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Abdalla Y, Kiliaridis S, Sonnesen L. Airway changes after fixed functional appliance treatment in children with and without morphologic deviations of the upper spine: A 3-dimensional CBCT study. Am J Orthod Dentofacial Orthop 2022; 161:791-797. [DOI: 10.1016/j.ajodo.2021.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 01/01/2021] [Accepted: 01/01/2021] [Indexed: 11/26/2022]
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Hansen C, Markström A, Sonnesen L. Sleep-disordered breathing and malocclusion in children and adolescents-a systematic review. J Oral Rehabil 2021; 49:353-361. [PMID: 34779522 DOI: 10.1111/joor.13282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/17/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) has negative influence on children's development and well-being. Malocclusion due to some craniofacial anatomical characteristics may be associated with SDB. OBJECTIVES The aim of this paper is to ascertain whether SDB is associated with malocclusion in children/adolescents, aged 6-15 years compared to healthy controls. METHODS Prospero ID: CRD42021232103. A systematic electronic literature search following PRISMA was performed in PubMed, Embase and Cochrane Library. Inclusion criteria were as follows: Healthy children/adolescents aged 6-15 years with malocclusion undergoing polysomnography (PSG) or polygraphy (PG) and/or sleep questionnaire and orthodontic screening; compared to a healthy age-matched control group with neutral or minor deviation in the occlusion without requirement for orthodontic treatment; publications in English, Danish, Norwegian or Swedish published until 23 March 2021. JBI Critical Appraisal Tools and GRADE were used to evaluate the risk of bias and level of evidence. RESULTS The search resulted in 1996 records, 610 duplicates were removed, 1386 records were screened, and 1322 records were excluded. Sixty-four studies were selected for full-text reading, and four publications fulfilled the inclusion criteria. The included studies had moderate risk of bias, and the quality of evidence was low. CONCLUSION No firm conclusion can be drawn regarding an association between specific malocclusion traits and SDB. Thus, the studies found no association between molar relationship and crowding and SDB symptoms in children. It may be recommended that future studies include objective PSG or PG in diagnosis of SDB and compare groups of children with skeletal malocclusion and controls with neutral malocclusion.
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Affiliation(s)
- Camilla Hansen
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Agneta Markström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Sciences, Respiratory-, Allergy- and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Liselotte Sonnesen
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Villamil CI, Santiago-Nazario A. Integration between the cranial boundaries of the nasopharynx and the upper cervical vertebrae in Homo and Pan. Anat Rec (Hoboken) 2021; 305:1974-1990. [PMID: 34510776 DOI: 10.1002/ar.24750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/13/2021] [Accepted: 07/27/2021] [Indexed: 01/17/2023]
Abstract
The nasopharynx is an important anatomical structure involved in respiration. Its bony boundaries, including the basicranium and upper cervical vertebrae, may be subject to selective pressures and constraints related to respiratory function. Here, we investigate phenotypic integration, or covariation, between the face, the basicranial boundaries of the nasopharynx, and the atlas and axis to understand constraints affecting these structures. We collected three-dimensional coordinate data from a sample of 80 humans and 44 chimpanzees, and used two-block partial least squares to assess RV (a multivariate generalization of Pearson's r2 ), rPLS , the covariance ratio, and effect size for integration among structures. We find that integration is significant among some of these structures, and that integration between the basicranial nasopharynx and vertebrae and between the face and vertebrae is likely independent. We also find divergences in the pattern of integration between humans and chimpanzees suggesting greater constraints among the human face and nasopharynx, which we suggest are linked to divergent developmental trajectories in the two taxa. Evolutionary changes in human basicranial anatomy, coupled with human-like developmental trajectories, may have required that the face grow to compensate any variation in nasopharyngeal structure. However, we were unable to determine whether the nasopharynx or the face is more strongly integrated with the vertebrae, and therefore whether respiration or biomechanical considerations related to positional behavior may be more strongly tied to vertebral evolution. Future work should focus on greater sample sizes, soft tissue structures, and more diverse taxa to further clarify these findings.
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Parizotto JDOL, Peixoto AP, Borsato KT, Bianchi J, Vendramini Pittoli S, Tonello C, Gonçalves JR. Craniofacial and airway morphology of individuals with oculoauriculovertebral spectrum. Orthod Craniofac Res 2021; 24:575-584. [PMID: 33713375 DOI: 10.1111/ocr.12483] [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: 11/09/2020] [Revised: 02/03/2021] [Accepted: 02/19/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objectives of this study were to characterize the craniofacial and airway morphology of oculo-auriculo-vertebral spectrum (OAVS) individuals using computed tomography (CT) examination. SETTING AND SAMPLE POPULATION This sample included individuals in the age range from 5 to 14 years, consisted of a group of 18 OAVS individuals (12 females and 6 males), Pruzansky-Kaban1 IIB and III and by a paired control group matched by age and sex for comparison of morphometric and airway variables. MATERIALS AND METHODS Through the CT examination, airway analysis was performed using Dolphin Imaging® Software, and seven morphometric measurements were performed to evaluate craniofacial morphology by Materialize Mimics® Software. To compare airway and morphometric variables, the control group was used. Student's t test and Mann-Whitney U test were performed to compare differences between the groups. RESULTS Statistically significant differences were showed between the control and OAVS groups for the variables: total airway (TA) area, volume and MAA, RP area, RP volume, RP MAA, RG volume, RG MAA, total posterior height diff, Md incl and y-axis asymmetry. Pearson and Spearman's correlation showed mostly moderate correlations between Mand Occlusal canting AS with TA area and RP volume, Ax-Gn with TA area and Hy-C3 with TA volume. CONCLUSIONS The OAVS's airway was altered and worse than the control group. Our results suggest that the contralateral side of OAVS individuals is unaffected; however, longitudinal assessments are needed to confirm it. Hyoid bone and postural measures play an important role in interpreting airway features of individuals with and without OAVS.
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Affiliation(s)
| | - Adriano Porto Peixoto
- Department of Orthodontics, University of São Paulo (USP), Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, Brazil
| | - Karina Tostes Borsato
- Department of Pediatric Dentistry, School of Dentistry, São Paulo State University (UNESP), Araraquara, Brazil
| | - Jonas Bianchi
- Department of Pediatric Dentistry, School of Dentistry, São Paulo State University (UNESP), Araraquara, Brazil.,Department of Orthodontics Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, United States.,Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA, United States
| | - Siulan Vendramini Pittoli
- Department of Clinical Genetics, University of São Paulo (USP), Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, Brazil
| | - Cristiano Tonello
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (USP), São Paulo, Brazil
| | - João Roberto Gonçalves
- Department of Pediatric Dentistry, School of Dentistry, São Paulo State University (UNESP), Araraquara, Brazil
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Rai D, Navit P, Singh R, Grover N, Navit S, Khan SA. Effect of Obstructive Sleep Apnea on Condylar Malformation, Vertebral Column, and Head Posture: A Cephalometric Evaluation. Int J Clin Pediatr Dent 2020; 13:S64-S68. [PMID: 34434016 PMCID: PMC8359876 DOI: 10.5005/jp-journals-10005-1876] [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] [Indexed: 11/23/2022] Open
Abstract
Aims and objectives Obstructive sleep apnea (OSA) is by far the most common sleep-related breathing disorder, affecting 2–4% of the adult population. The present study aims to compare the descriptive morphology of the cervical column in subjects with normal craniofacial morphology with those having condylar hypoplasia with OSA and to evaluate a positive correlation between the cervical columns, the cranial base angle, and the posture of the head and neck in subjects of condylar hypoplasia. Materials and methods The present study comprised of lateral cephalogram of 40 subjects divided into two equal groups—control groups (n = 20) and OSA with condylar hypoplasia (n = 20). Results and observation The condylar hypoplasia group has fusion anomalies of 65% and 35% has a posterior arch deficiency. The cervical lordosis, inclination of the cervical column is found to have a positive statistically significant correlation in condylar hypoplasia subjects. Conclusion Morphological deviations and deviation pattern of the cervical column occurred significantly more often in subjects with condylar hypoplasia as compared with normal craniofacial morphology which can be verified by the increased cranial base angle, cervical lordosis, the inclination of the upper cervical spine, and cranial base angle were positively correlated with a fusion of cervical column. Clinical significance Specific types of craniofacial morphology and head postures such as a reduced posterior airway space, an abnormally long soft palate, a low position of the hyoid bone, and an extended head posture are considered predisposing factors of OSA. As posture of the head and neck is considered to be associated with OSA, OSA may be associated with fusion of the cervical column. Hence, to know the result of malformation in the cervical column prove to be important with regard to phenotypical subdivision, diagnosis, and treatment of OSA. How to cite this article Divya, Navit P, Singh R, et al. Effect of Obstructive Sleep Apnea on Condylar Malformation, Vertebral Column, and Head Posture: A Cephalometric Evaluation. Int J Clin Pediatr Dent 2020;13(S-1):S64–S68.
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Affiliation(s)
- Divya Rai
- Department of Orthodontics and Dentofacial Orthopedics, Chandra Dental College and Hospital, Lucknow, Uttar Pradesh, India
| | - Pragati Navit
- Department of Orthodontics and Dentofacial Orthopedics, Chandra Dental College and Hospital, Lucknow, Uttar Pradesh, India
| | - Richa Singh
- Department of Orthodontics and Dentofacial Orthopedics, Chandra Dental College and Hospital, Lucknow, Uttar Pradesh, India
| | - Nishi Grover
- Department of Pedodontics and Preventive Dentistry, Saraswati Dental College, Lucknow, Uttar Pradesh, India
| | - Saumya Navit
- Department of Pedodontics and Preventive Dentistry, Saraswati Dental College, Lucknow, Uttar Pradesh, India
| | - Suleman A Khan
- Department of Pedodontics and Preventive Dentistry, Saraswati Dental College, Lucknow, Uttar Pradesh, India
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Petri N, Christensen IJ, Svanholt P, Sonnesen L, Wildschiødtz G, Berg S. Mandibular advancement device therapy for obstructive sleep apnea: a prospective study on predictors of treatment success. Sleep Med 2019; 54:187-194. [DOI: 10.1016/j.sleep.2018.09.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/28/2018] [Accepted: 09/30/2018] [Indexed: 10/27/2022]
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Adisen SR, Adisen MZ, Ozdiler FE. The evaluation of the relationship between cervical vertebral anomalies with skeletal malocclusion types and upper airway dimensions. Cranio 2018; 38:149-157. [PMID: 30063196 DOI: 10.1080/08869634.2018.1503136] [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: 10/28/2022]
Abstract
Objectives: To compare the prevalence of cervical vertebral anomalies (CVAs) in different skeletal malocclusions and to evaluate the relationship between upper airway dimension and vertebral anomalies. Methods: A retrospective study was performed on lateral cephalometric radiographs of 2062 patients aged 7-49 years. Skeletal malocclusion type, presence of CVAs, and upper airway area of 1856 patients who met the inclusion criteria of the study were recorded. The obtained data were transferred to the SPSS program for statistical analysis. Results: The mean age of the patients was 13.8 ± 3.7 years. The prevalence of CVAs was 45.7%. There was no significant difference in prevalence between skeletal malocclusions (p = 0.89). According to airway measurements, no significant difference was found between patients with and without CVAs (p = 0.718). Conclusion: The present results suggest that there is no direct effect of skeletal malocclusion type and upper airway dimension in the etiology of CVAs.
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Affiliation(s)
- Sirin Rabia Adisen
- Department of Orthodontics, Faculty of Dentistry, Kirikkale University, Kirikkale, Turkey
| | - Mehmet Zahit Adisen
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Kirikkale University, Kirikkale, Turkey
| | - Ferabi Erhan Ozdiler
- Department of Orthodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey
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Knappe SW, Sonnesen L. Mandibular positioning techniques to improve sleep quality in patients with obstructive sleep apnea: current perspectives. Nat Sci Sleep 2018; 10:65-72. [PMID: 29440942 PMCID: PMC5800493 DOI: 10.2147/nss.s135760] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The purpose of this article is to review 1) mandibular advancement device (MAD) - indication, treatment success, and side effects; 2) maxillomandibular advancement (MMA) surgery of the jaws - indication, treatment success, and side effects; and 3) current perspectives. Both MAD and MMA are administered to increase the upper airway volume and reduce the collapsibility of the upper airway. MAD is noninvasive and is indicated as a first-stage treatment in adult patients with mild-to-moderate obstructive sleep apnea (OSA) and in patients with severe OSA unable to adhere to continuous positive airway pressure (CPAP). MAD remains inferior to CPAP in reducing the apnea-hypopnea index (AHI) with a treatment success ranging between 24% and 72%. However, patient compliance to MAD is greater, and with regard to subjective sleepiness and health outcomes, MAD and CPAP have been found to be similarly effective. Short-term side effects of MAD are minor and often transient. Long-term side effects primarily appear as changes in the dental occlusion related to decreases in overjet and overbite. MMA is efficacious but highly invasive and indicated as a second-stage treatment in patients with moderate-to-severe OSA, with prior failure to other treatment modalities or with craniofacial abnormalities. The surgical success and cure rates are found to be 86.0% and 43.2%, respectively. Side effects may appear as postsurgical complications such as temporary facial paresthesia and compromised facial esthetics. However, most patients report satisfaction with their postsurgical appearance. Both treatment modalities require experienced clinicians and multidisciplinary approaches in order to efficaciously treat OSA patients. Some researchers do propose possible predictors of treatment success, but clear patient selection criteria and clinical predictive values for treatment success are still needed in both treatment modalities.
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Affiliation(s)
- Sofie Wilkens Knappe
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Liselotte Sonnesen
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Sonnesen L, Petersson A, Berg S, Svanholt P. Pharyngeal Airway Dimensions and Head Posture in Obstructive Sleep Apnea Patients with and without Morphological Deviations in the Upper Cervical Spine. J Oral Maxillofac Res 2017; 8:e4. [PMID: 29142656 PMCID: PMC5676314 DOI: 10.5037/jomr.2017.8304] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 09/26/2017] [Indexed: 11/16/2022]
Abstract
Objectives The aim of the study was to analyse differences in pharyngeal airway dimensions and head posture between obstructive sleep apnea patients with and without morphological deviations in the upper cervical spine and to analyse associations between pharyngeal airway dimensions and head posture in the total sample. Material and Methods The sample comprised 53 obstructive sleep apnea (OSA) patients of which 32.1% had upper spine morphological deviations. Accordingly two groups were defined: 17 OSA patients with morphological deviations in the upper spine and 36 without upper spine deviations. Pharyngeal airway dimensions in terms of distances, cross-sectional areas and volume and upper spine morphological deviations were evaluated on cone-beam computed tomography. Head posture was evaluated on two-dimensional generated lateral cephalograms. Differences were analysed and adjusted for age and gender by multiple linear regression analysis. Results OSA patients with upper spine morphological deviations had a significantly more backward and curved neck posture (OPT/HOR, P < 0.01; OPT/CVT, P < 0.05) compared to OSA patients without spine deviations. No significant differences were found in airway dimensions between patients with and without upper spine deviations. In the total group significant associations were found between head posture and pharyngeal airway distances and cross-sectional area at the nasal floor, epiglottis and hyoid bone level (P < 0.05, P < 0.01, P < 0.001). No significant association was found between head posture and airway volume. Conclusions The results may contribute to differentiate obstructive sleep apnea patients and thereby may prove valuable in diagnosis and treatment planning of obstructive sleep apnea patients.
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Affiliation(s)
- Liselotte Sonnesen
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of CopenhagenDenmark
| | - Arne Petersson
- Department of Oral and Maxillofacial Radiology, Malmö University, MalmöSweden
| | - Søren Berg
- Clinic for Infant and Adult Sleep Medicine, Lovisenberg Diakonale Sykehus, OsloNorway
| | - Palle Svanholt
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of CopenhagenDenmark
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Knappe SW, Bakke M, Svanholt P, Petersson A, Sonnesen L. Long-term side effects on the temporomandibular joints and oro-facial function in patients with obstructive sleep apnoea treated with a mandibular advancement device. J Oral Rehabil 2017; 44:354-362. [PMID: 28094865 DOI: 10.1111/joor.12485] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2017] [Indexed: 11/27/2022]
Abstract
Patients with obstructive sleep apnoea (OSA) in long-term treatment with a mandibular advancement device (MAD) to increase the upper airway space may develop changes in the temporomandibular joint (TMJ) and the oro-facial function due to the protruded jaw position during sleep. The aim was to investigate the influence of long-term MAD treatment on the TMJs, oro-facial function and occlusion. This prospective study included 30 men and 13 women (median age 54) with OSA [Apnoea-Hypopnoea Index (AHI): 7-57]. They were examined with the Nordic Orofacial Test Screening (NOT-S), the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and cone beam computed tomography (CBCT) of the TMJs. The examination was performed before MAD treatment (T0), and 3-6 months (T1, no CBCT), 1 year (T2) and 3 years (T3) after treatment start. The results were analysed as long term (T0-T3, n = 14) and short term (T0-T2, n = 24) by t-test, Fisher's exact test and anova. Both long- and short-term analyses revealed a reduction in AHI (P < 0·002). Significant long term were increased scores in the NOT-S Interview (P < 0·045), reduced vertical overbite (P < 0·031) and increased jaw protrusive movement (P < 0·027). TMJ changes were found as joint sounds in terms of reciprocal clicking and crepitus, short term as a decrease and subsequent recurrence (P < 0·053; P < 0·037). No significant radiological changes were found. In conclusion, MAD treatment is beneficial to some OSA patients, but might induce changes in the TMJs, the oro-facial function and the occlusion. However, these changes seemed to be less harmful than previously reported with careful adaptation, control and follow-ups.
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Affiliation(s)
- S W Knappe
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M Bakke
- Section of Oral Medicine (Clinical Oral Physiology), Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - P Svanholt
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - A Petersson
- Section of Radiology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - L Sonnesen
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Ray S, Datana S, Jayan B, Jain A. Cervical vertebral anomalies in patients with obstructive sleep apnea. APOS TRENDS IN ORTHODONTICS 2015. [DOI: 10.4103/2321-1407.169974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective
The aim of this study was to find an association between the patients with obstructive sleep apnea (OSA) and with cervical vertebral anomalies and any further correlation between various anomalies with varying severities of OSA.
Materials and Methods
The sample consisted lateral cephalograms of 70 subjects who were diagnosed with OSA and 70 other orthodontic patients who were selected as a control group. The lateral radiographs of both cases and controls were traced and findings were recorded.
Results
In total, 21.42% of subjects in the OSA group and 8.57% in the control group were affected with cervical vertebrae anomalies. The statistical analysis reveals that the number of subjects affected with cervical vertebrae anomalies in OSA group is highly significant. A number of cases of fusion were higher than posterior arch deficiency in OSA group and equal in the control group. However, in both the groups, the number of cases with two vertebrae fusion was higher. Further, the higher number of two vertebrae fusion cases in OSA group was found to be statistically significant. The findings of one-way ANOVA for OSA cases reveals the number of cases affected with cervical vertebrae anomalies were statistically highly significant (P < 0.01) in severe cases of OSA.
Conclusion
Patients of cervical vertebral anomalies may be at higher risk of developing OSA, and the possibility of the presence of cervical vertebral anomalies may increase with the increase in the severity of OSA. The most common vertebral anomaly was found to be two vertebral fusions.
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Affiliation(s)
- Saugat Ray
- Department of Orthodontics and Dentofacial Orthopedics, FDC, Fort, Mumbai, Maharashtra, India
| | - Sanjeev Datana
- Department of Orthodontics and Dentofacial Orthopedics, R&R, Delhi Cant., New Delhi, India
| | | | - Amit Jain
- Department of Orthodontics and Dentofacial Orthopedics, CMDC, Pune, Maharashtra, India
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Saleh A, Sultan I, Mahfouz Y. Alteration in cervical spine mechanics in obstructive sleep apnea syndrome patients. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2015.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Svanholt P, Petri N, Wildschiødtz G, Sonnesen L. Influence of craniofacial and upper spine morphology on mandibular advancement device treatment outcome in patients with obstructive sleep apnoea: a pilot study. Eur J Orthod 2014; 37:391-7. [PMID: 25351571 DOI: 10.1093/ejo/cju064] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND/OBJECTIVES The aim of the study was to assess cephalometric predictive markers in terms of craniofacial morphology including posterior cranial fossa and upper spine morphology for mandibular advancement device (MAD) treatment outcome in patients with obstructive sleep apnoea (OSA). MATERIAL/METHODS Twenty-seven OSA patients were treated with MAD for 4 weeks. Apnoea-hypopnoea index (AHI) was recorded before and after MAD treatment. The criteria of treatment success were 75 per cent reduction of AHI. Accordingly, two groups occurred: the success treatment group of 8 patients and the no success treatment group of 19 patients. Before MAD treatment lateral cephalograms were taken and analyses of the craniofacial morphology including the posterior cranial fossa and upper spine morphology were performed. Differences between the groups were analysed by Fisher's exact test, t-test, and multiple regression analysis. RESULTS Upper spine morphological deviations occurred non-significantly in 25 per cent in the success treatment group and in 42.1 per cent in the no success treatment group. Body mass index (BMI; P < 0.05), maxillary prognathism (S-N-Ss; P < 0.01), mandibular prognathism (S-N-Pg; P < 0.05 and S-N-Sm; P < 0.01), and the distance between sella turcica and the deepest point in posterior cranial fossa (S-D; P < 0.05) was significantly smaller in the success treatment group. The maxillary prognathism (P < 0.05) was the most important factor for the MAD treatment outcome (R (2) = 0.47). LIMITATIONS Relatively small sample size. CONCLUSIONS The results indicate that BMI, posterior cranial fossa morphology, and retrognathia of the jaws are factors related to MAD treatment outcome. Furthermore, OSA patients with upper spine morphological deviations may respond poorer to MAD treatment.
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Affiliation(s)
- Palle Svanholt
- *Section for Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Niels Petri
- **Department of Clinical Neurophysiology, Sleep Medicine Danish Epilepsy Centre, Filadelfia, Dianalund, and
| | | | - Liselotte Sonnesen
- *Section for Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen,
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Bartels RHMA. Reviewer's comment concerning "Sleep apnea and cervical spine pathology" (10.1007/s00586-013-3046-4 by Adam Khan, Khoi D. Than, Kevin S. Chen, Anthony C. Wang, Frank La Marca, Paul Park). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 23:648-9. [PMID: 24343153 DOI: 10.1007/s00586-013-3133-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/09/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Ronald H M A Bartels
- Department of Neurosurgery, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands,
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Khan A, Than KD, Chen KS, Wang AC, La Marca F, Park P. Sleep apnea and cervical spine pathology. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 23:641-7. [PMID: 24121751 DOI: 10.1007/s00586-013-3046-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 09/24/2013] [Accepted: 09/25/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Sleep apnea is a multi-factorial disease with a variety of identified causes. With its close proximity to the upper airway, the cervical spine and its associated pathologies can produce sleep apnea symptoms in select populations. The aim of this article was to summarize the literature discussing how cervical spine pathologies may cause sleep apnea. METHODS A search of the PubMed database for English-language literature concerning the cervical spine and its relationship with sleep apnea was conducted. Seventeen published papers were selected and reviewed. RESULTS Single-lesion pathologies of the cervical spine causing sleep apnea include osteochondromas, osteophytes, and other rare pathologies. Multifocal lesions include rheumatoid arthritis of the cervical spine and endogenous cervical fusions. Furthermore, occipital-cervical misalignment pre- and post-cervical fusion surgery may predispose patients to sleep apnea. CONCLUSIONS Pathologies of the cervical spine present significant additional etiologies for producing obstructive sleep apnea in select patient populations. Knowledge of these entities and their pathophysiologic mechanisms is informative for the clinician in diagnosing and managing sleep apnea in certain populations.
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Affiliation(s)
- Adam Khan
- University of Michigan Medical School, Ann Arbor, MI, USA
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Dubojska AM, Smiech-Slomkowska G. Natural head position and growth of the facial part of the skull. Cranio 2013; 31:109-17. [PMID: 23795400 DOI: 10.1179/crn.2013.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The aim of this study was to determine any correlation between natural head position and cranio-cervical growth direction and if natural head position influences facial growth direction. One hundred sixty (160) cephalometric radiographs were examined and cranio-cervical inclinations determined (angles: NS-Ver, NS-OPT, NS-CVT). On the basis of the NS-ML angle, radiographs were divided into two groups: mandibular anteriorotation and posteriorotation. On the basis of the SGo/NMe index, two groups were formed: short-faced and long-faced subjects. The angles NS-Ver, NS-OPT, and NS-CVT describe cranio-cervical inclination. Subjects with anterior mandible growth do position their heads more vertically and have a shorter face, and those with posterior mandible growth tilt their heads more backwards and have a longer face. An adaptive head position can be a factor in altering the direction of facial growth. Determination of head position and mandible growth direction can be an important indicator in patients with TMD treatment.
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Gjørup H, Sonnesen L, Beck-Nielsen SS, Haubek D. Upper spine morphology in hypophosphatemic rickets and healthy controls: a radiographic study. Eur J Orthod 2013; 36:217-25. [PMID: 23882087 DOI: 10.1093/ejo/cjt050] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND/OBJECTIVES The aim of this study was to describe upper spine morphology in adult patients with hypophosphatemic rickets (HR) compared with controls to assess differences in spine morphology in terms of severity of skeletal impact and to study associations between spine morphology and craniofacial morphology. MATERIAL/METHODS The study population comprised 36 HR patients and 49 controls. The atlas and axis dimensions were measured on cephalograms, and the differences between the groups were estimated by regression analysis. The upper spine morphology was visually assessed to estimate the prevalence of cervical vertebral anomalies. RESULTS The dimensions of the atlas and the axis were larger in HR patients than in controls (P ≤ 0.001), and fusions (FUS) occurred more often in HR patients (39%) than in controls (6%; P ≤ 0.001). In HR patients, the length of the atlas correlated positively (P = 0.008) and the height of the dens correlated negatively (P = 0.043) with the severity of skeletal impact. The height of the posterior arch of the atlas and the length of the axis correlated negatively with the cranial base angle (P ≤ 0.017), and the vertical dimensions of the atlas correlated positively with the thickness of the occipital skull (P ≤ 0.015). The length of the atlas correlated positively with mandibular prognathism (P = 0.042). FUS correlated positively with the frontal and parietal thickness (P = 0.034 and P = 0.003, respectively). CONCLUSIONS The dimension of the atlas and the axis and the prevalence of the FUS were increased in HR patients compared with controls. Upper spine dimensions were associated with craniofacial dimensions, primarily in relation to the posterior cranial fossa.
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Affiliation(s)
- Hans Gjørup
- Section of Oral Health in Rare Diseases, Department of Maxillofacial Surgery, Aarhus University Hospital
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Sonnesen L, Jensen KE, Petersson AR, Petri N, Berg S, Svanholt P. Cervical vertebral column morphology in patients with obstructive sleep apnoea assessed using lateral cephalograms and cone beam CT. A comparative study. Dentomaxillofac Radiol 2013; 42:20130060. [PMID: 23503808 DOI: 10.1259/dmfr.20130060] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Few studies have described morphological deviations in obstructive sleep apnoea (OSA) patients on two-dimensional (2D) lateral cephalograms, and the reliability of 2D radiographs has been discussed. The objective is to describe the morphology of the cervical vertebral column on cone beam CT (CBCT) in adult patients with OSA and to compare 2D lateral cephalograms with three-dimensional (3D) CBCT images. METHODS For all 57 OSA patients, the cervical vertebral column morphology was evaluated on lateral cephalograms and CBCT images and compared according to fusion anomalies and posterior arch deficiency. RESULTS The CBCT assessment showed that 21.1% had fusion anomalies of the cervical column, i.e. fusion between two cervical vertebrae (10.5%), block fusions (8.8%) or occipitalization (1.8%). Posterior arch deficiency occurred in 14% as partial cleft of C1 and in 3.5% in combination with block fusions. The agreement between the occurrence of morphological deviations in the cervical vertebral column between lateral cephalograms and CBCT images showed good agreement (κ = 0.64). CONCLUSIONS Prevalence and pattern in the cervical column morphology have now been confirmed on CBCT. The occurrence of morphological deviations in the cervical vertebral column showed good agreement between lateral cephalograms and CBCT images. This indicates that 2D lateral cephalograms (already available after indication in connection with, e.g. treatment planning) are sufficient for identifying morphological deviations in the cervical vertebral column. For a more accurate diagnosis and location of the deviations, CBCT is required. New 3D methods will suggest a need for new detailed characterization and division of deviations in cervical vertebral column morphology.
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Affiliation(s)
- L Sonnesen
- Department of Orthodontics, Institute of Odontology, Faculty of Health Sciences, University of Copenhagen, Denmark.
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Illusions of fusions: Assessing cervical vertebral fusion on lateral cephalograms, multidetector computed tomographs, and cone-beam computed tomographs. Am J Orthod Dentofacial Orthop 2013; 143:213-20. [DOI: 10.1016/j.ajodo.2012.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 09/01/2012] [Accepted: 09/01/2012] [Indexed: 01/28/2023]
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Bebnowski D, Hanggi MP, Markic G, Roos M, Peltomaki T. Cervical vertebrae anomalies in subjects with Class II malocclusion assessed by lateral cephalogram and cone beam computed tomography. Eur J Orthod 2011; 34:226-31. [DOI: 10.1093/ejo/cjq192] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Associations between the Cervical Vertebral Column and Craniofacial Morphology. Int J Dent 2010; 2010:295728. [PMID: 20628592 PMCID: PMC2901616 DOI: 10.1155/2010/295728] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 05/03/2010] [Indexed: 01/19/2023] Open
Abstract
Aim. To summarize recent studies on morphological deviations of the cervical vertebral column and associations with craniofacial morphology and head posture in nonsyndromic patients and in patients with obstructive sleep apnoea (OSA).
Design. In these recent studies, visual assessment of the cervical vertebral column and cephalometric analysis of the craniofacial skeleton were performed on profile radiographs of subjects with neutral occlusion, patients with severe skeletal malocclusions and patients with OSA. Material from human triploid foetuses and mouse embryos was analysed histologically.
Results. Recent studies have documented associations between fusion of the cervical vertebral column and craniofacial morphology, including head posture in patients with severe skeletal malocclusions. Histological studies on prenatal material supported these findings.
Conclusion. It is suggested that fusion of the cervical vertebral column is associated with development and function of the craniofacial morphology. This finding is expected to have importance for diagnostics and elucidation of aetiology and thereby for optimal treatment.
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Svanholt P, Petri N, Wildschiødtz G, Sonnesen L, Kjaer I. Associations between craniofacial morphology, head posture, and cervical vertebral body fusions in men with sleep apnea. Am J Orthod Dentofacial Orthop 2009; 135:702.e1-9; discussion 702-3. [PMID: 19524827 DOI: 10.1016/j.ajodo.2009.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 09/11/2008] [Accepted: 09/11/2008] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The aim of this study was to analyze craniofacial profiles and head posture in patients with obstructive sleep apnea (OSA) subgrouped according to cervical column morphology. METHODS Seventy-four white men aged 27 to 65 years (mean, 49.0 years) diagnosed with OSA in sleep studies by using overnight polysomnography were included. Only patients with apnea-hypopnea index scores between 5.1 and 92.7 (mean, 36.4) were included. Lateral profile radiographs in standardized head posture were taken, and cephalometric analyses of sagittal and vertical jaw relationships were made. The patients were divided into 4 groups according to fusion in the cervical vertebrae: group I, no fusions (42 subjects); group II, fusion of cervical vertebrae 2 and 3 (15 subjects); group III, occipitalization (10 subjects); and group IV, block fusion (11 subjects). Mean differences of craniofacial dimensions between the groups were assessed by unpaired t tests. RESULTS No significant differences were seen between groups I and III. Between groups I and II, significant differences were seen in jaw relationship (P < 0.05). Between groups I and IV, anterior face height and mandibular length deviated significantly. No significant differences were seen in head posture. CONCLUSIONS OSA patients with block fusions in the cervical vertebrae and fusion of 2 vertebrae differed significantly in craniofacial profile from other OSA patients.
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Affiliation(s)
- Palle Svanholt
- Department of Orthodontics, School of Dentistry, University of Copenhagen, Copenhagen, Denmark
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