative indices were 11.60 and to 12.69, respectively (P = 0.003, 0.003). The mean posterior pharyngeal airway space increased from 5357.88 mm3 preoperatively to 8481.94 mm3 after 6 postoperative months.Counterclockwise rotational orthognathic surgery for the correction of obstructive sleep apnea turned out to be the ideal solution not only in the correction of the sleep apnea, but also in the facial esthetics.
Collapse
Affiliation(s)
- Jong Woo Choi
- From the Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Seoul Asan Medical Center
| | - Woo Shik Jeong
- From the Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Seoul Asan Medical Center
| | - Min Kyu Kang
- From the Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Seoul Asan Medical Center
| | | | - Yoo Sam Chung
- Department of Otolaryngology, University of Ulsan College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
| |
Collapse
|
23
|
Eow PY, Lin KY, Kohli S, Math SY. Cone-beam computed tomography assessment of upper airway dimensions in patients at risk of obstructive sleep apnea identified using STOP-Bang scores. Imaging Sci Dent 2021; 51:439-446. [PMID: 34988005 PMCID: PMC8695467 DOI: 10.5624/isd.20210193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/29/2021] [Accepted: 09/08/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose The aim of this study was to identify correlations between the STOP-Bang score and upper airway dimensions using cone-beam computed tomography (CBCT) scans. Materials and Methods This study included 101 subjects (46 men, 55 women) from dental patients who received CBCT scans from 2014 to 2020. The patients were divided into those with a low obstructive sleep apnoea (OSA) risk (STOP-Bang score<3) and those with an intermediate to high OSA risk (STOP-Bang score≥3), and their upper airway dimensions were then analysed on CBCT scans. Comparisons between the low-risk and intermediate/high-risk groups were conducted using the t-test and the Mann-Whitney test. Correlations between the total STOP-Bang score and upper airway dimension parameters were established using Spearman correlation coefficients. P values≤0.05 were considered to indicate statistical significance. Results Intermediate/high-risk subjects were predominantly male and over 50 years of age, with a higher body mass index. They had significantly longer upper airways, smaller average airway volumes, and smaller widths and antero-posterior dimensions of the narrowest upper airway segment. The total upper airway length was positively correlated with the STOP-Bang score (rs= 0.278). The average volume (rs= −0.203) and width of the narrowest upper airway segment (rs= −0.305) were both negatively correlated with STOP-Bang scores. Conclusion Subjects with higher STOP-Bang scores had upper airways that were longer, narrower, and smaller in terms of average volume. CBCT scans taken for dental patients as part of investigative procedures could be correlated with STOP-Bang scores to screen for patients at risk of OSA.
Collapse
Affiliation(s)
- Pei Ying Eow
- School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Kar Yi Lin
- School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Shivani Kohli
- Division of Restorative Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Swarna Yerebairapura Math
- Division of Clinical Oral Health Sciences, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| |
Collapse
|
24
|
Saha S, Rattansingh A, Viswanathan K, Saha A, Martino R, Yadollahi A. Ultrasonographic Measurement of Pharyngeal-Airway Dimension and Its Relationship with Obesity and Sleep-Disordered Breathing. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2998-3007. [PMID: 32782086 DOI: 10.1016/j.ultrasmedbio.2020.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/01/2020] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
Previous studies based on magnetic resonance imaging (MRI) or computed tomography (CT) have shown that pharyngeal airway diameter during wakefulness is different between healthy controls and patients with a high risk of sleep-disordered breathing (SDB). However, MRI and CT are expensive and not easily accessible. Conversely, ultrasonography is more accessible and is getting more attention as a point-of-care technology to assess physiologic systems, such as the pharynx. Thus, we aimed to evaluate the feasibility of ultrasonography in estimating the pharyngeal airway dimension. To evaluate the pharyngeal airway with ultrasonography, we measured the parasagittal anterior-posterior (PAP) diameter and transverse diameter. For PAP diameter measurements, the transducer probe was placed in a submandibular lateral oblique position, with its superior margin abutting the angle of the left mandible. For the transverse measurement, the ultrasound probe was positioned in a submandibular location, in a near-coronal plane, just above the hyoid bone so that the tongue could be seen in cross-section. The diameter measurements were performed manually by two technicians. The reliability of these measurements was assessed by the intra-class correlation coefficient (ICC). To validate our measurements, we compared the measured PAP diameter with the average pharyngeal airway cross-sectional area from vellum to glottis measured by acoustic pharyngometry. Furthermore, we compared the influence of obesity and SDB in the measured pharyngeal diameters. Eighteen controls and 13 individuals with a high risk of SDB participated in this study. Reliability analysis of the PAP measurements yielded an ICC of 0.97 (95% confidence interval: 0.94-0.98). Furthermore, measured PAP diameters were significantly correlated with the pharyngeal airway cross-sectional area (r = 0.76, p < 0.01). Moreover, obesity and SDB were associated with decreases in PAP diameter. Our study shows that ultrasonography measurement of the PAP diameter may provide a quantitative assessment of the pharyngeal airway and may be useful for screening of SDB.
Collapse
Affiliation(s)
- Shumit Saha
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Anand Rattansingh
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Keerthana Viswanathan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Anamika Saha
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Rosemary Martino
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Azadeh Yadollahi
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
| |
Collapse
|
25
|
Whyte A, Gibson D. Imaging of sleep-disordered breathing in adults. Clin Radiol 2020; 75:960.e1-960.e16. [PMID: 32620255 DOI: 10.1016/j.crad.2020.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Abstract
Sleep-disordered breathing (SDB) is a term that includes several chronic conditions in which partial or complete cessation of breathing occurs multiple times throughout the night. Central sleep apnoea (CSA) is uncommon and defined by the episodic cessation of airflow without respiratory effort. Lesions involving the respiratory centre in the brainstem or the origin of the phrenic nerve from the mid-cervical cord are the commonest structural causes of CSA; magnetic resonance imaging (MRI) will demonstrate the lesion and frequently suggest the likely aetiology. In contrast, obstructive sleep apnoea (OSA) is defined as upper airway obstruction despite ongoing respiratory effort. Repetitive episodes of narrowing or closure of the upper airway are the predominant cause leading to snoring and OSA, respectively. OSA affects 33-40% of the adult population and is associated with multiple adverse health consequences, including a significantly increased risk of serious morbidity and mortality. The incidence is increasing proportionally to the worldwide rise in obesity. Imaging, performed primarily without the involvement of radiologists, has been integral to understanding the anatomical basis of SDB and especially OSA. This article will review the pathophysiology, imaging findings, and sequelae of these common conditions. The role of imaging both in suggesting the incidental diagnoses of SDB and in the investigation of these conditions when the diagnosis is suspected or has been established are also discussed.
Collapse
Affiliation(s)
- A Whyte
- Perth Radiological Clinic, Subiaco, WA 6008, Australia; Departments of Surgery and Dentistry, University of Western Australia, Nedlands, WA 6009, Australia; Departments of Medicine and Radiology, University of Melbourne, Carlton, Victoria 3000, Australia.
| | - D Gibson
- Departments of Surgery and Dentistry, University of Western Australia, Nedlands, WA 6009, Australia; Imaging Department, Fiona Stanley Hospital, Murdoch, WA 6150, Australia; Department of Medicine, Curtin Medical School, Bentley, WA 6102, Australia
| |
Collapse
|
26
|
Cho SH, Jeon JY, Jang KS, Kim SY, Kim KR, Ryu S, Hwang KG. Gender-specific cephalometric features related to obesity in sleep apnea patients: trilogy of soft palate-mandible-hyoid bone. Maxillofac Plast Reconstr Surg 2019; 41:58. [PMID: 31879661 PMCID: PMC6904695 DOI: 10.1186/s40902-019-0242-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/27/2019] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study is to investigate the relationship between gender-specific and obesity-related airway anatomy in patients with obstructive sleep apnea (OSA) by using cephalometric analyses. Methods We retrospectively evaluated 206 patients with suspected OSA undergoing polysomnography and anthropometric measurements such as body mass index, neck circumference, and waist-hip ratio. We checked lateral cephalometry to measure tissue landmarks including angle from A point to nasion to B point (ANB), soft palate length (SPL), soft palate thickness (SPT), retropalatal space (RPS), retrolingual space (RLS), and mandibular plane to hyoid (MPH). Results Male with OSA showed significantly increased SPL (P = .006) compared with controls. SPL and MPH had significant correlation with apnea-hypopnea index (AHI) and central obesity. Female with OSA showed significantly increased ANB (P = .013) and SPT (P = .004) compared with controls. The receiver operating characteristic curves revealed that SPT in male and ANB and SPT in female were significant in model 1 (AHI ≥ 5) and model 2 (AHI ≥ 15). MPH was also significant for male in model 2. Conclusion Male and female with OSA had distinct anatomic features of the upper airway and different interactions among soft palate, mandible, and hyoid bone.
Collapse
Affiliation(s)
- Seok Hyun Cho
- 1Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Hanyang University, Seoul, Korea
| | - Jae-Yun Jeon
- 2Department of Dentistry/Oral and Maxillofacial Surgery, School of Medicine, Hanyang University, 222-1 Wangshimniro, Seongdong-gu, Seoul, 133-792 Korea
| | - Kun-Soo Jang
- 2Department of Dentistry/Oral and Maxillofacial Surgery, School of Medicine, Hanyang University, 222-1 Wangshimniro, Seongdong-gu, Seoul, 133-792 Korea
| | - Sang Yoon Kim
- 3Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.,Vienna, USA
| | - Kyung Rae Kim
- 1Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Hanyang University, Seoul, Korea
| | - Seungho Ryu
- 5Department of Occupational Medicine, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Kyung-Gyun Hwang
- 2Department of Dentistry/Oral and Maxillofacial Surgery, School of Medicine, Hanyang University, 222-1 Wangshimniro, Seongdong-gu, Seoul, 133-792 Korea
| |
Collapse
|
27
|
Hassaan A, Trinidade A, Kotecha B, Tolley N. TORS for OSA: a practice, pitfalls and literature review. Int J Health Care Qual Assur 2019; 32:488-498. [PMID: 31017058 DOI: 10.1108/ijhcqa-05-2018-0112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Trans-oral robotic surgery (TORS) is increasingly employed in obstructive sleep apnoea (OSA) management. Objective outcomes are generally assessed through polysomnography. Pre-operative magnetic resonance imaging (MRI) can be a useful adjunct in objective upper airway assessment, in particular the tongue base, providing useful information for surgical planning and outcome assessment, though care must be taken in patient positioning during surgery. The purpose of this paper is to identify pitfalls in this process and suggest a protocol for pre-operative MRI scanning in OSA. DESIGN/METHODOLOGY/APPROACH This study is a four-patient prospective case-series and literature review. Outcome measures include pre- and post-operative volumetric changes in the pharynx as measured on MRI and apnoea-hypopnea indices (AHI), with cure being OSA resolution or a 50 per cent reduction in AHI. FINDINGS All patients achieved AHI reduction and/or OSA cure following TORS, despite a decrease in pharyngeal volume measurements at the tongue base level. This study and others lacked standardisation in the MRI scanning protocol, which resulted in an inability to effectively compare pre- and post-operative scans. Pitfalls were related to variation in head/tongue position, soft-tissue marker usage and assessed area boundary limits. PRACTICAL IMPLICATIONS TORS appears to be effective in OSA management. A new protocol for patient positioning and anatomical landmarks is suggested. ORIGINALITY/VALUE The findings could provide directly comparable data between scans and may allow correlation between tongue base volumetric changes and AHI through subsequent and historical study meta-analysis.
Collapse
Affiliation(s)
- Amro Hassaan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Aaron Trinidade
- Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
| | - Bhik Kotecha
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Neil Tolley
- Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
28
|
Resnick CM, Middleton JK, Calabrese CE, Ganjawalla K, Padwa BL. Retropalatal Cross-Sectional Area Is Predictive of Obstructive Sleep Apnea in Patients With Syndromic Craniosynostosis. Cleft Palate Craniofac J 2019; 57:560-565. [PMID: 31648545 DOI: 10.1177/1055665619882571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE There is a high rate of obstructive sleep apnea (OSA) in patients with syndromic craniosynostosis (SCS). Little is known about the airway anatomy in this population. The purpose of this study is to characterize the 3 dimensional (3D) upper airway in patients with SCS with and without OSA. DESIGN This is a retrospective study of patients with SCS treated at Boston Children's Hospital from 2000 to 2015. Patients were divided into OSA and no-OSA groups based on polysomnography. Predictor variables included age, sex, body mass index (BMI), and 3D upper airway measurements. The primary outcome variable was the presence or absence of OSA. Secondary outcome variables were apnea-hypopnea index and oxygen saturation nadir. Descriptive and bivariate statistics were computed, and significance was set as P < .05. RESULTS There were 24 patients: 16 in the OSA group and 8 in the no-OSA group. The 2 groups did not differ significantly by age, BMI, or syndromic diagnosis. The presence of OSA was associated with a smaller minimum retropalatal cross-sectional area (minRPCSA; P < .001). In a logistic regression model controlling for age, sex, and upper airway length, minRPCSA was the primary predictor of OSA (P ≤ .002). Receiver operating characteristic analysis determined minRPCSA = 55.3 mm2 to be the optimal diagnostic threshold for OSA, with sensitivity = 100% and specificity = 87.5% (P < .001). CONCLUSION A minRPCSA ≤55.3 mm2 is predictive of the presence of OSA in patients with SCS.
Collapse
Affiliation(s)
- Cory M Resnick
- Harvard School of Dental Medicine, Harvard Medical School, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, MA, USA
| | - Jason K Middleton
- Harvard School of Dental Medicine, Harvard Medical School, Boston, MA, USA
| | - Carly E Calabrese
- Harvard School of Dental Medicine, Harvard Medical School, Boston, MA, USA
| | - Karan Ganjawalla
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Bonnie L Padwa
- Harvard School of Dental Medicine, Harvard Medical School, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, MA, USA
| |
Collapse
|
29
|
Campos LD, Trindade IEK, Yatabe M, Trindade SHK, Pimenta LA, Kimbell J, Drake AF, Trindade-Suedam IK. Reduced pharyngeal dimensions and obstructive sleep apnea in adults with cleft lip/palate and Class III malocclusion. Cranio 2019; 39:484-490. [DOI: 10.1080/08869634.2019.1668997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Leticia Dominguez Campos
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, SP, Brazil
| | - Inge Elly Kiemle Trindade
- Department of Biological Sciences, Bauru School of Dentistry and Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, SP, Brazil
| | - Marilia Yatabe
- Department of Orthodontics and Pediatric Dentistry, University of Michigan, Ann Arbor, MI, USA
| | | | - Luiz Andre Pimenta
- Craniofacial Center and Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Julia Kimbell
- Department of Otolaryngology/Head and Neck Surgery (A.F.D.), School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amelia F. Drake
- Craniofacial Center, Department of Otolaryngology/Head and Neck Surgery (A.F.D.), School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ivy Kiemle Trindade-Suedam
- Department of Biological Sciences, Bauru School of Dentistry and Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, SP, Brazil
| |
Collapse
|
30
|
Klazen YP, Caron CJ, Schaal SC, Borghi A, Van der Schroeff MP, Dunaway DJ, Padwa BL, Koudstaal MJ. What Are the Characteristics of the Upper Airway in Patients With Craniofacial Microsomia? J Oral Maxillofac Surg 2019; 77:1869-1881. [DOI: 10.1016/j.joms.2019.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/03/2019] [Accepted: 03/16/2019] [Indexed: 10/27/2022]
|
31
|
Cillo JE, Dattilo DJ. Orthognathic surgery for obstructive sleep apnea. Semin Orthod 2019. [DOI: 10.1053/j.sodo.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
32
|
Respiratory and volumetric changes of the upper airways in craniofacial synostosis patients. J Craniomaxillofac Surg 2019; 47:548-555. [DOI: 10.1016/j.jcms.2019.01.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/15/2019] [Accepted: 01/28/2019] [Indexed: 11/17/2022] Open
|
33
|
Long-term quality of life outcomes of maxillomandibular advancement osteotomy in patients with obstructive sleep apnoea syndrome. Int J Oral Maxillofac Surg 2019; 48:332-340. [DOI: 10.1016/j.ijom.2018.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/17/2018] [Accepted: 08/31/2018] [Indexed: 11/21/2022]
|
34
|
Bolzer A, Toussaint B, Rumeau C, Gallet P, Jankowski R, Nguyen DT. Can anatomical assessment of hypopharyngolarynx in awake patients predict obstructive sleep apnea? Laryngoscope 2019; 129:2782-2788. [PMID: 30720214 DOI: 10.1002/lary.27851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/05/2019] [Accepted: 01/14/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess the relationships between laryngeal and hypopharyngeal morphology and obstructive sleep apnea-hypopnea syndrome (OSAHS) in awake patients. STUDY DESIGN Prospective study. METHODS Awake flexible fiberoptic laryngoscopy and sleep studies were performed in 80 patients for snoring or OSAHS suspicion. Endoscopic videos were reviewed by two examiners to assess morphological characteristics of hypopharynx and larynx using a standardized examination of appearance, shape and position of epiglottis, shape of retropharyngeal-epiglottic aerospace (RPEA), modified Cormack-Lehane score, and length ratios of the hypopharynx and epiglottis. The multivariate logistic regression model was used to assess independent predictors of moderate/severe OSAHS. RESULTS The interrater agreements were moderate for epiglottis appearance (κ = 0.52), epiglottis form (κ = 0.66), and epiglottis position (κ = 0.49), but fair for the shape of RPEA (κ = 0.26) and modified Cormack-Lehane scoring (κ = 0.38). The presence of a mega-epiglottis was significantly correlated with the severity of OSAHS (P < .05). By multivariate logistic regression analysis, independent predictors of moderate/severe obstructive sleep apnea were mega-epiglottis (adjusted odds ratio [aOR]: = 4.78, 95% confidence interval [CI]: 1.23-18.56, P = .024), modified Cormack-Lehane score of 2 (aOR: 15.3, 95% CI: 1.8-130.3, P = .012), or modified Cormack-Lehane score of 3 (aOR: 10.03, 95% CI: 1.3-78.2, P = .03) and aging (aOR = 1.07, 95% CI: 1.01-1.14, P = .025). CONCLUSIONS Routine flexible fiberoptic laryngoscopy performed by otorhinolaryngologists in awake patients may help to detect some predictors of OSAHS such as presence of mega-epiglottis, and modified Cormack-Lehane score of 2 or more. Investigation of sleep disorders should be proposed in these patients. LEVEL OF EVIDENCE 2 Laryngoscope, 129:2782-2788, 2019.
Collapse
Affiliation(s)
- Adrien Bolzer
- Department of Ear, Nose, and Throat-Head and Neck Surgery, University Hospital of Nancy, Hospitals of Brabois, Vandoeuvre-lès-Nancy, France
| | - Bruno Toussaint
- Department of Ear, Nose, and Throat-Head and Neck Surgery, University Hospital of Nancy, Hospitals of Brabois, Vandoeuvre-lès-Nancy, France
| | - Cécile Rumeau
- Department of Ear, Nose, and Throat-Head and Neck Surgery, University Hospital of Nancy, Hospitals of Brabois, Vandoeuvre-lès-Nancy, France.,Faculty of Medicine, University of Lorraine, Lorraine, France
| | - Patrice Gallet
- Department of Ear, Nose, and Throat-Head and Neck Surgery, University Hospital of Nancy, Hospitals of Brabois, Vandoeuvre-lès-Nancy, France.,Faculty of Medicine, University of Lorraine, Lorraine, France
| | - Roger Jankowski
- Department of Ear, Nose, and Throat-Head and Neck Surgery, University Hospital of Nancy, Hospitals of Brabois, Vandoeuvre-lès-Nancy, France.,Faculty of Medicine, University of Lorraine, Lorraine, France
| | - Duc Trung Nguyen
- Department of Ear, Nose, and Throat-Head and Neck Surgery, University Hospital of Nancy, Hospitals of Brabois, Vandoeuvre-lès-Nancy, France
| |
Collapse
|
35
|
Na JS, Jung HD, Cho HJ, Choi YJ, Lee JS. Computational analysis of airflow dynamics for predicting collapsible sites in the upper airways: a preliminary study. J Appl Physiol (1985) 2019; 126:330-340. [DOI: 10.1152/japplphysiol.00522.2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The present study aimed to detail the relationship between the flow and structure characteristics of the upper airways and airway collapsibility in obstructive sleep apnea. Using a computational approach, we performed simulations of the flow and structure of the upper airways in two patients having different facial morphologies: retruding and protruding jaws, respectively. First, transient flow simulation was performed using a prescribed volume flow rate to observe flow characteristics within upper airways with an unsteady effect. In the retruding jaw, the maximum magnitude of velocity and pressure drop with velocity shear and vortical motion was observed at the oropharyngeal level. In contrast, in the protruding jaw, the overall magnitude of velocity and pressure was relatively small. To identify the cause of the pressure drop in the retruding jaw, pressure gradient components induced by flow were examined. Of note, vortical motion was highly associated with pressure drop. Structure simulation was performed to observe the deformation and collapsibility of soft tissue around the upper airways using the surface pressure obtained from the flow simulation. At peak flow rate, the soft tissue of the retruding jaw was highly expanded, and a collapse was observed at the oropharyngeal and epiglottis levels. NEW & NOTEWORTHY Aerodynamic characteristics have been reported to correlate with airway occlusion. However, a detailed mechanism of the phenomenon within the upper airways and its impact on airway collapsibility remain poorly understood. This study provides in silico results for aerodynamic characteristics, such as vortical structure, pressure drop, and exact location of the obstruction using a computational approach. Large deformation of soft tissue was observed in the retruding jaw, suggesting that it is responsible for obstructive sleep apnea.
Collapse
Affiliation(s)
- Ji Sung Na
- Department of Mechanical Engineering, Yonsei University, Seoul, Korea
| | - Hwi-Dong Jung
- Department of Oral and Maxillofacial Surgery, Oral Science Research Institute, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyung-Ju Cho
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Jeong Choi
- Department of Mechanical Engineering, Yonsei University, Seoul, Korea
- Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
| | - Joon Sang Lee
- Department of Mechanical Engineering, Yonsei University, Seoul, Korea
- Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
| |
Collapse
|
36
|
Xu J, Sun R, Wang L, Hu X. Cone-beam evaluation of pharyngeal airway space in adult skeletal Class II patients with different condylar positions. Angle Orthod 2018; 89:312-316. [PMID: 30457352 DOI: 10.2319/040518-253.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To test the null hypothesis that there is no significant difference in pharyngeal airway space among adult skeletal Class II patients with different condylar positions using cone-beam computed tomography (CBCT). MATERIALS AND METHODS The CBCT records of 60 patients with skeletal Class II malocclusion (ANB angle ≥ 4°, Wits ≥ 0) were selected from the CBCT database. According to the condyle position, the patients were divided in three groups: anterior group (CD ≤ -12%), centric group (-12% ≤ CD ≤ +12%), and posterior group (CD ≥ +12%). Three-dimensional (3D) pharyngeal airway models were reconstructed using InvivoDental software 5.1.3. The volume and area of the pharyngeal airway space were measured in the 3D airway model. RESULTS The volume and area of the pharyngeal airway space in the centric group were significantly smaller than those in the posterior group ( P < .01). The volume and area of the pharyngeal airway space were smallest in the anterior group and significantly increased in the centric and posterior groups ( P < .001). CONCLUSIONS The null hypothesis was rejected. Significant differences were noted in pharyngeal airway space among adult skeletal Class II patients with different condylar positions.
Collapse
|
37
|
Upper airway morphologic changes after mandibular setback surgery in skeletal class III malocclusion patients measured using cone beam computed tomography superimposition. Int J Oral Maxillofac Surg 2018; 47:1405-1410. [DOI: 10.1016/j.ijom.2018.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/28/2018] [Accepted: 05/07/2018] [Indexed: 11/23/2022]
|
38
|
Chen YJ, Chen HH, Hsu LF, Wang SH, Chen YJ, Lai EHH, Chang JZC, Yao CCJ. Airway increase after open bite closure with temporary anchorage devices for intrusion of the upper posteriors: Evidence from 2D cephalometric measurements and 3D magnetic resonance imaging. J Oral Rehabil 2018; 45:939-947. [PMID: 30133810 DOI: 10.1111/joor.12712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/15/2018] [Accepted: 08/17/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to analyse morphological changes in the upper airways in patients with anterior open bite treated with temporary anchorage devices for intrusion of upper posterior teeth. MATERIALS AND METHODS Twelve nonobese (body mass index: <25) anterior open bite patients between the ages of 19 and 44 years (mean age: 22.83 ± 8.19 years) were recruited for this study. Cephalometric radiographs and magnetic resonance imaging (MRI) scans before and after anterior bite closure without bracketing on anterior teeth were used to measure the upper airway, which was divided into retropalatal and retroglossal regions. RESULTS The mandibular plane angle and lower facial height were significantly reduced by intrusion of the upper posteriors and autorotation of the mandible. The retroglossal airway width (AW2) and retroglossal area (RG area) measured on cephalometric radiographs both increased significantly after treatment. Retroglossal volume increased and the retroglossal width/length ratio decreased significantly in MRI analysis. All other measurements were not significantly changed. However, no statistically significant correlations were observed between all measurements in 2D and 3D images, with the exception of the AW2 linear measurement in 2D images correlating with the AP length in MRI axial view images (r = 0.56, P = 0.0430). CONCLUSION Counterclockwise rotation of the mandible after anterior open bite closed using orthodontic treatment changed the airway morphology. Retroglossal volume significantly increased and the airway shape became less elliptical after bite closure.
Collapse
Affiliation(s)
- Yunn-Jy Chen
- Division of Prosthodontics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsin-Ho Chen
- Division of Orthodontics, Dental Department, Taoyuan Armed Forces General Hospital, Lungtan, Taiwan
| | - Li-Fang Hsu
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Shin-Huei Wang
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Jane Chen
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Eddie Hsiang-Hua Lai
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Jenny Zwei-Chieng Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Chen Jane Yao
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
39
|
Imaging of adult obstructive sleep apnoea. Eur J Radiol 2018; 102:176-187. [PMID: 29685533 DOI: 10.1016/j.ejrad.2018.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/26/2018] [Accepted: 03/05/2018] [Indexed: 12/15/2022]
Abstract
Obstructive sleep apnoea (OSA) is characterised by recurrent upper airway collapse during sleep resulting in chronic and repetitive hypoxia, hypercapnia, subsequent arousal and fragmented sleep. Symptoms are insidious and diagnosis is usually delayed. Moderate to severe OSA has serious health implications with significant increase in all causes of mortality in patients with the condition as compared with unaffected individuals. The prevalence of OSA in the 30-70 year age group is estimated at 27% of males and 11% of females and it increases with age. 80% of affected individuals are obese and as obesity rates rise, so has the prevalence of OSA. An overnight polysomnogram (PSG) is required for a definitive diagnosis of OSA. Imaging has played a fundamental role in the evaluation of the anatomical factors associated with recurrent upper airway collapse and the pathogenesis of OSA. The upper airway is frequently imaged by radiologists, providing an opportunity to detect features that are strongly associated with unsuspected OSA and to raise the possibility of this diagnosis. The gold standard of treatment is continuous positive airway pressure (CPAP) which acts as a pneumatic splint for the upper airway. However, efficacy is frequently limited by poor tolerance; clinicians and patients are increasingly opting for one of a range of surgical procedures. Dedicated imaging protocols can be performed for evaluation of the upper airway to aid surgical planning.
Collapse
|
40
|
Liu NC, Troconis EL, McMillan M, Genain MA, Kalmar L, Price DJ, Sargan DR, Ladlow JF. Endotracheal tube placement during computed tomography of brachycephalic dogs alters upper airway dimensional measurements. Vet Radiol Ultrasound 2018; 59:289-304. [PMID: 29336085 DOI: 10.1111/vru.12590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/10/2017] [Accepted: 10/15/2017] [Indexed: 10/18/2022] Open
Abstract
Computed tomography (CT) is used to document upper airway lesions in dogs with brachycephalic obstructive airway syndrome. The presence of an endotracheal tube during CT scanning is often required for general anesthesia. We hypothesized that the endotracheal tube placement would change the soft tissue dimensions of the upper airway. The aims of this prospective, method comparison study were to evaluate the reliability of the previously reported upper airway CT measurements with endotracheal tube placement, and to propose measurements that are minimally affected by the endotracheal tube. Twenty brachycephalic dogs were included in this study. Each dog underwent head/neck CT with an endotracheal tube, followed by a second scan without the endotracheal tube. Ten measurements of the soft palate, nasopharynx, and trachea were performed. Tracheal dimension was significantly larger with the endotracheal tube compared to without, whereas the soft palate cross-sectional area was significantly smaller with the endotracheal tube than without the endotracheal tube. The influence of the endotracheal tube on the caudal nasopharynx cross-sectional (transverse-sectional) area varied with a mean proportional absolute difference of 35%. Rostral soft palate thickness, tracheal perimeter, and cross-sectional area of the rostral nasopharynx were the measurements least affected by the endotracheal tube (intraclass correlation coefficient = 0.964, 0.967, and 0.951, respectively). Therefore, we proposed that these three measurements may be most useful for future brachycephalic obstructive airway syndrome studies that require CT scanning of intubated animals. However, with endotracheal tube placement, measurements of soft palate length, caudal nasopharyngeal cross-sectional area, and trachea height and width may not be reliable.
Collapse
Affiliation(s)
- Nai-Chieh Liu
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | | | - Matthew McMillan
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.,Queen's Veterinary School Hospital, University of Cambridge, Cambridge, UK
| | - Marie-Aude Genain
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.,Queen's Veterinary School Hospital, University of Cambridge, Cambridge, UK
| | - Lajos Kalmar
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - David J Price
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - David R Sargan
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Jane F Ladlow
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.,Queen's Veterinary School Hospital, University of Cambridge, Cambridge, UK
| |
Collapse
|
41
|
Dultra FKAA, Tavares A, Dultra JDA, Salles C, Crusoé-Rebelo IM, Barbosa I, Souza-Machado A. Pharyngeal airspace of asthmatic individuals and those suffering from obstructive sleep apnea syndrome: Study by CBCT. Eur J Radiol 2017; 95:342-348. [PMID: 28987691 DOI: 10.1016/j.ejrad.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The objective of the present study was to comparatively evaluate the oropharyngeal space of patients with obstructive sleep apnea syndrome (OSA) and asthma by means of Cone Beam Computed Tomography (CBCT) images. MATERIAL AND METHODS The study included individuals with OSA and asthma (n=10), with OSA and without asthma (n=6), asthmatics without OSA (n=6) and healthy individuals (n=25). All patients were evaluated by a pneumologist and submitted to a nocturnal polysomnogram. Participants underwent CBCT examinations using an I-CAT® device (Imaging Sciences International, Hatfield, PA, U.S.A.) and all images were exported to Dolphin Image 3D® software. Cephalometric measurements were taken, as well as measurements of length (C), volume (VOL), sagittal area (SA) and minimum cross-sectional area (MCA); an evaluation was made of the format and contour of the upper airway in three dimensions, with p<0.05 considered significant. RESULTS In the results of the present study, a statistically significant difference was found between VOL, SA and MCA (p=0.011; p=0.009; p=0.010) with reduced elevated values among the OSA+Asthma, OSA, Asthma and Control groups. Significant differences were seen between the linear (AP), cross-sectional (TR) and mean transverse area (TA) measurements in the group of patients with OSA and asthma as compared to the control group. In the control group, the greatest narrowing of the airway was observed either in the retroglossal or retropalatal area, while more patients in the experimental groups showed narrowing in the retropalatal area. CONCLUSION The condition of OSA+asthma was associated with a substantial reduction in upper airway measurements in comparison to controls.
Collapse
Affiliation(s)
- Fátima Karoline Araújo Alves Dultra
- Metropolitan Union of Education and Culture (UNIME), PhD in Processes of Organs and Systems and Master in Dentistry - Bahia Federal University (UFBA), Rua Barão de Loreto, Edf Barão de Coubertin, n. 519, Graça, Bahia, 40150270, Brazil.
| | - Alana Tavares
- Orthodontics - Bahia Federal University (UFBA),Masters' Student in Odontology and Health - UFBA, Rua Priscila Dultra, n. 1229, Lauro de Freitas, Bahia, 42700000, Brazil.
| | - Joaquim de Almeida Dultra
- State University of Southwest Bahia (UESB), PhDs' Student in Odontology and Health - UFBA, Master in Dentistry, Rua Barão de Loreto, Edf Barão de Coubertin, n. 519, Graça, Bahia, 40150270, Brazil.
| | - Cristina Salles
- Bahiana School of Medicine and Public Health (EBMSPD), Preceptor at University Hospital Professor Edgard Santos, PhD in Medicine and Health, Master in Internal Medicine, Salvador, Bahia, Brazil; Av. Professor Magalhães net, 1541, Hospital da Bahia, sala 2010, Pituba, Salvador, Bahia, 41810011, Brazil.
| | - Iêda Margarida Crusoé-Rebelo
- Bahia Federal University (UFBA), Specialist in Radiology, PhD and Master in Dentistry at UFBA, Avenida Araújo Pinho, n. 62, Canela, Salvador, Bahia, 40110140, Brazil.
| | - Inessa Barbosa
- Orthodontics - Bahia Federal University (UFBA), PhDs' student and Master in Odontology and Health - UFBA, Avenida Araújo Pinho, n. 62, Canela, Salvador, Bahia, 40110140, Brazil.
| | - Adelmir Souza-Machado
- Sciences and Health Institute, Federal University of Bahia (UFBA), PhD and Master in Medicine and Health at UFBA, Av. Reitor Miguel Calmon s/n priemiro andar, Canela, Salvador, Bahia, 40500020, Brazil.
| |
Collapse
|
42
|
Wanzeler AMV, Renda MDO, de Oliveira Pereira ME, Alves-Junior SM, Tuji FM. Anatomical relation between nasal septum deviation and oropharynx volume in different facial patterns evaluated through cone beam computed tomography. Oral Maxillofac Surg 2017; 21:341-346. [PMID: 28735346 DOI: 10.1007/s10006-017-0641-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 07/11/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The objective of this study was to establish the anatomical relation between nasal septum deviation (NSD) and oropharynx volume in different facial patterns using cone beam computed tomography (CBCT). METHODS Ninety CBCT examinations were analyzed. InVivoDental software was used to evaluate cephalometric image reconstructions in terms of facial type, determined from cephalometric measurements indicative of growth direction; the presence of NSD was also evaluated. ITK-SNAP software was employed for delimitation of the oropharynx. Intra-examiner error methods were recorded. The results were subjected to parametric and non-parametric tests using Bioestat 5.0. RESULTS A comparison of facial types revealed a significantly lower prevalence of NSD in the dolichofacial group compared with the brachyfacial and mesofacial groups (P = 0.0101 and 0.0149, respectively). In the total sample, there was a very strong positive relation between the presence of NSD and oropharynx space volume (P = 0.0162). The oropharynx volume was larger in all facial patterns in the presence of NSD. CONCLUSION The presence of NSD was not associated with facial type, although the oropharynx volume in patients with NSD increased. Therefore, deviation of the septum influences oropharynx volume.
Collapse
Affiliation(s)
- Ana Márcia Viana Wanzeler
- Department of Oral Radiology, Federal University of Pará, Belém, Pará, Brazil.
- Federal University of Pará, Rua Augusto Corrêa, 1, Belém, Pará, 66075-110, Brazil.
| | - Maria Daniela Oliveira Renda
- Department of Oral Radiology, Federal University of Pará, Belém, Pará, Brazil
- Federal University of Pará, Rua Augusto Corrêa, 1, Belém, Pará, 66075-110, Brazil
| | - Maria Eduarda de Oliveira Pereira
- Department of Oral Radiology, Federal University of Pará, Belém, Pará, Brazil
- Federal University of Pará, Rua Augusto Corrêa, 1, Belém, Pará, 66075-110, Brazil
| | - Sérgio Melo Alves-Junior
- Department of Oral Radiology, Federal University of Pará, Belém, Pará, Brazil
- Federal University of Pará, Rua Augusto Corrêa, 1, Belém, Pará, 66075-110, Brazil
| | - Fabricio Mesquita Tuji
- Department of Oral Radiology, Federal University of Pará, Belém, Pará, Brazil
- Federal University of Pará, Rua Augusto Corrêa, 1, Belém, Pará, 66075-110, Brazil
| |
Collapse
|
43
|
Change in Posterior Pharyngeal Space After Counterclockwise Rotational Orthognathic Surgery for Class II Dentofacial Deformity Diagnosed With Obstructive Sleep Apnea Based on Cephalometric Analysis. J Craniofac Surg 2017; 28:e488-e491. [DOI: 10.1097/scs.0000000000003761] [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] Open
|
44
|
Chen H, van Eijnatten M, Aarab G, Forouzanfar T, de Lange J, van der Stelt P, Lobbezoo F, Wolff J. Accuracy of MDCT and CBCT in three-dimensional evaluation of the oropharynx morphology. Eur J Orthod 2017; 40:58-64. [DOI: 10.1093/ejo/cjx030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
45
|
Yajima Y, Oshima M, Iwai T, Kitajima H, Omura S, Tohnai I. Computational fluid dynamics study of the pharyngeal airway space before and after mandibular setback surgery in patients with mandibular prognathism. Int J Oral Maxillofac Surg 2017; 46:839-844. [PMID: 28412180 DOI: 10.1016/j.ijom.2017.03.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 01/21/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to investigate the relationship between the pressure drop in the pharyngeal airway space (ΔPPAS) and the minimum cross-sectional area (minCSA) of the pharyngeal airway before and after mandibular setback surgery using computational fluid dynamics, in order to prevent iatrogenic obstructive sleep apnoea. Eleven patients with mandibular prognathism underwent bilateral sagittal split osteotomy for mandibular setback. Three-dimensional models of the upper airway were reconstructed from preoperative and postoperative computed tomography images, and simulations were performed using computational fluid dynamics. ΔPPAS and the minCSA of the pharyngeal airway were calculated, and the relationship between them was evaluated by non-linear regression analysis. In all cases, the minCSA was found at the level of the velopharynx. After surgery, ΔPPAS increased significantly and the minCSA decreased significantly. The non-linear regression equation expressing the relationship between these variables was ΔPPAS=3.73×minCSA-2.06. When the minCSA was <1cm2, ΔPPAS increased greatly. The results of this study suggest that surgeons should consider bimaxillary orthognathic surgery rather than mandibular setback surgery to prevent the development of iatrogenic obstructive sleep apnoea when correcting a skeletal class III malocclusion.
Collapse
Affiliation(s)
- Y Yajima
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - M Oshima
- Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
| | - T Iwai
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
| | - H Kitajima
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - S Omura
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - I Tohnai
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| |
Collapse
|
46
|
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
| |
Collapse
|
47
|
Alsufyani NA, Noga ML, Witmans M, Major PW. Upper airway imaging in sleep-disordered breathing: role of cone-beam computed tomography. Oral Radiol 2017. [DOI: 10.1007/s11282-017-0280-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
48
|
Three-dimensional airways volumetric analysis before and after fast and early mandibular osteodistraction. J Craniomaxillofac Surg 2017; 45:377-380. [DOI: 10.1016/j.jcms.2016.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 10/16/2016] [Accepted: 12/06/2016] [Indexed: 11/22/2022] Open
|
49
|
Rodrigues MM, Pereira Filho VA, Gabrielli MFR, Oliveira TFMD, Batatinha JAP, Passeri LA. Volumetric evaluation of pharyngeal segments in obstructive sleep apnea patients. Braz J Otorhinolaryngol 2017; 84:S1808-8694(17)30001-0. [PMID: 28233709 PMCID: PMC9442808 DOI: 10.1016/j.bjorl.2016.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 06/14/2016] [Accepted: 12/10/2016] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnea occurs by recurrent collapse of the upper airway during sleep, resulting in total (apnea) or partial (hypopnea) reduction of the airflow and has intimate relation with changes in the upper airway. Cone Beam CT allows the analysis of the upper airway and its volume by three-dimensional reconstruction. OBJECTIVE To evaluate a possible correlation between the volume of the upper airway and the severity of the obstructive sleep apnea. METHODS A retrospective study was performed reviewing polysomnographic data and Cone Beam CT records of 29 patients (13 males and 16 females). The correlation between the volume of the nasopharynx, the oropharynx and the total superior pharynx with the AHI was assessed by Pearson's rank correlation coefficient. RESULTS The obstructive sleep apnea severity division was: ten patients had severe, 7 had moderate, 6 had mild and 6 of them were healthy. The correlation between the nasopharynx, the oropharynx and the total superior pharynx volumes and the Apnea-Hypopnea-Index was respectively: -0.415 (p=0.025), 0.186 (p=0.334) and -0329 (p=0.089). The Spearman's rank controlled by the Body Mass Index, the age and the gender was: -0.206 (p=0.304), -0.155 (p=0.439) and 0.242 (p=0.284). CONCLUSION There is no correlation between the volume of the airway and the obstructive sleep apnea, assessed by Apnea-Hypopnea-Index and controlled by the Body Mass Index, the age and the gender. The volume of the upper airways as an isolated parameter did not correlate to the severity of the obstructive sleep apnea syndrome, and should be evaluated together with other factors.
Collapse
Affiliation(s)
- Marcos Marques Rodrigues
- Universidade de Araraquara, Faculdade de Medicina da Araraquara, Divisão de Otorrinolaringologia, Araraquara, SP, Brazil.
| | - Valfrido Antonio Pereira Filho
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Faculdade de Odontologia de Araraquara, Departamento de Diagnóstico e Cirurgia, Programa de Cirurgia Oral e Maxilofacial, Araraquara, SP, Brazil
| | - Mário Francisco Real Gabrielli
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Faculdade de Odontologia de Araraquara, Departamento de Diagnóstico e Cirurgia, Programa de Cirurgia Oral e Maxilofacial, Araraquara, SP, Brazil
| | - Talles Fernando Medeiros de Oliveira
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Faculdade de Odontologia de Araraquara, Departamento de Ortodontia, Araraquara, SP, Brazil
| | | | - Luis Augusto Passeri
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Medicina e Ciências, Departamento de Cirurgia, Cirurgia Oral e Maxilofacial, Campinas, SP, Brazil
| |
Collapse
|
50
|
Bianchi FA, Gerbino G, Corsico M, Schellino E, Barla N, Verzè L, Ramieri G. Soft, hard-tissues and pharyngeal airway volume changes following maxillomandibular transverse osteodistraction: Computed tomography and three-dimensional laser scanner evaluation. J Craniomaxillofac Surg 2017; 45:47-55. [DOI: 10.1016/j.jcms.2016.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 08/26/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022] Open
|