1
|
Doberschütz PH, Schwahn C, Krey KF. Cephalometric analyses for cleft patients: a statistical approach to compare the variables of Delaire's craniofacial analysis to Bergen analysis. Clin Oral Investig 2021; 26:353-364. [PMID: 34050425 PMCID: PMC8791903 DOI: 10.1007/s00784-021-04006-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
Objectives Cephalometric analyses using lateral craniofacial radiographs are common diagnostic procedures for evaluating skeletal patterns. However, in patients with pronounced abnormalities like cleft lip and palate, standard cephalometric analyses and landmarks may not be suitable. This study aims to clarify whether the inclusion of landmarks less compromised by the cleft defect or located outside the cleft area results in a different cephalometric assessment of the viscerocranium. Delaire’s whole-skull analysis and Bergen analysis were examined for similarities and underlying common observations. Materials/methods Based on the cephalometric evaluation of 217 patients with different types of non-syndromal cleft formation, Delaire and Bergen analysis were compared using three statistical methods: correlation analysis, factor analysis, and cluster analysis. Reproducibility was assessed by Bland–Altman plots, intraclass correlation coefficients, mean absolute differences, and coefficients of variability. Results Although Delaire analysis and Bergen analysis are based on different concepts and landmarks, a majority of corresponding variables was found. Certain aspects of craniofacial base relation and craniospinal articulation are only assessed by Delaire analysis. All but one variable showed very good reproducibility. Conclusions The inclusion of landmarks less compromised by or located outside the cleft area does not result in variables that provide a different assessment of the viscerocranial area. Clinical Relevance The findings contradict the concept of invalidity of landmarks compromised by the cleft defect or located within the affected cleft area. Within the scope of its viscerocranial field of view, Bergen analysis appears to be on a par with Delaire analysis in the diagnosis of cleft patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-021-04006-3.
Collapse
Affiliation(s)
| | - Christian Schwahn
- Department of Prosthetic Dentistry, Gerodontology and Biomaterials, University Medicine Greifswald, Fleischmannstraße 42-44, 17475 Greifswald, Germany
| | - Karl-Friedrich Krey
- Department of Orthodontics, University Medicine Greifswald, Fleischmannstraße 42-44, 17475 Greifswald, Germany
| |
Collapse
|
2
|
Paris M, Jean S, Bouchard C. Maxillomandibular Advancement: The Canadian Experience. Atlas Oral Maxillofac Surg Clin North Am 2019; 27:37-42. [PMID: 30717922 DOI: 10.1016/j.cxom.2018.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Mélinda Paris
- Service de chirurgie buccale et maxillo-faciale, CHU de Québec-Université Laval, Hôpital de l'Enfant-Jésus, 1401 18e rue, Québec city, Québec G1J 1Z4, Canada.
| | - Simon Jean
- Service de chirurgie buccale et maxillo-faciale, CHU de Québec-Université Laval, Hôpital de l'Enfant-Jésus, 1401 18e rue, Québec city, Québec G1J 1Z4, Canada
| | - Carl Bouchard
- Service de chirurgie buccale et maxillo-faciale, CHU de Québec-Université Laval, Hôpital de l'Enfant-Jésus, 1401 18e rue, Québec city, Québec G1J 1Z4, Canada
| |
Collapse
|
3
|
Carneiro Júnior JT, Voss de Oliveira D, Goodday R. Maxillary stability following Le Fort I osteotomy using prebent plates and wire fixation in patients undergoing surgery for OSAS. J Craniomaxillofac Surg 2018; 46:1448-1454. [PMID: 30196854 DOI: 10.1016/j.jcms.2018.05.052] [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: 09/17/2017] [Revised: 04/29/2018] [Accepted: 05/29/2018] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to analyze the stability of Le Fort I maxillary advancement in the vertical and horizontal directions using a combination of wire and rigid fixation in patients undergoing surgery to treat obstructive sleep apnea (OSA). Wire osteosynthesis can be performed quicker and at a reduced cost. The lateral cephalograms of 21 patients were evaluated preoperatively (T0), immediately postoperatively (T1), and at least 6 months postoperatively (T2). Four cephalometric points were used to measure movement in the horizontal and vertical directions. Mean values were determined, and data were statistically analyzed by ANOVA to determine differences between time points. Of the four points analyzed, the average maxillary advancement in the horizontal direction was 7.48 mm and the relapse was 0.56 mm with absence of statistically significant differences between the measurements taken (T1) and (T2). There was a 5% probability of error in the vertical movements at the points I and posterior nasal spine. The combination of two pre-bent plates in piriform aperture with osteosynthesis using surgical steel wires in the zygomatic buttress in patients undergoing maxillary surgery for OSA stabilized the large horizontal maxillary advancements and enhanced vertical stability in the first molar and A point regions.
Collapse
Affiliation(s)
- José Thiers Carneiro Júnior
- Federal University of Pará, (Head of the institution: Emmanuel Zagury Tourinho, PhD), Augusto Corrêa, 01, Guamá, CEP: 66075-110, Belém, PA, Brazil.
| | - Douglas Voss de Oliveira
- Federal University of Pará, (Head of the institution: Emmanuel Zagury Tourinho, PhD), Augusto Corrêa, 01, Guamá, CEP: 66075-110, Belém, PA, Brazil.
| | - Reginald Goodday
- Department of Oral and Maxillofacial Sciences, (Head of the institution: Dr. Ben Davis, DDS), Dalhousie University, 5981, University Ave, Halifax, NS, Canada.
| |
Collapse
|
4
|
Bayat M, Shariati M, Rakhshan V, Abbasi M, Fateh A, Sobouti F, Davoudmanesh Z. Cephalometric risk factors of obstructive sleep apnea. Cranio 2016; 35:321-326. [DOI: 10.1080/08869634.2016.1239850] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mohamad Bayat
- Craniomaxillofacial Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Shariati
- Craniomaxillofacial Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Rakhshan
- Research Council, Iranian Center for Tissue Engineering and Graft Research, Tehran University of Medical Sciences, Tehran, Iran
- Department of Dental Anatomy and Morphology, Dental Branch, Islamic Azad University, Tehran, Iran
| | - Mohsen Abbasi
- Craniomaxillofacial Research Center, Dental Branch, Islamic Azad University, Tehran, Iran
| | - Ali Fateh
- Craniomaxillofacial Research Center, Dental Branch, Islamic Azad University, Tehran, Iran
| | - Farhad Sobouti
- Department of Orthodontics, Faculty of Dental, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zeinab Davoudmanesh
- Craniomaxillofacial Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Craniomaxillofacial Research Center, Dental Branch, Islamic Azad University, Tehran, Iran
| |
Collapse
|
5
|
Goodday RH, Bourque SE, Edwards PB. Objective and Subjective Outcomes Following Maxillomandibular Advancement Surgery for Treatment of Patients With Extremely Severe Obstructive Sleep Apnea (Apnea-Hypopnea Index >100). J Oral Maxillofac Surg 2016; 74:583-9. [DOI: 10.1016/j.joms.2015.07.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/07/2015] [Accepted: 07/20/2015] [Indexed: 11/26/2022]
|
6
|
The status of cephalometry in the prediction of non-CPAP treatment outcome in obstructive sleep apnea patients. Sleep Med Rev 2015; 27:56-73. [PMID: 26452001 DOI: 10.1016/j.smrv.2015.05.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 04/26/2015] [Accepted: 05/26/2015] [Indexed: 12/24/2022]
Abstract
Obstructive sleep apnea syndrome (OSAS) is the most common sleep disordered breathing disorder (SDB) in adults and is characterized by a recurrent partial or complete collapse of the upper airway during sleep. This can be caused by many factors, sometimes interacting, such as skeletal malformations, soft tissue crowding, respiratory instability and the various effects of aging, obesity and gender that dictate craniofacial and upper airway anatomy. Research has demonstrated that the majority of patients exhibit at least one anatomical component such as retrognathia or a narrow posterior airway space that predisposes to the development of OSAS. Within the predisposing elements for OSAS many seem to point to anatomical characteristics. A standardized and relatively simple radiologic technique to evaluate anatomical craniofacial relationships is cephalometry. This has been used already for a long time in orthodontics, but is now gradually being introduced in OSAS treatment to envisage optimal treatment selection as well as to predict treatment outcomes. The purpose of the present review is to evaluate the contribution of cephalometry in the prediction of outcomes from OSAS treatments that depend on the upper airway morphology in their mechanisms of action such as oral appliances that advance the mandible as well as various surgical methods. In addition, an overview of imaging modalities and methods that currently are being used in cephalometric analysis in OSAS patients is provided. The findings indicate that isolated cephalometric parameters cannot be used to reliably predict treatment outcomes from mandibular advancement devices and surgical methods for OSAS. Extreme or outlying values of cephalometric parameters may rather be used as contra-indicators or 'red flags' instead of predictors.
Collapse
|
7
|
Luginbuhl A, Baker A, Curry J, Drejet S, Miller M, Cognetti D. Preoperative cephalometric analysis to predict transoral robotic surgery exposure. J Robot Surg 2014; 8:313-7. [PMID: 25419245 PMCID: PMC4236604 DOI: 10.1007/s11701-014-0471-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 05/27/2014] [Indexed: 11/30/2022]
Abstract
Transoral robotic surgery (TORS) is being increasingly used in the treatment of head and neck cancer and we wanted to determine the feasibility of predicting TORS access using cephalometric measurements obtained from preoperative imaging. 20 cephalometric measurements were obtained from imaging on 31 TORS base of tongue (BOT) resections and compared to adequacy of exposure. Three measurements were found to be significantly different between the restricted and adequate exposure groups. Distances from posterior pharyngeal wall (PPW) to hyoid, PPW to soft palate and epiglottis to vertical laryngeal angle were all statistically different between the two groups. Receiver operating characteristic (ROC) analysis revealed strong correlation to exposure for all three measurements with cut offs ≤30 mm between the PPW and the hyoid, ≤8.1 mm PPW and soft palate and ≥130° between the epiglottis and vertical plain of the larynx all representing restricted exposure. Duration of surgery for the restricted group, 85 min, was significantly longer than the adequate exposure group, 51 min (p = 0.026). Preoperative measurements of radiographic images of the oropharyngeal working space can predict restricted exposure for TORS resection of the BOT. These measures may be used in conjunction with other subjective assessment parameters to predict which patients could benefit from a staging endoscopy to determine adequate TORS exposure.
Collapse
Affiliation(s)
- Adam Luginbuhl
- Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut St, 6th Floor, Philadelphia, PA 19107 USA
| | - Adam Baker
- Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut St, 6th Floor, Philadelphia, PA 19107 USA
| | - Joseph Curry
- Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut St, 6th Floor, Philadelphia, PA 19107 USA
| | - Sarah Drejet
- Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut St, 6th Floor, Philadelphia, PA 19107 USA
| | - Matthew Miller
- Department of Otolaryngology Head and Neck Surgery, University of Rochester, Rochester, NY USA
| | - David Cognetti
- Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut St, 6th Floor, Philadelphia, PA 19107 USA
| |
Collapse
|
8
|
Silva VG, Pinheiro LAM, Silveira PLD, Duarte ASM, Faria AC, Carvalho EGBD, Zancanella E, Crespo AN. Correlation between cephalometric data and severity of sleep apnea. Braz J Otorhinolaryngol 2014; 80:191-5. [PMID: 25153101 PMCID: PMC9535488 DOI: 10.1016/j.bjorl.2013.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 11/10/2013] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnea syndrome has a high prevalence among adults. Cephalometric variables can be a valuable method for evaluating patients with this syndrome. OBJECTIVE To correlate cephalometric data with the apnea-hypopnea sleep index. METHODS We performed a retrospective and cross-sectional study that analyzed the cephalometric data of patients followed in the Sleep Disorders Outpatient Clinic of the Discipline of Otorhinolaryngology of a university hospital, from June 2007 to May 2012. RESULTS Ninety-six patients were included, 45 men, and 51 women, with a mean age of 50.3 years. A total of 11 patients had snoring, 20 had mild apnea, 26 had moderate apnea, and 39 had severe apnea. The distance from the hyoid bone to the mandibular plane was the only variable that showed a statistically significant correlation with the apnea-hypopnea index. CONCLUSION Cephalometric variables are useful tools for the understanding of obstructive sleep apnea syndrome. The distance from the hyoid bone to the mandibular plane showed a statistically significant correlation with the apnea-hypopnea index.
Collapse
Affiliation(s)
| | - Laíza Araújo Mohana Pinheiro
- Discipline of Otorhinolaryngology, Head and Neck, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | | | | | - Ana Célia Faria
- Discipline of Otorhinolaryngology, Head and Neck, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | | | - Edilson Zancanella
- Discipline of Otorhinolaryngology, Head and Neck, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Agrício Nubiato Crespo
- Discipline of Otorhinolaryngology, Head and Neck, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| |
Collapse
|
9
|
Lateral cephalometric analysis and the risks of moderate to severe obstructive sleep-disordered breathing in Thai patients. Sleep Breath 2013; 17:1249-55. [PMID: 23508488 DOI: 10.1007/s11325-013-0830-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 01/28/2013] [Accepted: 03/04/2013] [Indexed: 10/27/2022]
Abstract
PURPOSES This cross-sectional study was aimed to compare lateral cephalometric parameters among patients with different severities of obstructive sleep-disordered breathing and to determine if there are radiographic variables that increase risk of moderate to severe obstructive sleep apnea (OSA). METHODS Ten linear and 5 angular parameters of lateral cephalometry in 188 adult subjects which included 47 controls and 141 patients with OSA classified by apnea-hypopnea index (AHI) from level-I polysomnography, were analyzed. All radiographs were done under standardized processes and measured twice on separate occasions. RESULTS There were statistically significant differences between controls and patients with AHI ≥ 15 in parameters such as a distance from mandibular plane to hyoid (MP-H), posterior airway space (PAS), skull base angle (NSBA), a distance from posterior nasal spine to posterior pharyngeal wall (PNS-PP), and soft palate length (PNS-P), (p < 0.01). However, no significant difference was found between controls and mild OSA. Logistic regression analysis showed that only MP-H with cutoff point of ≥ 18 millimeters, NSBA ≤ 130°, and PAS ≤ 10 millimeters were independent cephalometric variables that increased risk of having AHI ≥ 15 compared to controls with adjusted odds ratio of 17.1, 8.3 and 4.2, respectively. Gender did not significantly associate with OSA severity in this analysis. CONCLUSIONS Patients who had longer MP-H, narrower PAS and narrower NSBA than specific cutoff points significantly increased risks of moderate to severe OSA. Treatments that effectively improve these parameters, particularly at tongue base level (MP-H and PAS), may decrease the severity of disease.
Collapse
|
10
|
Cohen-Levy J, Petelle B, Vieille E, Dumitrache M, Fleury B. Évolution du profil facial après chirurgie d’avancée maxillomandibulaire dans le traitement du syndrome d’apnées obstructives du sommeil. Int Orthod 2013. [DOI: 10.1016/j.ortho.2012.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
11
|
Changes in facial profile after maxillomandibular advancement surgery for obstructive sleep apnea syndrome. Int Orthod 2013; 11:71-92. [PMID: 23402956 DOI: 10.1016/j.ortho.2012.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED The aim of this study was to assess changes in the profile of adult male patients treated for obstructive sleep apnea syndrome (OSAS) with maxillomandibular advancement (MMA) surgery and to measure patient perception of changes compared with that of different panels. MATERIALS AND METHODS Fifteen consecutive apneic patients displaying a wide variety of morphological types, mean age 42 years (20-59), a BMI of 26.60 kg/m(2) (22-29), a mean initial Apnea Hypopnea Index (AHI) of 50.9 (19-85), underwent MMA. Assessment was done by facial photography, lateral cephalographs (Tweed analysis modified by Riley and Delaire architectural analysis), polysomnographic records and a validated self-assessment questionnaire. Patients' pre- and postoperative profiles were taken from photographs using Photoshop 7™ software. Their darkened outlines were shown randomly in positions A or B (pre- and postoperative) to panels composed of orthodontists (n=40), fine arts students (n=50) and lay persons (n=50) who were requested to choose the most attractive profiles. RESULTS The MMA success rate for OSAS was 80% (12/15) for an AHI less than 15, with no surgical complications. All patients reported a reduction of their symptoms and 14 out of 15 were satisfied with the esthetic outcome. Mean advancement was 8.4mm (3.0-10.0) for the maxilla and 10.8mm (10.0-13.0) for the mandible. Following MMA, 12 out of 15 exhibited maxillary protrusion and six out of 15 mandibular protrusion. The mean change in the nasolabial angle was -5.7° (-27°; 14°). The postoperative profiles were preferred by 85% of the combined panels (P=<0.001), showing no significant difference from one panel to another. No skeletal characteristic could be correlated with the esthetic preference. Upper lip retrusion, open nasolabial angle and dolichofacial type emerged as positive preoperative predictors of esthetic preference. CONCLUSION The profile changes following MMA were favorably perceived in the majority of cases. However, specific orthodontic preparation could be offered to patients with pronounced preoperative protrusion.
Collapse
|