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Jara SM, Thuler ER, Hutz MJ, Yu JL, Cheong CS, Boucher N, Evans M, Dedhia RC. Posterior Palatal Expansion via Subnasal Endoscopy (2PENN) for Maxillary Deficiency: A Pilot Study. Laryngoscope 2024; 134:1970-1977. [PMID: 37772955 PMCID: PMC10947985 DOI: 10.1002/lary.31060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 05/01/2023] [Accepted: 06/28/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE Surgically assisted rapid palatal expansion (SARPE) addresses transverse maxillary deficiency, a known contributor to nasal obstruction. The purpose of this study was to assess the feasibility, preliminary outcomes, and safety of posterior palatal expansion via subnasal endoscopy (2PENN), a modified SARPE procedure, aimed at achieving anterior and posterior maxillary expansion. METHODS This prospective case series included consecutive adult patients with findings of transverse maxillary deficiency that underwent the 2PENN procedure from 4/2021 to 4/2022. Patients completed pre- and post-operative clinical evaluations, Nasal Obstruction and Septoplasty Effectiveness (NOSE) questionnaires, and computed tomography (CT), with measures including expansion at the level of the posterior nasal spine (PNS), first maxillary inter-molar distance (IMD), and anterior nasal spine (ANS). RESULTS The cohort (N = 20) was middle-aged (39 ± 11 years), predominantly male (80%), and overweight (BMI 28 ± 4 kg/m2 ). The majority (85%) of patients had sleep breathing issues, of which 10 (59%) had polysomnography-confirmed obstructive sleep apnea (OSA). Full anterior-posterior separation of the mid-palatal suture line was evident on all post-operative CT scans, with mean expansion at the PNS of 3.6 ± 1.3 mm, IMD of 6.1 ± 1.6 mm and ANS of 7.0 ± 1.6 mm (p < 0.001). Following surgery, mean NOSE scores improved from 57 ± 23 to 14 ± 13 (p < 0.001). One patient required maxillary antrostomy for post-operative sinusitis. CONCLUSION 2PENN is an effective and safe technique for achieving both anterior and posterior maxillary expansion in patients with transverse maxillary deficiency. Further study is warranted to better understand the effect of 2PENN in patients with OSA, particularly as it relates to improving pharyngeal patency. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1970-1977, 2024.
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Affiliation(s)
- Sebastian M Jara
- Division of Sleep Surgery, Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Eric R Thuler
- Division of Sleep Surgery, Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Michael J Hutz
- Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jason L Yu
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Crystal S Cheong
- Division of Sleep Surgery, Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Normand Boucher
- Department of Orthodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Marianna Evans
- Division of Sleep Surgery, Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Raj C Dedhia
- Division of Sleep Surgery, Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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Abdelwahab M, Taheri N, Eltahir L, Erdogan C, Lee K, Liu SYC. Maxillomandibular Advancement Efficacy in Obstructive Sleep Apnea Patients With Class 2 Versus 3 Dentofacial Deformity. Otolaryngol Head Neck Surg 2023; 169:1366-1373. [PMID: 37449410 DOI: 10.1002/ohn.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 04/09/2023] [Accepted: 05/01/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To compare the efficacy of maxillomandibular advancement (MMA) for patients with obstructive sleep apnea (OSA) with class 2 versus 3 dentofacial deformities (DFDs). STUDY DESIGN Retrospective chart review. SETTING Tertiary sleep surgery center. METHODS Patients with OSA and DFD class 2 versus 3 undergoing MMA at Stanford Sleep Surgery between 2014 and 2021 were matched by preoperative body mass index (BMI), age, and sex. Postoperative outcome was compared with polysomnography measures and patient-reported outcome measures (PROMs). RESULTS Twenty-eight matched subjects, 14 in each deformity group were identified and assessed. The mean age (standard deviation) was 34.29 (10.21) and 33.86 (10.23) for classes 2 and 3, respectively. The apnea-hypopnea index (AHI) decreased from 43.42 (28.30) to 9.6 (5.29) (p < .001) and 37.17 (35.77) to 11.81 (15.74) (p = .042) in class 2 and 3 subjects, respectively. The oxygen desaturation index (ODI) changed from 30.48 (24.02) to 6.88 (3.39) (p = .024) and 11.43 (11.40) to 5.44 (7.96) (p = .85) in class 2 and 3 subjects, respectively. The Epworth sleepiness scale changed from 8.93 (5.28) to 3.91 (2.70) (p = .018) and 10.23 (4.38) to 4.22 (3.07) (p = .006) in class 2 and 3 subjects, respectively. CONCLUSION Among age, sex, and BMI-matched subjects, MMA is equally effective in both dentofacial class 2 and 3 groups, both objectively and subjectively. Preoperatively, dentofacial class 2 patients with OSA presented with the more severe disease with higher AHI and ODI. Dentofacial class 3 patients with OSA may require additional attention to improve nasal function outcomes.
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Affiliation(s)
- Mohamed Abdelwahab
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Medical University of South Carolina, Charleston, South Carolina, SC, USA
| | - Nazlie Taheri
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Lina Eltahir
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Can Erdogan
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Kyra Lee
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry, San Francisco, California, USA
| | - Stanley Y-C Liu
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University School of Medicine, Stanford, California, USA
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Yoon A, Kim TK, Abdelwahab M, Nguyen M, Suh HY, Park J, Oh H, Pirelli P, Liu SYC. What changes in maxillary morphology from distraction osteogenesis maxillary expansion (DOME) correlate with subjective and objective OSA measures? Sleep Breath 2023; 27:1967-1975. [PMID: 36806968 DOI: 10.1007/s11325-022-02761-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 11/22/2022] [Accepted: 12/01/2022] [Indexed: 02/23/2023]
Abstract
OBJECTIVES To correlate skeletal and airway measures on imaging with polysomnographic and self-reported measures after distraction osteogenesis maxillary expansion (DOME), in the effort to identify clinically relevant sites of expansion to guide treatment for adult patients with obstructive sleep apnea (OSA). MATERIALS AND METHODS This is a retrospective study reviewing subjects who underwent DOME and had the complete set of the following data: peri-treatment cone-beam computed tomography (CBCT) scans, polysomnography (PSG), Epworth Sleepiness Scale (ESS), and nasal obstruction symptom (NOSE) scores. RESULTS Of 132 subjects who underwent DOME, 35 met inclusion criteria (71% men, mean age 27.7 ± 6.5 years, mean BMI 26.0 ± 6.4 kg/m2) and were enrolled in the study. There was a significant reduction in the NOSE score from 11.4 ± 5.5 to 3.6 ± 3.1, in the ESS score from 12.0 ± 4.6 to 7.1 ± 4.7, and in the apnea-hypopnea index (AHI) from 17.1 ± 15.8 to 7.01 ± 6.2 (p < 0.0001), after DOME. Nasal floor width at the nasopalatine canal level showed a statistically significant correlation with AHI reduction (p < .0001). CONCLUSIONS DOME is significantly associated with reduction of nasal obstruction, sleepiness, and severity of OSA. The findings suggest that expansion at the anterior third of the bony nasal passage, specifically where the nasopalatine canal is located predicts its clinical efficacy. This site may be a useful target anatomically via imaging.
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Affiliation(s)
- Audrey Yoon
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry at the University of the Pacific, San Francisco, CA, USA.
| | - Tae Keong Kim
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry at the University of the Pacific, San Francisco, CA, USA
| | - Mohamed Abdelwahab
- Division of Sleep Surgery, Department of Otolaryngology Head & Neck Surgery, School of Medicine, Stanford University, 801 Welch Road, Stanford, CA, 94305, USA
| | - Mai Nguyen
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry at the University of the Pacific, San Francisco, CA, USA
| | - Hee Yeon Suh
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry at the University of the Pacific, San Francisco, CA, USA
| | - Joorok Park
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry at the University of the Pacific, San Francisco, CA, USA
| | - Heesoo Oh
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry at the University of the Pacific, San Francisco, CA, USA
| | - Paola Pirelli
- Pediatric Dentistry and Orthodontics, Department of Clinical Science and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Stanley Yung-Chuan Liu
- Division of Sleep Surgery, Department of Otolaryngology Head & Neck Surgery, School of Medicine, Stanford University, 801 Welch Road, Stanford, CA, 94305, USA.
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Patrocinio LG. Commentary on "A Minimally Invasive Nasal Endoscopic Approach to Distraction Osteogenesis Maxillary Expansion to Restore Nasal Breathing for Adults with Narrow Maxilla" by Liu et al. Facial Plast Surg Aesthet Med 2022; 24:422-423. [PMID: 35180009 DOI: 10.1089/fpsam.2022.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lucas G Patrocinio
- Otolaryngology, Medical School, Federal University of Uberlandia, Uberlandia, Brazil
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