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Maken P, Gupta A, Gupta MK. A systematic review of the techniques for automatic segmentation of the human upper airway using volumetric images. Med Biol Eng Comput 2023; 61:1901-1927. [PMID: 37248380 DOI: 10.1007/s11517-023-02842-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: 09/22/2022] [Accepted: 04/20/2023] [Indexed: 05/31/2023]
Abstract
The human upper airway is comprised of many anatomical volumes. The obstructions in the upper airway volumes are needed to be diagnosed which requires volumetric segmentation. Manual segmentation is time-consuming and requires expertise in the field. Automatic segmentation provides reliable results and also saves time and effort for the expert. The objective of this study is to systematically review the literature to study various techniques used for the automatic segmentation of the human upper airway regions in volumetric images. PRISMA guidelines were followed to conduct the systematic review. Four online databases Scopus, Google Scholar, PubMed, and JURN were used for the searching of the relevant papers. The relevant papers were shortlisted using inclusion and exclusion eligibility criteria. Three review questions were made and explored to find their answers. The best technique among all the literature studies based on the Dice coefficient and precision was identified and justified through the analysis. This systematic review provides insight to the researchers so that they shall be able to overcome the prominent issues in the field identified from the literature. The outcome of the review is based on several parameters, e.g., accuracy, techniques, challenges, datasets, and segmentation of different sub-regions. Flowchart of the search process as per PRISMA guidelines along with inclusion and exclusion criteria.
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Affiliation(s)
- Payal Maken
- School of Computer Science and Engineering, Shri Mata Vaishno Devi University, Katra, India
| | - Abhishek Gupta
- Biomedical Application Division, CSIR-Central Scientific Instruments Organisation, Chandigarh, 160030, India.
| | - Manoj Kumar Gupta
- School of Computer Science and Engineering, Shri Mata Vaishno Devi University, Katra, India
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Savoldi F, Fung KKF, Mak WS, Kan EYL, Yang Y, Kwok KL, Gu M. Are the severity of obstruction and the apnea-hypopnea index related to orofacial anatomy in children with obstructive sleep apnea? a kinetic MRI study. Dentomaxillofac Radiol 2023; 52:20220422. [PMID: 37192022 PMCID: PMC10304841 DOI: 10.1259/dmfr.20220422] [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: 12/13/2022] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVES The proportionality between anatomical characteristics and disease severity in children and adolescents with obstructive sleep apnea (OSA) has not been well characterized. The present study investigated the relationship between the dentoskeletal and oropharyngeal features of young patients with OSA and either the apnea-hypopnea index (AHI) or the amount of upper airway obstruction. METHODS MRI of 25 patients (8- to 18-year-old) with OSA (mean AHI = 4.3 events/h) was retrospectively analyzed. Sleep kinetic MRI (kMRI) was used to assess airway obstruction, and static MRI (sMRI) was used to assess dentoskeletal, soft tissue, and airway parameters. Factors related to AHI and obstruction severity were identified with multiple linear regression (significance level α = 0.05). RESULTS As evidenced by kMRI, circumferential obstruction was present in 44% of patients, while laterolateral and anteroposterior was present in 28%; as evidenced by kMRI, obstructions were retropalatal in 64% of cases and retroglossal in 36% (no nasopharyngeal obstructions); kMRI showed a higher prevalence of retroglossal obstructions compared to sMRI(p = 0.037); the main obstruction airway area was not related to AHI; the maxillary skeletal width was related to AHI (β = -0.512, p = 0.007) and obstruction severity (β = 0.625, p = 0.002); and the retropalatal width was related to AHI (β = -0.384, p = 0.024) and obstruction severity (β = 0.519, p = 0.006). CONCLUSIONS In children and adolescents, the severity of OSA and obstruction were inversely proportional to the maxillary basal width and retropalatal airway width. Further studies are needed to assess the benefits of targeted clinical treatments widening the transverse dimension of these structures.
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Affiliation(s)
- Fabio Savoldi
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, the University of Hong Kong, Hong Kong, Hong Kong SAR, PRC
| | - Kevin KF Fung
- Department of Radiology, Hong Kong Children’s Hospital, Hong Kong, Hong Kong SAR, PRC
| | - Wing-Sze Mak
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong, Hong Kong SAR, PRC
| | - Elaine YL Kan
- Department of Radiology, Hong Kong Children’s Hospital, Hong Kong, Hong Kong SAR, PRC
| | - Yanqi Yang
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, the University of Hong Kong, Hong Kong, Hong Kong SAR, PRC
| | - Ka-Li Kwok
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, Hong Kong SAR, PRC
| | - Min Gu
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, the University of Hong Kong, Hong Kong, Hong Kong SAR, PRC
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Teplitzky TB, Zauher AJ, Isaiah A. Alternatives to Polysomnography for the Diagnosis of Pediatric Obstructive Sleep Apnea. Diagnostics (Basel) 2023; 13:diagnostics13111956. [PMID: 37296808 DOI: 10.3390/diagnostics13111956] [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: 04/11/2023] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Diagnosis of obstructive sleep apnea (OSA) in children with sleep-disordered breathing (SDB) requires hospital-based, overnight level I polysomnography (PSG). Obtaining a level I PSG can be challenging for children and their caregivers due to the costs, barriers to access, and associated discomfort. Less burdensome methods that approximate pediatric PSG data are needed. The goal of this review is to evaluate and discuss alternatives for evaluating pediatric SDB. To date, wearable devices, single-channel recordings, and home-based PSG have not been validated as suitable replacements for PSG. However, they may play a role in risk stratification or as screening tools for pediatric OSA. Further studies are needed to determine if the combined use of these metrics could predict OSA.
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Affiliation(s)
- Taylor B Teplitzky
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Audrey J Zauher
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Chen Y, Feng X, Shi XQ, Cai W, Li B, Zhao Y. Computational fluid-structure interaction analysis of flapping uvula on aerodynamics and pharyngeal vibration in a pediatric airway. Sci Rep 2023; 13:2013. [PMID: 36737491 PMCID: PMC9898500 DOI: 10.1038/s41598-023-28994-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
The uvula flapping is one of the most distinctive features of snoring and is critical in affecting airway aerodynamics and vibrations. This study aimed to elucidate the mechanism of pharyngeal vibration and pressure fluctuation due to uvula flapping employing fluid-structure interaction simulations. The followings are the methodology part: we constructed an anatomically accurate pediatric pharynx model and put attention on the oropharynx region where the greatest level of upper airway compliance was reported to occur. The uvula was assumed to be a rigid body with specific flapping frequencies to guarantee proper boundary conditions with as little complexity as possible. The airway tissue was considered to have a uniform thickness. It was found that the flapping frequency had a more significant effect on the airway vibration than the flapping amplitude, as the flapping uvula influenced the pharyngeal aerodynamics by altering the jet flow from the mouth. Breathing only through the mouth could amplify the effect of flapping uvula on aerodynamic changes and result in more significant oropharynx vibration.
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Affiliation(s)
- Yicheng Chen
- School of Energy Science and Engineering, Harbin Institute of Technology, Harbin, China
| | - Xin Feng
- Division of Ear, Nose and Throat Surgery, Akerhus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Xie-Qi Shi
- Department of Clinical Dentistry, Section for Oral and Maxillofacial Radiology, University of Bergen, Bergen, Norway.,Department of Oral Maxillofacial Radiology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Weihua Cai
- School of Energy Science and Engineering, Harbin Institute of Technology, Harbin, China. .,School of Energy and Power Engineering, Northeast Electric Power University, Jilin, China.
| | - Biao Li
- School of Energy Science and Engineering, Harbin Institute of Technology, Harbin, China.
| | - Yijun Zhao
- School of Energy Science and Engineering, Harbin Institute of Technology, Harbin, China
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Simakova AA, Gorbatova LN, Grjibovski AM, Arutyunyan KS, Ryzhkov IA. [Dimensions of the upper airways and its impact on the dentoalveolar system development]. STOMATOLOGIIA 2022; 101:93-99. [PMID: 35362710 DOI: 10.17116/stomat202210102193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Due to the high mobility and variability of bone structures and soft tissues surrounding the upper respiratory tract, the exact boundaries for measuring and normalizing the size of the respiratory tract have not yet been determined. Studies have determined the relationship between the narrowing of the upper jaw and a decrease in the transverse dimensions of the airways, as well as a positive effect in changing the size of the airways after orthodontic treatment and/or orthognathic surgery. Nevertheless, the results of research in this area may differ greatly from different specialists, which indicates that the topic is poorly studied and it is necessary to continue and expand the range of scientific works to assess the state of the upper respiratory tract and their relationship with the orthodontic status.
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Affiliation(s)
- A A Simakova
- Northern State Medical University, Arkhangelsk, Russia
| | - L N Gorbatova
- Northern State Medical University, Arkhangelsk, Russia
| | - A M Grjibovski
- Northern State Medical University, Arkhangelsk, Russia
- West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
- Al Farabi Kazakh National University, Almaty, Kazakhstan
- North-Eastern Federal University, Yakutsk, Russia
| | | | - I A Ryzhkov
- Northern State Medical University, Arkhangelsk, Russia
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Bitners AC, Sin S, Agrawal S, Lee S, Udupa JK, Tong Y, Wootton DM, Choy KR, Wagshul ME, Arens R. Effect of sleep on upper airway dynamics in obese adolescents with obstructive sleep apnea syndrome. Sleep 2021; 43:5819384. [PMID: 32280981 DOI: 10.1093/sleep/zsaa071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Indexed: 02/06/2023] Open
Abstract
STUDY OBJECTIVES The biomechanical basis of obstructive sleep apnea syndrome (OSAS) may influence upper airway dynamics. In this study, we investigate dynamic changes during respiration in wakefulness and sleep in obese adolescents with and without OSAS. METHODS Respiratory-gated dynamic magnetic resonance imaging (MRI) at the retropalatal and retroglossal regions was performed with simultaneous measurement of SpO2 and nasal-oral mask airflow and pressure. Airway cross-sectional area (CSA) was determined using AMIRA. Percent change in CSA was calculated from five continuous tidal breaths in states of wakefulness and sleep. Mixed effects models were used to evaluate interactions between group (OSAS/control), site (retropalatal/retroglossal), and stage (wake/sleep). RESULTS We studied 24 children with OSAS (mean age 15.49 ± 2.00 years, mean apnea-hypopnea index [AHI] 16.53 ± 8.72 events/h) and 19 controls (mean age 14.86 ± 1.75 years, mean AHI 2.12 ± 1.69 events/h). Groups were similar in age, sex, height, weight, and BMI Z-score. Participants with OSAS had a 48.17% greater increase in percent change of airway CSA during sleep than controls (p < 0.0001), while there was no difference between groups during wakefulness (p = 0.6589). Additionally, participants with OSAS had a 48.80% increase in percent change of airway CSA during sleep as compared with wakefulness (p < 0.0001), whereas no such relationship was observed in controls (p = 0.5513). CONCLUSIONS This study demonstrates significant effects of sleep on upper airway dynamics in obese children with OSAS. Dynamic MRI with physiological data can potentially provide further insight into the biomechanical basis of OSAS and assist in more effective management.
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Affiliation(s)
| | - Sanghun Sin
- Department of Pediatrics, Division of Respiratory and Sleep Medicine, Children's Hospital at Montefiore, Bronx, NY
| | - Sabhyata Agrawal
- Department of Pediatrics, Division of Respiratory and Sleep Medicine, Children's Hospital at Montefiore, Bronx, NY
| | - Seonjoo Lee
- Department of Biostatistics and Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY
| | - Jayaram K Udupa
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Yubing Tong
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - David M Wootton
- Department of Mechanical Engineering, Cooper Union, New York, NY
| | - Kok Ren Choy
- Department of Mechanical Engineering, Cooper Union, New York, NY
| | - Mark E Wagshul
- Albert Einstein College of Medicine, Bronx, NY.,Department of Radiology, Montefiore Medical Center, Bronx, NY
| | - Raanan Arens
- Albert Einstein College of Medicine, Bronx, NY.,Department of Pediatrics, Division of Respiratory and Sleep Medicine, Children's Hospital at Montefiore, Bronx, NY
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Overview of Recent Advances in Surgical Treatments for OSA. CURRENT SLEEP MEDICINE REPORTS 2020. [DOI: 10.1007/s40675-020-00186-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Role of dynamic sleep MRI in obstructive sleep apnea syndrome. Oral Radiol 2020; 37:376-384. [PMID: 32556868 DOI: 10.1007/s11282-020-00455-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To identify obstruction sites of the upper airway during sleep in patients with obstructive sleep apnea syndrome (OSAS) under dynamic conditions and improve knowledge to guide surgical treatment and advancements. MATERIALS AND METHODS The study included 15 patients (5 females and 10 males) who were diagnosed as having OSAS. Overall mean age was 40.2 years (± 7.01 years). All the patients underwent drug-induced sleep endoscopy (DISE) and dynamic sleep MRI. The presence, location, and direction of airway collapse were assessed. Dynamic MRI findings were correlated to DISE. Data of the site and direction of airway collapse were correlated with those of endoscopic findings and interobserver agreement was done. RESULTS The dynamic images in sagittal section showed collapse of the upper airway at retropalatal level in 14 patients (93.33%) and at retroglossal level in seven patients (46.7%) and of these 14 patients; seven had combined retropalatal and retroglossal collapse. These findings were highly correlated with DISE findings with an excellent interobserver agreement for retropalatal and retroglossal levels (Kappa = 1 and 0.867, P value = 0.000), respectively. Objective measurements of the direction of collapse in axial dynamic sleep MRI images showed significant statistical correlation with endoscopic findings regarding retropalatal anteroposterior and circumferential collapse (Kappa = 0.58 and 0.52, P value = 0.02 and 0.03, respectively). CONCLUSION Dynamic sleep MRI can reliably characterize the actual site of dynamic airway obstruction and has the potential of improving predictions of successful surgical outcomes in OSAS patients.
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Quinlan CM, Otero H, Tapia IE. Upper airway visualization in pediatric obstructive sleep apnea. Paediatr Respir Rev 2019; 32:48-54. [PMID: 31076378 PMCID: PMC6776720 DOI: 10.1016/j.prrv.2019.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/28/2019] [Indexed: 10/27/2022]
Abstract
Pediatric Obstructive Sleep Apnea (OSA) is a condition that may lead to a variety of comorbidities in adolescence and adulthood. The gold standard of diagnosing OSA is polysomnography (PSG). Over the past fifteen years numerous publications have explored how to better visualize the upper airway to further assess OSA in the pediatric population, and eventually institute personalized treatment. Lateral neck radiograph, cephalometry, computed axial tomography, and magnetic resonance imaging are all unique imaging techniques that are used in the diagnosis of OSA. Drug Induced Sleep Endoscopy is a direct visualization technique that is gathering momentum in pediatrics. Each approach has respective benefits and weaknesses. However, none of them at this time can replace PSG. They are a helpful supplement in those patients with complicated upper airway anatomy and in those with residual OSA.
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Affiliation(s)
- Courtney M Quinlan
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hansel Otero
- Division of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ignacio E Tapia
- Sleep Center, Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Zhang Y, Wang Y, Zhang Y, Li S, Wang L, Qian Y. Cone-Beam Computed Tomography Evaluation of Skeletal Deformities and Pharyngeal Airway in Chinese Han Individuals With Nonsyndromic Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2019; 57:65-72. [PMID: 31296040 DOI: 10.1177/1055665619860700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: This study examined the relationships between skeletal deformities and the pharyngeal airway of patients with nonsyndromic unilateral cleft lip and palate (UCLP). Design: Retrospective study. Setting: Orthodontics and Oral and Maxillofacial Surgery Departments in the Affiliated Hospital of Stomatology, Nanjing Medical University, China. Patients, Participants: The sample comprised 30 nonsyndromic UCLP patients and 30 healthy controls. Each group has 23 males and 7 females. Interventions: All cone-beam computed tomography images were obtained with the participant in the standard supine position and asked to bite with intercuspal position without swallowing or moving their heads and tongues during scanning. Main Outcome Measure(s): SNA, SNB, ANB, anterior cranial base, Wits appraisal, maxillary length (PTM-ANS || FH), maxillary position (S-PTM || FH), mandibular length (Go-Pog || MP), FMA, posterior face height, anterior face height, Posterior-Anterior face height, lower face height, pharyngeal airway volumes, and areas were evaluated by Dolphin imaging software. Results: The UCLP group showed significantly decreased SNA, SNB, ANB, PTM-ANS || FH, S-PTM || FH, P-A Face Height compared with the controls. However, the airway volumes and areas showed no significant difference between 2 groups. The total airway volume and minimum cross-sectional area in UCLP patients were related to the Go-Pog || MP and FMA. Conclusions: Patients with UCLP have both the maxillary and mandibular deficiencies in the sagittal dimension. Both the sagittal and vertical relationships of the jaw might affect the airway volume and area. However, no significant difference was detected in airway volume and area in UCLP patients when compared with the controls.
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Affiliation(s)
- Yuan Zhang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuhua Wang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yaoyuan Zhang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Sheng Li
- Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lin Wang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yajing Qian
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu, China
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Evaluation of Three-Dimensional Changes in Pharyngeal Airway Following Isolated Lefort One Osteotomy for the Correction of Vertical Maxillary Excess: A Prospective Study. J Maxillofac Oral Surg 2019; 18:139-146. [PMID: 30728705 DOI: 10.1007/s12663-018-1113-4] [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] [Received: 11/16/2017] [Accepted: 04/21/2018] [Indexed: 10/17/2022] Open
Abstract
Background Orthognathic surgery involves movement of jaws in all three planes, and this being a part of airway complex, displacement of jaws can influence the dimension of airway at all levels. Lefort one osteotomy surgery with superior repositioning is a common procedure done for patients with vertical maxillary excess. Purpose The purpose of this study was to evaluate the three-dimensional volumetric changes in airway after lefort one impaction surgery using three-dimensional cone beam computed tomography (3D-CBCT) in patients with vertical maxillary excess (VME). Methods A prospective analysis of 15 patients who underwent isolated lefort one impaction surgery was done with pre-operative (T0) and 3-months (T1) post-operative 3D-CBCT scans. Airway was divided into three segments, nasopharyngeal, velopharyngeal and oropharyngeal. Volumetric analysis of all these segments was done before and after surgery. Paired 't test' was used to assess the mean difference in airway volume and area between T0 and T1. One-way ANOVA was used to check the mean percentage difference in airway volume and area among the three segments. Results The mean percentage of nasopharyngeal volume difference was - 0.6299 ± 0.9146%, velopharyngeal volume difference was - 0.5205 ± 1.107%, oropharyngeal volume difference was - 1.492 ± 2.745%. Though volume and area of pharyngeal airway were decreased after maxillary impaction surgery in all three segments of airway studied, they were not statistically significant. Conclusion Among the three segments of airway studied, oropharyngeal airway volume has shown the highest post-surgical reduction though statistically insignificant. ESS scores were within normal limits. Hence, we are of the opinion that there is lack of evidence to conclude that the patients undergoing lefort one superior repositioning for the treatment of VME might develop significant narrowing of PAS that may predispose the patient to breathing disorders.
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Kim YC. Fast upper airway magnetic resonance imaging for assessment of speech production and sleep apnea. PRECISION AND FUTURE MEDICINE 2018. [DOI: 10.23838/pfm.2018.00100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Quo S, Lo LF, Guilleminault C. Maxillary protraction to treat pediatric obstructive sleep apnea and maxillary retrusion: a preliminary report. Sleep Med 2018; 60:60-68. [PMID: 30642692 DOI: 10.1016/j.sleep.2018.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/05/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Midface retrusion creates a size deficiency problem in the upper airway that has been improved in children using surgical midface advancement and orthopedic protraction of the maxilla. The results of these treatments have been mostly promising at enlarging the pharyngeal airway. Recently introduced bone anchored maxillary protraction (BAMP) uses implant inserted devices in the jaws to pull the maxilla forward against a backward pressure to the lower jaw. This is a pilot study that examines the use of BAMP as a strategy to treat maxillary retrusion, malocclusion and children with obstructive sleep apnea. METHODS 15 children, ages 9-16 years with maxillary retrusion creating a skeletal malocclusion were treated with bone anchored maxillary protraction (BAMP) and the results were compared against an untreated control group. 8 children in the treatment group also had sleep disordered breathing/obstructive sleep apnea. All subjects had lateral cephalograms before and after BAMP therapy. The OSA cohort completed the pediatric sleep questionnaire (PSQ) and polysomnography prior to and at the end of BAMP. RESULTS The majority of the OSA children (n = 5) showed improvement in their apnea-hypopnea index (AHI) and OSA symptoms after BAMP. Preliminary results of BAMP therapy show improvement in respiratory and airway parameters in OSA children with a highly significant change in the forward position of the upper jaw and enlargement in the nasopharyngeal to oropharyngeal junction as compared to an age and sex matched untreated control group. The outcomes were dependent on the age of treatment initiation and patient compliance. CONCLUSIONS This preliminary work suggests that bone anchored maxillary protraction may be considered as an adjunctive treatment option in adolescents for improving midface retrusion and sleep apnea, but further work is needed to explore this therapy.
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Affiliation(s)
- Stacey Quo
- Department of Orofacial Sciences, UCSF School of Dentistry, San Francisco, CA, USA.
| | - Lauren F Lo
- Creighton University School of Medicine, Omaha, NE, USA
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Bates AJ, Schuh A, McConnell K, Williams BM, Lanier JM, Willmering MM, Woods JC, Fleck RJ, Dumoulin CL, Amin RS. A novel method to generate dynamic boundary conditions for airway CFD by mapping upper airway movement with non-rigid registration of dynamic and static MRI. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34:e3144. [PMID: 30133165 DOI: 10.1002/cnm.3144] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/21/2018] [Accepted: 08/12/2018] [Indexed: 06/08/2023]
Abstract
Computational fluid dynamics (CFD) simulations of airflow in the human airways have the potential to provide a great deal of information that can aid clinicians in case management and surgical decision making, such as airway resistance, energy expenditure, airflow distribution, heat and moisture transfer, and particle deposition, as well as the change in each of these due to surgical interventions. However, the clinical relevance of CFD simulations has been limited to date, as previous models either did not incorporate neuromuscular motion or any motion at all. Many common airway pathologies, such as obstructive sleep apnea (OSA) and tracheomalacia, involve large movements of the structures surrounding the airway, such as the tongue and soft palate. Airway wall motion may be due to many factors including neuromuscular motion, internal aerodynamic forces, and external forces such as gravity. Therefore, to realistically model these airway diseases, a method is required to derive the airway wall motion, whatever the cause, and apply it as a boundary condition to CFD simulations. This paper presents and validates a novel method of capturing in vivo motion of airway walls from magnetic resonance images with high spatiotemporal resolution, through a novel combination of non-rigid image, surface, and surface-normal-vector registration. Coupled with image-synchronous pneumotachography, this technique provides the necessary boundary conditions for dynamic CFD simulations of breathing, allowing the effect of the airway's complex motion to be calculated for the first time, in both normal subjects and those with conditions such as OSA.
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Affiliation(s)
- Alister J Bates
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Bioengineering, Imperial College London, UK
| | - Andreas Schuh
- Department of Computing, Imperial College London, UK
| | - Keith McConnell
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Brynne M Williams
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J Matthew Lanier
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Matthew M Willmering
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jason C Woods
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Departments of Radiology and Physics, University of Cincinnati, Cincinnati, OH, USA
| | - Robert J Fleck
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, University of Cincinnati, Cincinnati, OH, USA
| | - Charles L Dumoulin
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Raouf S Amin
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
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15
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Fleck RJ, Shott SR, Mahmoud M, Ishman SL, Amin RS, Donnelly LF. Magnetic resonance imaging of obstructive sleep apnea in children. Pediatr Radiol 2018; 48:1223-1233. [PMID: 30078047 DOI: 10.1007/s00247-018-4180-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 05/09/2018] [Accepted: 06/10/2018] [Indexed: 11/25/2022]
Abstract
Sleep-disordered breathing has a spectrum of severity that spans from snoring and partial airway collapse with increased upper airway resistance, to complete upper airway obstruction with obstructive sleep apnea during sleeping. While snoring occurs in up to 20% of children, obstructive sleep apnea affects approximately 1-5% of children. The obstruction that occurs in obstructive sleep apnea is the result of the airway collapsing during sleep, which causes arousal and impairs restful sleep. Adenotonsillectomy is the first-line treatment of obstructive sleep apnea and is usually effective in otherwise healthy nonsyndromic children. However, there are subgroups in which this surgery is less effective. These subgroups include children with obesity, severe obstructive sleep apnea preoperatively, Down syndrome, craniofacial anomalies and polycystic ovarian disease. Continuous positive airway pressure (CPAP) is the first-line therapy for persistent obstructive sleep apnea despite previous adenotonsillectomy, but it is often poorly tolerated by children. When CPAP is not tolerated or preferred by the family, surgical options beyond adenotonsillectomy are discussed with the parent and child. Dynamic MRI of the airway provides a means to identify and localize the site or sites of obstruction for these children. In this review the authors address clinical indications for imaging, ideal team members to involve in an effective multidisciplinary program, basic anesthesia requirements, MRI protocol techniques and interpretation of the findings on MRI that help guide surgery.
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Affiliation(s)
- Robert J Fleck
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital, Cincinnati, OH, USA.
- Imaging Research Center, Cincinnati Children's Hospital, Cincinnati, OH, USA.
| | - Sally R Shott
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Mohamed Mahmoud
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stacey L Ishman
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Raouf S Amin
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lane F Donnelly
- Department of Radiology, Stanford University, Stanford, CA, USA
- Quality and Safety, Lucile Packard Children's Hospital, Stanford, CA, USA
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16
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Smitthimedhin A, Whitehead MT, Bigdeli M, Nino G, Perez G, Otero HJ. MRI determination of volumes for the upper airway and pharyngeal lymphoid tissue in preterm and term infants. Clin Imaging 2018; 50:51-56. [DOI: 10.1016/j.clinimag.2017.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/28/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
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17
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Balakrishnan S, Bu R, Price H, Zdanski C, Oldenburg AL. Multi-modal anatomical Optical Coherence Tomography and CT for in vivo Dynamic Upper Airway Imaging. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2017; 10039. [PMID: 29056811 DOI: 10.1117/12.2250348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
We describe a novel, multi-modal imaging protocol for validating quantitative dynamic airway imaging performed using anatomical Optical Coherence Tomography (aOCT). The aOCT system consists of a catheter-based aOCT probe that is deployed via a bronchoscope, while a programmable ventilator is used to control airway pressure. This setup is employed on the bed of a Siemens Biograph CT system capable of performing respiratory-gated acquisitions. In this arrangement the position of the aOCT catheter may be visualized with CT to aid in co-registration. Utilizing this setup we investigate multiple respiratory pressure parameters with aOCT, and respiratory-gated CT, on both ex vivo porcine trachea and live, anesthetized pigs. This acquisition protocol has enabled real-time measurement of airway deformation with simultaneous measurement of pressure under physiologically relevant static and dynamic conditions- inspiratory peak or peak positive airway pressures of 10-40 cm H2O, and 20-30 breaths per minute for dynamic studies. We subsequently compare the airway cross sectional areas (CSA) obtained from aOCT and CT, including the change in CSA at different stages of the breathing cycle for dynamic studies, and the CSA at different peak positive airway pressures for static studies. This approach has allowed us to improve our acquisition methodology and to validate aOCT measurements of the dynamic airway for the first time. We believe that this protocol will prove invaluable for aOCT system development and greatly facilitate translation of OCT systems for airway imaging into the clinical setting.
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Affiliation(s)
- Santosh Balakrishnan
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill
| | - Ruofei Bu
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill
| | - Hillel Price
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill
| | - Carlton Zdanski
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Amy L Oldenburg
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill.,Department of Physics and Astronomy, University of North Carolina at Chapel Hill.,Biomedical Research Imaging Center, University of North Carolina at Chapel Hill
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18
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Barrera JE, Pau CY, Forest VI, Holbrook AB, Popelka GR. Anatomic measures of upper airway structures in obstructive sleep apnea. World J Otorhinolaryngol Head Neck Surg 2017; 3:85-91. [PMID: 29204584 PMCID: PMC5683643 DOI: 10.1016/j.wjorl.2017.05.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Indexed: 11/25/2022] Open
Abstract
Objective Determine if anatomic dimensions of airway structures are associated with airway obstruction in obstructive sleep apnea (OSA) patients. Methods Twenty-eight subjects with (n = 14) and without (n = 14) OSA as determined by clinical symptoms and sleep studies; volunteer sample. Skeletal and soft tissue dimensions were measured from radiocephalometry and magnetic resonance imaging. The soft palate thickness, mandibular plane-hyoid (MP-H) distance, posterior airway space (PAS) diameters and area, and tongue volume were calculated. Results Compared to controls, the OSA group demonstrated a significantly longer MP-H distance (P = 0.009) and shorter nasal PAS diameter (P = 0.02). The PAS area was smaller (P = 0.002) and tongue volume larger in the OSA group (P = 0.004). The MP-H distance, PAS measurements, and tongue volume are of clinical relevance in OSA patients. Conclusions A long MP-H distance, and small PAS diameters and area are significant anatomic measures in OSA; however the most substantial parameter found was a large tongue volume.
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Affiliation(s)
- Jose E. Barrera
- Corresponding author. 555 East Basse Road, Ste 201, San Antonio, TX 78209, USA. Fax: +1 210 468 3282.555 East Basse RoadSte 201San AntonioTX78209USA
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19
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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]
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20
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Fleck RJ, Ishman SL, Shott SR, Gutmark EJ, McConnell KB, Mahmoud M, Mylavarapu G, Subramaniam DR, Szczesniak R, Amin RS. Dynamic Volume Computed Tomography Imaging of the Upper Airway in Obstructive Sleep Apnea. J Clin Sleep Med 2017; 13:189-196. [PMID: 27784422 PMCID: PMC5263074 DOI: 10.5664/jcsm.6444] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 09/14/2016] [Indexed: 12/22/2022]
Abstract
STUDY OBJECTIVES To describe a dynamic three-dimensional (3D) computed tomography (CT) technique for the upper airway and compare the required radiation dose to that used for common clinical studies of a similar anatomical area, such as for subjects undergoing routine clinical facial CT. METHODS Dynamic upper-airway CT was performed on eight subjects with persistent obstructive sleep apnea, four of whom were undergoing magnetic resonance imaging and an additional four subjects who had a contraindication to magnetic resonance imaging. This Health Insurance Portability and Accountability Act-compliant study was approved by our institutional review board, and informed consent was obtained. The control subjects (n = 41) for comparison of radiation dose were obtained from a retrospective review of the clinical picture-archiving computer system to identify 10 age-matched patients per age-based control group undergoing facial CT. RESULTS Dynamic 3D CT can be performed with an effective radiation dose of less than 0.38 mSv, a dose that is less than or comparable to that used for clinical facial CT. The resulting data- set is a uniquely complete, dynamic 3D volume of the upper airway through a full respiratory cycle that can be processed for clinical and modeling analyses. CONCLUSIONS A dynamic 3D CT technique of the upper airway is described that can be performed with a clinically reasonable radiation dose and sets a benchmark for future use.
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Affiliation(s)
- Robert J. Fleck
- Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Stacey L. Ishman
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, OH
| | - Sally R. Shott
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, OH
| | - Ephraim J. Gutmark
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, OH
- Department of Aerospace Engineering and Engineering Mechanics, CEAS, University of Cincinnati, Cincinnati, OH
| | - Keith B. McConnell
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Mohamed Mahmoud
- Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Goutham Mylavarapu
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Dhananjay R. Subramaniam
- Department of Aerospace Engineering and Engineering Mechanics, CEAS, University of Cincinnati, Cincinnati, OH
| | - Rhonda Szczesniak
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Raouf S. Amin
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH
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21
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Furuya J, Tamada Y, Sato T, Hara A, Nomura T, Kobayashi T, Sakai M, Kondo H. Wearing complete dentures is associated with changes in the three-dimensional shape of the oropharynx in edentulous older people that affect swallowing. Gerodontology 2016; 33:513-521. [PMID: 25939853 DOI: 10.1111/ger.12197] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the effects of wearing complete dentures on pharyngeal shape for swallowing in edentulous older people. BACKGROUND In the absence of complete dentures, edentulous older people often lose the occlusal support necessary to position the mandible, which leads to an anterosuperior shift of the mandible during swallowing. This may result in pharyngeal shape changes effecting swallowing function in older people. However, the details of this phenomenon are currently unclear. MATERIALS AND METHODS Participants were 17 older edentulous volunteers. Cone-beam computed tomography imaging was performed with the participant in the seated position and wearing (i) both maxillary and mandibular dentures, (ii) maxillary dentures only and (iii) no dentures. During imaging, participants were instructed to keep their mouth closed to the mandibular position determined in advance during swallowing for each denture-wearing condition. The volume, height and average cross-sectional area of the velopharynx and oropharynx were measured, and the positions of the epiglottis and mandible were recorded. RESULTS While the vertical height of the oral cavity and pharynx significantly decreased, the volume and average cross-sectional area of the oropharynx significantly increased when dentures were not worn (p < 0.01). The absence of dentures caused an anterosuperior shift of the mandible when swallowing and drew the epiglottis forward, resulting in expansion of the oropharynx where the tongue base forms the anterior wall. CONCLUSION The absence of dentures results in anatomical changes in oropharyngeal shape that may exacerbate the pharyngeal expansion caused by ageing and reduce the swallowing reserve.
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Affiliation(s)
- Junichi Furuya
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Iwate, Japan.
| | - Yasushi Tamada
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Iwate, Japan
| | - Tomohide Sato
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Iwate, Japan
| | - Atsushi Hara
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Iwate, Japan
| | - Taro Nomura
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Iwate, Japan
| | - Takuya Kobayashi
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Iwate, Japan
| | - Maiko Sakai
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA, USA
| | - Hisatomo Kondo
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Iwate, Japan
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Al-Fahdawi MA, El-Kassaby MA, Farid MM, El-Fotouh MA. Cone Beam Computed Tomography Analysis of Oropharyngeal Airway in Preadolescent Nonsyndromic Bilateral and Unilateral Cleft Lip and Palate Patients. Cleft Palate Craniofac J 2016; 55:883-890. [PMID: 27427930 DOI: 10.1597/15-322] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess the volume, area, and dimensions of the oropharyngeal airway (OPA) in a previously repaired nonsyndromic unilateral cleft lip and palate (UCLP) versus bilateral cleft lip and palate (BCLP) patients when compared with noncleft controls using cone beam computed tomography (CBCT). DESIGN This was a retrospective case-control study. SETTING The Cleft Care Center and outpatient clinic that are affiliated to our faculty were the settings for the study. PARTICIPANTS A total of 58 CBCT scans were selected of preadolescent individuals: 14 BCLP, 20 UCLP, and 24 age- and gender-matched noncleft controls. VARIABLES Variables were volume, cross-sectional area (CSA), midsagittal area (MSA), and dimensions of OPA. STATISTICAL ANALYSIS One-way analysis of variance and post hoc tests were used to compare variables. Statistical significance was set at P ≤ .05. RESULTS UCLP showed significantly smaller superior oropharyngeal airway volume than both controls and BCLP ( P ≤ .05). BCLP showed significantly larger CSA at soft palate plane and significantly larger MSA than both UCLP and controls ( P < .05). CONCLUSIONS UCLP patients at the studied age and stage of previously repaired clefts have significantly less superior oropharyngeal airway volume than both controls and BCLP patients. This confirms that preadolescents with UCLP are at greater risk for superior oropharyngeal airway obstruction when compared with those BCLP and controls. Furthermore, BCLP patients showed significantly larger CSA at soft palate plane and MSA than both controls and UCLP patients. These variations in OPA characteristics of cleft patients can influence function in terms of respiration and vocalization.
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23
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Wu Z, Chen W, Khoo MC, Ward SLD, Nayak KS. Evaluation of upper airway collapsibility using real-time MRI. J Magn Reson Imaging 2016; 44:158-67. [PMID: 26708099 PMCID: PMC6768084 DOI: 10.1002/jmri.25133] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/02/2015] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To develop and demonstrate a real-time MRI method for assessing upper airway collapsibility in sleep apnea. MATERIALS AND METHODS Data were acquired on a clinical 3 Tesla scanner using a radial CAIPIRIHNA sequence with modified golden angle view ordering and reconstructed using parallel imaging and compressed sensing with temporal finite difference sparsity constraint. Segmented airway areas together with synchronized facemask pressure were used to calculate airway compliance and projected closing pressure, Pclose , at four axial locations along the upper airway. This technique was demonstrated in five adolescent obstructive sleep apnea (OSA) patients, three adult OSA patients and four healthy volunteers. Heart rate, oxygen saturation, facemask pressure, and abdominal/chest movements were monitored in real-time during the experiments to determine sleep/wakefulness. RESULTS Student's t-tests showed that both compliance and Pclose were significantly different between healthy controls and OSA patients (P < 0.001). The results also suggested that a narrower airway site does not always correspond to higher collapsibility. CONCLUSION With the proposed methods, both compliance and Pclose can be calculated and used to quantify airway collapsibility in OSA with an awake scan of 30 min total scan room time. J. Magn. Reson. Imaging 2016;44:158-167.
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Affiliation(s)
- Ziyue Wu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA
- Alltech Medical Systems America, Solon, Ohio, USA
| | - Weiyi Chen
- Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, California, USA
| | - Michael C.K. Khoo
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA
| | - Sally L. Davidson Ward
- Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Krishna S. Nayak
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA
- Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, California, USA
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24
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Faria AC, Garcia LV, Santos AC, Eckeli AL, Garcia DM, Mello-Filho FV. Dynamic comparison of pharyngeal stability during sleep in patients with obstructive sleep apnea syndrome treated with maxillomandibular advancement. Sleep Breath 2016; 21:25-30. [PMID: 27225872 DOI: 10.1007/s11325-016-1362-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/11/2016] [Accepted: 05/18/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare the dynamic differences occurring in the pharynx during sleep after maxillomandibular advancement (MMA) surgery for the treatment of patients with obstructive sleep apnea syndrome. METHODS This was a prospective, cross-sectional study conducted on 20 patients (15 men and 5 women) with a polysomnography diagnosis of obstructive sleep apnea (OSA) submitted to surgical treatment with MMA. All patients were submitted to magnetic resonance (MR) during propofol-induced sleep before and 6 months after surgery. Thirty linear measurements (30 sections) were obtained over time in the retrolingual (RL) region to compare their variability before and after MMA. RESULTS The mean linear anteroposterior increase of the pharynx during induced sleep after MMA was 66 % in the RL region (P < 0.01). The coefficient of variation of the linear measurements was 117.5 % before surgery, being reduced to 51 % after surgery. CONCLUSIONS MMA promoted an important increase of the pharynx during induced sleep and a more significant change in the variability of its lumen. With a lower variation in the diameter of the organ during the respiratory movements, there is greater airway stability and a consequent maintenance of the pharyngeal lumen that reduces or even prevents pharyngeal collapse.
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Affiliation(s)
- Ana Celia Faria
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of São Paulo, Ribeirão Preto, SP, Brazil. .,Faculty of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900, 14049-900, Ribeirão Preto, SP, Brazil.
| | - Luis Vicente Garcia
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Antonio Carlos Santos
- Center of Imaging Sciences and Medical Physics, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Alan Luiz Eckeli
- Department of Neurology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Denny Marcos Garcia
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of São Paulo, Ribeirão Preto, SP, Brazil.,Craniofacial Research Support Center, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Francisco Verissimo Mello-Filho
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of São Paulo, Ribeirão Preto, SP, Brazil.,Craniofacial Research Support Center, University of São Paulo, Ribeirão Preto, SP, Brazil
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Basart H, König A, Bretschneider J, Hoekstra C, Oomen K, Pullens B, Rinkel R, van Gogh C, van der Horst C, Hennekam R. Awake Flexible Fiberoptic Laryngoscopy to diagnose glossoptosis in Robin Sequence patients. Clin Otolaryngol 2016; 41:467-71. [DOI: 10.1111/coa.12552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 11/30/2022]
Affiliation(s)
- H. Basart
- Department of Pediatrics; Academic Medical Center/Emma Pediatric Hospital; Amsterdam Netherlands
- Department of Plastic, Reconstructive and Hand Surgery; Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | - A.M. König
- Department of Otolaryngology; Academic Medical Center; Amsterdam Netherlands
| | | | - C.E.L. Hoekstra
- Department of Otolaryngology; Academic Medical Center; Amsterdam Netherlands
| | - K.P.Q. Oomen
- Department of Otolaryngology; Utrecht Medical Center/Wilhelmina Children's Hospital; Utrecht Netherlands
| | - B. Pullens
- Department of Otolaryngology; Erasmus Medical Center/Sophia Pediatric Hospital; Rotterdam Netherlands
| | - R.N.P.M. Rinkel
- Department of Otolaryngology; VU Medical Center; Amsterdam Netherlands
| | - C.D.L. van Gogh
- Department of Otolaryngology; VU Medical Center; Amsterdam Netherlands
| | - C.M.A.M. van der Horst
- Department of Plastic, Reconstructive and Hand Surgery; Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | - R.C. Hennekam
- Department of Pediatrics; Academic Medical Center/Emma Pediatric Hospital; Amsterdam Netherlands
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26
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Tripathi A, Gupta A, Sarkar S, Tripathi S, Gupta N. Changes in Upper Airway Volume in Edentulous Obstructive Sleep Apnea Patients Treated with Modified Mandibular Advancement Device. J Prosthodont 2015; 25:453-8. [DOI: 10.1111/jopr.12335] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - Ashutosh Gupta
- Department of Prosthodontics; Saraswati Dental College and Hospital; Lucknow India
| | | | - Suryakant Tripathi
- Department of Pulmonary Medicine; King George's Medical University; Lucknow India
| | - Narendra Gupta
- Department of Prosthodontics; BBD College of Dental Sciences; Lucknow India
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27
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Slaats MA, Van Hoorenbeeck K, Van Eyck A, Vos WG, De Backer JW, Boudewyns A, De Backer W, Verhulst SL. Upper airway imaging in pediatric obstructive sleep apnea syndrome. Sleep Med Rev 2015; 21:59-71. [DOI: 10.1016/j.smrv.2014.08.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 08/12/2014] [Accepted: 08/12/2014] [Indexed: 11/28/2022]
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Intraoperative long range optical coherence tomography as a novel method of imaging the pediatric upper airway before and after adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2015; 79:63-70. [PMID: 25479699 PMCID: PMC4313623 DOI: 10.1016/j.ijporl.2014.11.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 11/04/2014] [Accepted: 11/07/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND/OBJECTIVES While upper airway obstruction is a common problem in the pediatric population, the first-line treatment, adenotonsillectomy, fails in up to 20% of patients. The decision to proceed to surgery is often made without quantitative anatomic guidance. We evaluated the use of a novel technique, long-range optical coherence tomography (LR-OCT), to image the upper airway of children under general anesthesia immediately before and after tonsillectomy and/or adenoidectomy. We investigated the feasibility of LR-OCT to identify both normal anatomy and sites of airway narrowing and to quantitatively compare airway lumen size in the oropharyngeal and nasopharyngeal regions pre- and post-operatively. METHODS 46 children were imaged intraoperatively with a custom-designed LR-OCT system, both before and after adenotonsillectomy. These axial LR-OCT images were both rendered into 3D airway models for qualitative analysis and manually segmented for quantitative comparison of cross-sectional area. RESULTS LR-OCT images demonstrated normal anatomic structures (base of tongue, epiglottis) as well as regions of airway narrowing. Volumetric rendering of pre- and post-operative images clearly showed regions of airway collapse and post-surgical improvement in airway patency. Quantitative analysis of cross-sectional images showed an average change of 70.52mm(2) (standard deviation 47.87mm(2)) in the oropharynx after tonsillectomy and 105.58mm(2) (standard deviation 60.62mm(2)) in the nasopharynx after adenoidectomy. CONCLUSIONS LR-OCT is an emerging technology that rapidly generates 3D images of the pediatric upper airway in a feasible manner. This is the first step toward development of an office-based system to image awake pediatric subjects and thus better identify loci of airway obstruction prior to surgery.
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29
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Fukushi I, Okada Y. Dynamics of upper airways during the Müller maneuver in healthy subjects: a cine MRI study. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 788:189-95. [PMID: 23835978 DOI: 10.1007/978-94-007-6627-3_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
The Müller maneuver has been widely applied to mimic the pathophysiological condition of obstructive sleep apnea (OSA) during wakefulness. We applied cine MRI to elucidate dynamics of the upper airway during the Müller maneuver in healthy subjects (n = 7). Three sets of images (during quiet nose breathing, quiet mouth breathing, and Müller maneuver) were recorded on sagittal midline plane together with impedance pneumography. The position of the tongue root changed during a respiratory cycle when subjects breathed quietly. At the early inspiratory phase the tongue root moved forward and upward, the retroglossal airway size increased toward the middle of inspiration, and the airway size became smaller again toward the end of inspiration. During expiration the airway size became further smaller. When the subject performed the Müller maneuver, the movement of the oropharynx and its narrowing were greater than those of the velopharynx. However, the airway was not completely obstructed. A relatively large morphological change was observed in the retropalatal and retroglossal regions with the backward and downward motion of the tongue root and flattening of the tongue shape during the Müller maneuver. Although patterns of upper airway narrowing and tongue shape alterations were variable among subjects, upper airway narrowing was commonly prominent in the retroglossal area. Cine MRI with the Müller maneuver enables to visualize the upper airway dynamics and could be easily applied to evaluate upper airway collapsibility during wakefulness.
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Patino M, Sadhasivam S, Mahmoud M. Obstructive sleep apnoea in children: perioperative considerations. Br J Anaesth 2013; 111 Suppl 1:i83-95. [DOI: 10.1093/bja/aet371] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mello Junior CFD, Guimarães Filho HA, Gomes CADB, Paiva CCDA. Radiological findings in patients with obstructive sleep apnea. J Bras Pneumol 2013; 39:98-101. [PMID: 23503492 PMCID: PMC4075807 DOI: 10.1590/s1806-37132013000100014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 10/10/2012] [Indexed: 11/21/2022] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstruction
occurring at the level of the pharynx during sleep. Although cephalometric analysis
is an important method in the diagnosis of craniofacial deformities, CT and magnetic
resonance imaging have been highlighted as the major imaging methods to investigate
the possible causes of OSA, which, in most cases, is multifactorial. Magnetic
resonance and CT both allow an excellent evaluation of the various anatomical planes
of the site of obstruction, which enables better clinical assessment and surgical
approach. This pictorial essay aims to describe the aspects that must be evaluated in
the diagnostic imaging of patients presenting with the major predisposing factors for
OSA.
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Affiliation(s)
- Carlos Fernando de Mello Junior
- Department of Radiology, Universidade Federal da Paraíba - UFPB, Federal University of Paraíba - School of Medicine, João Pessoa, Brazil.
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Chang Y, Koenig LJ, Pruszynski JE, Bradley TG, Bosio JA, Liu D. Dimensional changes of upper airway after rapid maxillary expansion: a prospective cone-beam computed tomography study. Am J Orthod Dentofacial Orthop 2013; 143:462-70. [PMID: 23561406 DOI: 10.1016/j.ajodo.2012.11.019] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Revised: 11/01/2012] [Accepted: 11/01/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The aim of this prospective study was to use cone-beam computed tomography to assess the dimensional changes of the upper airway in orthodontic patients with maxillary constriction treated by rapid maxillary expansion. METHODS Fourteen orthodontic patients (mean age, 12.9 years; range, 9.7-16 years) were recruited. The patients with posterior crossbite and constricted maxilla were treated with rapid maxillary expansion as the initial part of their comprehensive orthodontic treatments. Before and after rapid maxillary expansion cone-beam computed tomography scans were taken to measure the retropalatal and retroglossal airway changes in terms of volume, and sagittal and cross-sectional areas. The transverse expansions by rapid maxillary expansion were assessed between the midlingual alveolar bone plates at the maxillary first molar and first premolar levels. The measurements of the before and after rapid maxillary expansion scans were compared by using paired t tests with the Bonferroni adjustment for multiple comparisons. RESULTS After rapid maxillary expansion, significant and equal amounts of 4.8 mm of expansion were observed at the first molar (P = 0.0000) and the first premolar (P = 0.0000) levels. The width increase at the first premolar level (20.0%) was significantly greater than that at the first molar level (15.0%) (P = 0.035). As the primary outcome variable, the cross-sectional airway measured from the posterior nasal spine to basion level was the only parameter showing a significant increase of 99.4 mm(2) (59.6%) after rapid maxillary expansion (P = 0.0004). CONCLUSIONS These results confirm the findings of previous studies of the effect of rapid maxillary expansion on the maxilla. Additionally, we found that only the cross-sectional area of the upper airway at the posterior nasal spine to basion level significantly gains a moderate increase after rapid maxillary expansion.
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Affiliation(s)
- Yoon Chang
- Department of Developmental Science/Orthodontics, School of Dentistry, Marquette University, Milwaukee, WI 53233, USA
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Parikh SR, Sadoughi B, Sin S, Willen S, Nandalike K, Arens R. Deep cervical lymph node hypertrophy: a new paradigm in the understanding of pediatric obstructive sleep apnea. Laryngoscope 2013; 123:2043-9. [PMID: 23666635 DOI: 10.1002/lary.23748] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 07/16/2012] [Accepted: 08/24/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine if adenotonsillar hypertrophy is an isolated factor in pediatric obstructive sleep apnea (OSA), or if it is part of larger spectrum of cervical lymphoid hypertrophy. STUDY DESIGN Prospective case control study. METHODS A total of 70 screened patients (mean age 7.47 years) underwent polysomnography to confirm OSA, and then underwent MRI of the upper airway. Seventy-six matched controls (mean age 8.00 years) who already had an MRI underwent polysomnography. Volumetric analysis of lymphoid tissue volumes was carried out. Chi-square analysis and Student's t test were used to compare demographic data and lymph node volumes between cohorts. Fisher's Exact test and Chi-square analysis were used to compare sleep data. RESULTS Patients and controls demonstrated no significant difference in mean age (7.47 vs. 8.00 yrs), weight (44.87 vs. 38.71 kg), height (124.68 vs. 127.65 cm), or body-mass index (23.63 vs. 20.87 kg/m(2)). OSA patients demonstrated poorer sleep measures than controls (P < 0.05) in all polysomnography categories (sleep efficiency, apnea index, apnea-hypopnea index, baseline SpO2, SpO2 nadir, baseline ETCO2, peak ETCO2 , and arousal awakening index). Children with OSA had higher lymphoid tissue volumes than controls in the retropharyngeal region (3316 vs. 2403 mm(3), P < 0.001), upper jugular region (22202 vs. 16819 mm(3), P < 0.005), and adenotonsillar region (18994 vs. 12675 mm(3), P < 0.0001). CONCLUSIONS Children with OSA have larger volumes of deep cervical lymph nodes and adenotonsillar tissue than controls. This finding suggests a new paradigm in the understanding of pediatric OSA, and has ramifications for future research and clinical care.
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Affiliation(s)
- Sanjay R Parikh
- Department of Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital-University of Washington School of Medicine, Seattle, Washington 98105, USA.
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Van Holsbeke C, Vos W, Van Hoorenbeeck K, Boudewyns A, Salgado R, Verdonck PR, Ramet J, De Backer J, De Backer W, Verhulst SL. Functional respiratory imaging as a tool to assess upper airway patency in children with obstructive sleep apnea. Sleep Med 2013; 14:433-9. [PMID: 23474060 DOI: 10.1016/j.sleep.2012.12.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Revised: 11/28/2012] [Accepted: 12/01/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aim to investigate if anatomical and functional properties of the upper airway using computerized 3D models derived from computed tomography (CT) scans better predict obstructive sleep apnea (OSA) severity than standard clinical markers. METHODS Consecutive children with suspected OSA underwent polysomnography, clinical assessment of upper airway patency, and a CT scan while awake. A three-dimensional (3D) reconstruction of the pharyngeal airway was built from these images, and computational fluid dynamics modeling of low inspiratory flow was performed using open-source software. RESULTS Thirty-three children were included (23 boys; mean age, was 6.0±3.2y). OSA was diagnosed in 23 patients. Children with OSA had a significantly lower volume of the overlap region between tonsils and the adenoids (median volume, 1408 mm compared to 2173 mm; p=0.04), a lower mean cross-sectional area at this location (median volume, 69.3mm(2) compared to 114.3mm2; p=0.04), and a lower minimal cross-sectional area (median volume, 17.9 mm2 compared to 25.9 mm2; p=0.05). Various significant correlations were found between several imaging parameters and the severity of OSA, most pronounced for upper airway conductance (r=-0.46) (p<0.01) for correlation between upper airway conductance and the apnea-hypopnea index. No differences or significant correlations were observed with clinical parameters of upper airway patency. Preliminary data after treatment showed that none of the patients with residual OSA had their smallest cross-sectional area located in segment 3, and this frequency was significantly lower than in their peers whose sleep study normalized (64%; p=0.05). CONCLUSION Functional imaging parameters are highly correlated with OSA severity and are a more powerful correlate than clinical scores of upper airway patency. Preliminary data also showed that we could identify differences in the upper airway of those subjects who did not benefit from a local upper airway treatment.
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Shin LK, Holbrook AB, Capasso R, Kushida CA, Powell NB, Fischbein NJ, Pauly KB. Improved sleep MRI at 3 tesla in patients with obstructive sleep apnea. J Magn Reson Imaging 2013; 38:1261-6. [DOI: 10.1002/jmri.24029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 12/12/2012] [Indexed: 12/12/2022] Open
Affiliation(s)
- Lewis K. Shin
- Department of Radiology; Stanford University; Stanford California USA
- VA Palo Alto Health Care System; Palo Alto California USA
| | | | - Robson Capasso
- Department of Otolaryngology; Stanford University; Stanford California USA
| | - Clete A. Kushida
- Department of Psychiatry; Stanford University Center of Excellence for Sleep Disorders; Stanford California USA
| | - Nelson B. Powell
- Department of Otolaryngology; Stanford University; Stanford California USA
| | | | - Kim Butts Pauly
- Department of Radiology; Stanford University; Stanford California USA
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Sleep Nasopharyngoscopy in Children with Snoring/Sleep Disordered Breathing: Purpose and Validity. CURRENT OTORHINOLARYNGOLOGY REPORTS 2013. [DOI: 10.1007/s40136-012-0006-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Evaluation and management of pediatric obstructive sleep apnea beyond tonsillectomy and adenoidectomy. Curr Opin Otolaryngol Head Neck Surg 2012; 19:449-54. [PMID: 22052530 DOI: 10.1097/moo.0b013e32834c1728] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW There is an increasing percentage of children with persistent obstructive sleep apnea (OSA) after removal of the tonsils and adenoids (T&A). Although sleep apnea has been an active area of research and treatment in the adult population, our awareness of this problem in children is still in its initial stages. In addition, therapies to successfully treat this residual OSA are still not fully established. It is important to develop evaluation and management protocols for these children. RECENT FINDINGS This review will discuss risk factors associated with persistent OSA after T&A and techniques to evaluate the pediatric airway in order to identify the site, or sites, of obstruction. Various medical and surgical options are presented. SUMMARY Clinicians need to be aware of the potential for persistent sleep disordered breathing and OSA in children, despite previous T&A. Evaluation protocols and techniques will differ in children, due to limitations in their cooperation during the physical examination. Alternative methods, such as airway endoscopy and cine MRI, are presented. Medical and surgical options are presented. Outcomes data for pediatric populations are rare. Multilevel, single stage surgery has a higher risk for oropharyngeal stenosis in children compared with adults and conservative, multistage approaches may be more appropriate.
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Faria AC, da Silva-Junior SN, Garcia LV, dos Santos AC, Fernandes MRF, de Mello-Filho FV. Volumetric analysis of the pharynx in patients with obstructive sleep apnea (OSA) treated with maxillomandibular advancement (MMA). Sleep Breath 2012; 17:395-401. [DOI: 10.1007/s11325-012-0707-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 03/18/2012] [Accepted: 04/12/2012] [Indexed: 11/27/2022]
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Laya BF, Lee EY. Congenital Causes of Upper Airway Obstruction in Pediatric Patients: Updated Imaging Techniques and Review of Imaging Findings. Semin Roentgenol 2012; 47:147-58. [DOI: 10.1053/j.ro.2011.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Faria AC, Garcia LV, dos Santos AC, Diniz PRB, Ribeiro HT, de Mello-Filho FV. Comparison of the area of the pharynx during wakefulness and induced sleep in patients with Obstructive Sleep Apnea (OSA). Braz J Otorhinolaryngol 2012; 78:103-8. [PMID: 22392246 PMCID: PMC9444543 DOI: 10.1590/s1808-86942012000100016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 10/02/2011] [Indexed: 12/04/2022] Open
Abstract
The study of obstructive sleep apnea (OSA) has received growing attention over the past years since various aspects have not been sufficiently established. Aim To evaluate, with the use of magnetic resonance imaging (MRI), changes in the area of the pharynx during wakefulness and induced sleep in patients with OSA. Materials and Methods A prospective study of thirty-two patients with a polysomnographic diagnosis of OSA. All patients were submitted to MR imaging in order to obtain high-definition anatomical sagittal sequences during wakefulness and during sleep induced with Propofol. An area was defined on the sagittal plane in the midline of the pharynx. This region was called pharyngeal midplane (PMP) area. Results A significant difference in PMP area (mm2) was observed between wakefulness and induced sleep in each patient (p < 0.000001). Conclusion The patients with OSA suffer a significant reduction of 75,5 % in the area of the pharynx during induced sleep compared to wakefulness.
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Stratemann S, Huang JC, Maki K, Hatcher D, Miller AJ. Three-dimensional analysis of the airway with cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2011; 140:607-15. [PMID: 22051480 DOI: 10.1016/j.ajodo.2010.12.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Revised: 12/01/2010] [Accepted: 12/01/2010] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In this study, using a cone-beam computed tomography system, we evaluated the airways of 30 adults. METHODS The shapes of the 3-dimensional volume of the airway were analyzed and compared among the subjects by using surface superimposition software techniques. RESULTS The airway had the greatest variability in the hypopharynx, in the region below the epiglottis, and above the vocal folds. Moderate variation was apparent at the nares, behind the soft palate, and at the base of the tongue. Conservation of form was seen at the central portion of the nasal airway surrounding the inferior turbinate. CONCLUSIONS The potential for comparing the shape of the airway among subjects is possible.
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Affiliation(s)
- Scott Stratemann
- Division of Orthodontics, Department of Orofacial Sciences, School of Dentistry, University of California at San Francisco, CA 94143-0438, USA
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Hernández-Alfaro F, Guijarro-Martínez R, Mareque-Bueno J. Effect of Mono- and Bimaxillary Advancement on Pharyngeal Airway Volume: Cone-Beam Computed Tomography Evaluation. J Oral Maxillofac Surg 2011; 69:e395-400. [DOI: 10.1016/j.joms.2011.02.138] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 02/08/2011] [Accepted: 02/20/2011] [Indexed: 11/24/2022]
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FURUYA J, TAMADA Y, SUZUKI T. Effect of mandibular position on three-dimensional shape of the oropharynx in seated posture. J Oral Rehabil 2011; 39:277-84. [DOI: 10.1111/j.1365-2842.2011.02263.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Guijarro-Martínez R, Swennen GRJ. Cone-beam computerized tomography imaging and analysis of the upper airway: a systematic review of the literature. Int J Oral Maxillofac Surg 2011; 40:1227-37. [PMID: 21764260 DOI: 10.1016/j.ijom.2011.06.017] [Citation(s) in RCA: 174] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 06/13/2011] [Indexed: 01/07/2023]
Abstract
A systematic review of the literature concerning upper airway imaging and analysis using cone-beam computed tomography (CBCT) was performed. A PubMed search (National Library of Medicine, NCBI; revised 9th January 2011) yielded 382 papers published between 1968 and 2010. The 382 full papers were screened in detail. 46 articles were considered clinically or technically relevant and were included in this systematic review. These were classified as articles on accuracy and reliability of CBCT imaging of the upper airway (n=4), accuracy and reliability of DICOM viewers (n=2), synopsis (n=10), technical (n=7) and clinical applications (n=27). When one paper was considered related to two or more categories, it was assigned to each relevant group. Results indicate that three-dimensional (3D) analysis of the upper airway using CBCT can be achieved in an accurate and reliable manner. Important obstacles still need to be addressed, including the impact of respiration phase, influence of tongue position and mandible morphology, longitudinal and cross-sectional 3D CBCT upper airway evaluation, and 3D CBCT definition of the anatomical boundaries of the upper airway.
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Affiliation(s)
- R Guijarro-Martínez
- Department of Oral and Maxillofacial Surgery, Hospital Clínico Universitario of Valencia, Valencia, Spain.
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Vicente González E, Leza IA, Maltrana García JA, Facerías EA, García AO. Fisiopatología de los trastornos respiratorios del sueño en los niños. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 61 Suppl 1:14-21. [DOI: 10.1016/s0001-6519(10)71240-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Moon IJ, Han DH, Kim JW, Rhee CS, Sung MW, Park JW, Kim DS, Lee CH. Sleep magnetic resonance imaging as a new diagnostic method in obstructive sleep apnea syndrome. Laryngoscope 2010; 120:2546-54. [DOI: 10.1002/lary.21112] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Measurement, Reconstruction, and Flow-Field Computation of the Human Pharynx With Application to Sleep Apnea. IEEE Trans Biomed Eng 2010; 57:2535-48. [DOI: 10.1109/tbme.2010.2052808] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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