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Charles D, Harrison L, Hassanipour F, Hallac RR. Nasal Airflow Dynamics following LeFort I Advancement in Cleft Nasal Deformities: A Retrospective Preliminary Study. Diagnostics (Basel) 2024; 14:1294. [PMID: 38928709 PMCID: PMC11203135 DOI: 10.3390/diagnostics14121294] [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: 05/13/2024] [Revised: 06/15/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024] Open
Abstract
Unilateral cleft lip and palate (UCLP) nasal deformity impacts airflow patterns and pressure distribution, leading to nasal breathing difficulties. This study aims to create an integrated approach using computer-aided design (CAD) and computational fluid dynamics (CFD) to simulate airway function and assess outcomes in nasal deformities associated with unilateral cleft lip and palate (UCLP) after LeFort I osteotomy advancement. Significant alterations were observed in nasal geometry, airflow velocity, pressure dynamics, volumetric flow rate, and nasal resistance postoperatively, indicating improved nasal airflow. The cross-sectional area increased by 26.6%, airflow rate by 6.53%, and nasal resistance decreased by 6.23%. The study offers quantitative insights into the functional impacts of such surgical interventions, contributing to a deeper understanding of UCLP nasal deformity treatment and providing objective metrics for assessing surgical outcome.
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Affiliation(s)
- Daniel Charles
- Department of Mechanical Engineering, University of Texas at Dallas, Richardson, TX 75080, USA;
| | - Lucas Harrison
- Department of Plastic and Craniofacial Surgery, UT Southwestern Medical Center, Dallas, TX 75390, USA; (L.H.); (R.R.H.)
| | - Fatemeh Hassanipour
- Department of Mechanical Engineering, University of Texas at Dallas, Richardson, TX 75080, USA;
| | - Rami R. Hallac
- Department of Plastic and Craniofacial Surgery, UT Southwestern Medical Center, Dallas, TX 75390, USA; (L.H.); (R.R.H.)
- Analytical Imaging and Modeling Center, Children’s Medical Center Dallas, Dallas, TX 75235, USA
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Numerical and Experimental Analysis of Drug Inhalation in Realistic Human Upper Airway Model. Pharmaceuticals (Basel) 2023; 16:ph16030406. [PMID: 36986505 PMCID: PMC10054804 DOI: 10.3390/ph16030406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/14/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023] Open
Abstract
The demand for a more efficient and targeted method for intranasal drug delivery has led to sophisticated device design, delivery methods, and aerosol properties. Due to the complex nasal geometry and measurement limitations, numerical modeling is an appropriate approach to simulate the airflow, aerosol dispersion, and deposition for the initial assessment of novel methodologies for better drug delivery. In this study, a CT-based, 3D-printed model of a realistic nasal airway was reconstructed, and airflow pressure, velocity, turbulent kinetic energy (TKE), and aerosol deposition patterns were simultaneously investigated. Different inhalation flowrates (5, 10, 15, 30, and 45 L/min) and aerosol sizes (1, 1.5, 2.5, 3, 6, 15, and 30 µm) were simulated using laminar and SST viscous models, with the results compared and verified by experimental data. The results revealed that from the vestibule to the nasopharynx, the pressure drop was negligible for flow rates of 5, 10, and 15 L/min, while for flow rates of 30 and 40 L/min, a considerable pressure drop was observed by approximately 14 and 10%, respectively. However, from the nasopharynx and trachea, this reduction was approximately 70%. The aerosol deposition fraction alongside the nasal cavities and upper airway showed a significant difference in pattern, dependent on particle size. More than 90% of the initiated particles were deposited in the anterior region, while just under 20% of the injected ultrafine particles were deposited in this area. The turbulent and laminar models showed slightly different values for the deposition fraction and efficiency of drug delivery for ultrafine particles (about 5%); however, the deposition pattern for ultrafine particles was very different.
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Zambon C, Cherobin G, Utumi E, Machado G, de Vasconcellos F, Peres M, Pilan R, Voegels R, Pinna F. Computational fluid dynamics and NOSE scale to assess nasal respiratory function, and correlation with linear maxillary measurements after surgically assisted rapid maxillary expansion. Int J Oral Maxillofac Surg 2022:S0901-5027(22)00422-2. [DOI: 10.1016/j.ijom.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 10/07/2022] [Accepted: 10/13/2022] [Indexed: 02/09/2023]
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Corda JV, Shenoy BS, Ahmad KA, Lewis L, K P, Khader SMA, Zuber M. Nasal airflow comparison in neonates, infant and adult nasal cavities using computational fluid dynamics. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 214:106538. [PMID: 34848078 DOI: 10.1016/j.cmpb.2021.106538] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/29/2021] [Accepted: 11/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Neonates are preferential nasal breathers up to 3 months of age. The nasal anatomy in neonates and infants is at developing stages whereas the adult nasal cavities are fully grown which implies that the study of airflow dynamics in the neonates and infants are significant. In the present study, the nasal airways of the neonate, infant and adult are anatomically compared and their airflow patterns are investigated. METHODS Computational Fluid Dynamics (CFD) approach is used to simulate the airflow in a neonate, an infant and an adult in sedentary breathing conditions. The healthy CT scans are segmented using MIMICS 21.0 (Materialise, Ann arbor, MI). The patient-specific 3D airway models are analyzed for low Reynolds number flow using ANSYS FLUENT 2020 R2. The applicability of the Grid Convergence Index (GCI) for polyhedral mesh adopted in this work is also verified. RESULTS This study shows that the inferior meatus of neonates accounted for only 15% of the total airflow. This was in contrast to the infants and adults who experienced 49 and 31% of airflow at the inferior meatus region. Superior meatus experienced 25% of total flow which is more than normal for the neonate. The highest velocity of 1.8, 2.6 and 3.7 m/s was observed at the nasal valve region for neonates, infants and adults, respectively. The anterior portion of the nasal cavity experienced maximum wall shear stress with average values of 0.48, 0.25 and 0.58 Pa for the neonates, infants and adults. CONCLUSIONS The neonates have an underdeveloped nasal cavity which significantly affects their airway distribution. The absence of inferior meatus in the neonates has limited the flow through the inferior regions and resulted in uneven flow distribution.
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Affiliation(s)
- John Valerian Corda
- Department of Aeronautical and Automobile Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India
| | - B Satish Shenoy
- Department of Aeronautical and Automobile Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India
| | - Kamarul Arifin Ahmad
- Department of Aerospace Engineering, Universiti Putra Malaysia, Jalan Universiti 1 Serdang, Seri Kembangan, Selangor 43400, Malaysia
| | - Leslie Lewis
- Department of Paediatrics, Kasturba Medical College and Hospital, Manipal 576104, India
| | - Prakashini K
- Department of Radio Diagnosis, Kasturba Medical College and Hospital, Manipal 576104, India
| | - S M Abdul Khader
- Department of Mechanical and Manufacturing Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India
| | - Mohammad Zuber
- Department of Aeronautical and Automobile Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India.
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Cone beam CT evaluation of skeletal and nasomaxillary complex volume changes after rapid maxillary expansion in OSA children. Sleep Med 2021; 86:81-89. [PMID: 34479051 DOI: 10.1016/j.sleep.2021.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The first objective of this study was to evaluate skeletal changes and changes in dimensions and volume of the upper airways before and after rapid maxillary expansion (RME) therapy in children with obstructive sleep apnoea (OSA), by Cone Beam computed tomography (CBCT). The second objective was to evaluate if RME therapy could improve both the patency of the nasal airways and the Obstructive Sleep Apnoea Syndrome (OSAS). METHODS 19 children with OSA and malocclusion took CBCT scans with a Dentascan and 3D reconstruction program before (T0) and 4 months after (T1) RME. Patients underwent an ENT visit with auditory and respiratory tests, including a daytime sleepiness questionnaire, a 19-channel polysomnography, and an orthognatodontic examination before orthodontic therapy (T0), after 2 months (T1) with the device still on, and 4 months after the end of the orthodontic treatment (T2). RESULTS In all cases opening of the mid-palatal suture was demonstrated. Nasal osseous width, volume of the total upper airways, nasal cavity and nasopharynx and oropharynx increased significantly (P, .001). The increased W-ANS, W-mid and WPNS were closed linked to the enlarged midpalatal suture (P, .001). The increased WPNS were closed linked to the enlarged pterygoid processes (P, .001). The increased V-NC and V-NPA was closely linked to the enlarged W-PNS (P, .001) as well as VOPA and consequently to the enlarged midpalatal suture and pterygoid processes. CONCLUSION RME treatment had a positive effect on children affected by chronic snoring and OSA, causing an increase in volume of the nasal cavity and nasopharynx, with expansion of the nasal osseous width and maxillary width. Enlarged nasal width at the PNS plane contributed to the increase in nasopharynx volume. Enlarged maxillary width showed a direct correlation to increased airways volume, bringing a functional improvement. The results show that the RME therapy can restore and improve a normal nasal airflow with disappearance of obstructive sleep breathing disorder.
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Li J, Shi L, Zhang X, Weng L, Chen H, Lin J. Evaluating the effect of midpalatal corticotomy-assisted rapid maxillary expansion on the upper airway in young adults using computational fluid dynamics. J Zhejiang Univ Sci B 2021; 22:146-155. [PMID: 33615755 DOI: 10.1631/jzus.b2000090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Midpalatal corticotomy-assisted rapid maxillary expansion (MCRME) is a minimally invasive treatment of maxillary transverse deficiency (MTD) in young adults. However, the effect of MCRME on respiratory function still needs to be determined. In this study, we evaluated the changes in maxillary morphology and the upper airway following MCRME using computational fluid dynamics (CFD). Twenty patients with MTD (8 males, 12 females; mean age 20.55 years) had cone-beam computed tomography (CBCT) images taken before and after MCRME. The CBCT data were used to construct a three-dimensional (3D) upper airway model. The upper airway flow characteristics were simulated using CFD, and measurements were made based on the CBCT images and CFD. The results showed that the widths of the palatal bone and nasal cavity, and the intermolar width were increased significantly after MCRME. The volume of the nasal cavity and nasopharynx increased significantly, while there were no obvious changes in the volumes of the oropharynx and hypopharynx. CFD simulation of the upper airway showed that the pressure drop and maximum velocity of the upper airway decreased significantly after treatment. Our results suggest that in these young adults with MTD, increasing the maxillary width, upper airway volume, and quantity of airflow by MCRME substantially improved upper airway ventilation.
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Affiliation(s)
- Juan Li
- Department of Stomatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Lingfang Shi
- Department of Stomatology, the First People's Hospital of Xiaoshan, Hangzhou 311200, China
| | - Xiayao Zhang
- Department of Stomatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Luxi Weng
- Department of Stomatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Hong Chen
- Department of Stomatology, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou 310014, China
| | - Jun Lin
- Department of Stomatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
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Chen S, Wang J, Xi X, Zhao Y, Liu H, Liu D. Rapid Maxillary Expansion Has a Beneficial Effect on the Ventilation in Children With Nasal Septal Deviation: A Computational Fluid Dynamics Study. Front Pediatr 2021; 9:718735. [PMID: 35223705 PMCID: PMC8866691 DOI: 10.3389/fped.2021.718735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/06/2021] [Indexed: 11/15/2022] Open
Abstract
Nasal septal deviation (NSD) is one of the most common nasal diseases. Different from common clinical examination methods, computational fluid dynamics (CFD) can provide visual flow information of the nasal cavity. The dimension and volume of the nasal cavity are easily affected by rapid maxillary expansion (RME). The purpose of this study was to use CFD to evaluate the effect of RME on the aerodynamics of the nasal cavity in children with maxillary transverse deficiency and NSD. Computational fluid dynamics was implemented after 3D reconstruction based on the CBCT of 15 children who have completed RME treatment. After treatment, the volume increases in the nasal cavity, nasopharynx, oropharynx, and pharynx were not statistically significant. The wall shear stress of the nasal cavity after RME, 1.749 ± 0.673 Pa, was significantly lower than that before RME, 2.684 ± 0.919 Pa. Meanwhile, the maximal negative pressure in the pharyngeal airway during inspiration was smaller after RME (-31.058 Pa) than before (-48.204 Pa). This study suggests that RME has a beneficial effect on nasal ventilation. The nasal airflow became more symmetrical in the bilateral nasal cavity after RME. Pharyngeal resistance decreased with the reduction in nasal resistance and the increase in the volume of oropharynx after RME.
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Affiliation(s)
- Shuai Chen
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Jingying Wang
- Institute of Thermodynamics and Fluid Mechanics, School of Energy and Power Engineering, Shandong University, Jinan, China
| | - Xun Xi
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Yi Zhao
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Hong Liu
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Dongxu Liu
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
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Kocakara G, Buyukcavus MH, Orhan H. Evaluation of pharyngeal airway dimensions and hyoid bone position according to craniofacial growth pattern. Cranio 2020; 40:313-323. [PMID: 32692620 DOI: 10.1080/08869634.2020.1796060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare pharyngeal airway dimensions and hyoid bone position in different craniofacial growth patterns. METHODS In total, 611 patients divided into 9 subgroups were compared according to malocclusion classification and vertical growth pattern, and these subgroups were compared in terms of pharyngeal airway and hyoid measurements. A two-way ANOVA test was used to compare the findings of the subgroups. RESULTS No significant difference was found for the pharyngeal measurements between the groups (p>0.05). The vertical airway length (PNS-Ep) was significantly shorter in the Class III malocclusion group (p<0.05) and in the hypodivergent group (p<0.05). No statistically significant difference was found between any subgroups in any measurements of the position of the hyoid bone (p>0.05). CONCLUSION The pharyngeal airway dimensions and hyoid bone position are similar among individuals in the sagittal direction. The vertical airway length is significantly shorter in Class III and hypodivergent individuals.
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Affiliation(s)
- Gönül Kocakara
- Department of Orthodontics, Faculty of Dentistry, Suleyman Demirel University, Isparta, Turkey
| | | | - Hikmet Orhan
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
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Effects of Maxillary Skeletal Expansion on Upper Airway Airflow: A Computational Fluid Dynamics Analysis. J Craniofac Surg 2020; 31:e6-e10. [PMID: 31449208 DOI: 10.1097/scs.0000000000005806] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The effect of maxillary skeletal expansion (MSE) on upper airway in adolescent patients is not clear. The purpose of this study was to determine the upper airway airflow with MSE treatment using computational fluid dynamics analysis. Three-dimensional upper airway finite element models fabricated from cone beam computed tomography images were obtained before and after treatment in an adolescent patient with maxillary constriction. Turbulent analyses were applied. The nasal cavity (NC) was divided into 6 planes along the y-axis and the pharynx was divided into 7 planes in the z-axis. Changes in cross-sectional area, airflow velocity, pressure, and total resistance at maximum expiration and maximum inspiration were determined at each plane after MSE treatment. The greatest increase in area occurred in the oropharynx which was around 40.65%. The average increase in area was 7.42% in the NC and 22.04% in the pharynx. The middle part of pharynx showed the greatest increase of 212.81 mm and 217.99 mm or 36.58% and 40.66%, respectively. During both inspiration and expiration, airflow pressure decreased in both the NC and pharynx, which ranged from -11.34% to -23.68%. In the NC, the average velocity decrease was -0.18 m/s at maximum expiration (ME) and -0.13 m/s at maximum inspiration (MI). In the pharynx, the average velocity decrease was -0.07 m/s for both ME and MI. These results suggest that treatment of maxillary constriction using MSE appliance may show positive effects in improvement of upper airway cross-sectional areas and reduction of upper airway resistance and velocity.
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Numerical simulation of nasal airflows and thermal air modification in newborns. Med Biol Eng Comput 2019; 58:307-317. [PMID: 31848979 DOI: 10.1007/s11517-019-02092-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 11/27/2019] [Indexed: 12/23/2022]
Abstract
Warming, filtering, and humidification of inspired air are major functions of the upper airway, which can be negatively altered by local disorders or surgical interventions. These functions have not been described in neonates because of ethical and technical problems difficult to solve. Numerical simulations can get around these limitations. The objective of this study was to analyze physiological nasal airflow and thermal distribution using computational fluid dynamics (CFD) techniques in neonates. CT imaging of neonates was collected from the Pediatric Radiology Department of our center. CFD has been used to simulate nasal airflow numerically, with ambient air set at 19 °C, following the recommendations for a neonate's bedroom. Thermal distribution within the nasal cavity was analyzed and coupled with airflow patterns over complete respiratory cycles. Sixteen patients have been included in the study. During inspiration, important air warming is noticed in the first centimeter of the nasal cavity (+ 8 °C at the anterior end of the inferior turbinate). During the expiration phase, the temperature decreases slightly (- 3 °C) between the pharynx and the nostrils. A model with asymmetric nasal fossae showed that nasal obstruction leads to decreased airflow and abnormally high temperatures in the obstructed side (+ 2 °C at the nasal valve, + 4 °C at the choana). According to our results, the nasal valve area is of crucial importance in air warming in neonates, when ambient air is 19 °C, since about 70% of air warming is performed in this area. When needed, surgical interventions should respect the anatomy of this zone and restore normal airflows and warming. Graphical abstract .
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Cephalometric Evaluation of the Upper Airway in Different Skeletal Classifications of Jaws. J Craniofac Surg 2019; 30:e469-e474. [PMID: 31299819 DOI: 10.1097/scs.0000000000005637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Respiratory system is an important section in development of maxillofacial components and many studies indicated its effect on normal growth of the jaws. The aim of this study is to evaluate upper airway in different skeletal classifications of jaws in lateral cephalogram and its relation to age and gender. MATERIALS AND METHODS Study samples were 105 digital cephalometric radiographies, 72 females and 33 males. Lateral cephalograms were hand traced and based on Stainer analysis, there were 30 samples in Class I, 30 samples in Class II and 45 samples in Class III subgroup. Vertical linear measurements, horizontal linear measurements, and angular measurement, proportions and space measurements of the airway in the Cephalograms were analyzed by AutoCAD software. RESULTS Data were analyzed using SPSS software version 20. Two horizontal linear measurement (the hypo pharyngeal airway depth, the nasopharyngeal airway depth) and one space measurement (soft palate space) were significantly different in skeletal classes. Vertical and horizontal linear measurements in the 3 groups were increased significantly in men rather than women. The developmental age of groups showed some significant differences. CONCLUSION Upper airway dimension is different in different skeletal classes, developmental ages, and gender.
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Cappellette M, Alves FEMM, Nagai LHY, Fujita RR, Pignatari SSN. Impact of rapid maxillary expansion on nasomaxillary complex volume in mouth-breathers. Dental Press J Orthod 2018; 22:79-88. [PMID: 28746491 PMCID: PMC5525449 DOI: 10.1590/2177-6709.22.3.079-088.oar] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 01/30/2017] [Indexed: 11/22/2022] Open
Abstract
Objective: To assess the volumetric changes that occur in the nasomaxillary complex of mouth-breathing patients with transverse maxillary deficiency subjected to rapid maxillary expansion (RME). Methods: This was a controlled, prospective intervention study involving 38 mouth-breathing patients presenting with transverse maxillary deficiency, regardless of malocclusion type or race. Twenty-three of them comprised the experimental group, which was composed of 11 (47.8%) boys, and 12 (52.2%) girls, with a mean age of 9.6 years, ranging from 6.4 to 14.2 years and standard deviation of 2.3 years; and 15 of them comprised the control group, composed of 9 (60%) boys and 6 (40%) girls with an mean age of 10.5 years, ranging from 8.0 to 13.6 years, and standard deviation of 1.9 years. All patients were scanned (CT) according to a standard protocol: Initial CT (T1), and CT three months thereafter (T2), and the patients in the experimental group were treated with RME using a Hyrax expander for the correction of maxillary deficiency during the T1-T2 interval. The CT scans were manipulated using Dolphin® Imaging version 11.7 software for total and partial volumetric assessment of the nasomaxillary complex. Results: The results revealed that in the experimental group there was a significant increase in the size of the structures of interest compared to the control group, both in general aspect and in specific regions. Conclusions: Rapid maxillary expansion (RME) provided a significant expansion in all the structures of the nasomaxillary complex (nasal cavity, oropharynx, right and left maxillary sinuses).
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Affiliation(s)
- Mario Cappellette
- Universidade Federal de São Paulo (UNIFESP/EPM), Department of Otorhinolaryngology and Head and Neck Surgery, São Paulo, Brazil
| | | | - Lucia Hatsue Yamamoto Nagai
- Universidade Federal de São Paulo (UNIFESP/EPM), Department of Otorhinolaryngology and Head and Neck Surgery, São Paulo, Brazil
| | - Reginaldo Raimundo Fujita
- Universidade Federal de São Paulo (UNIFESP/EPM), Department of Otorhinolaryngology and Head and Neck Surgery, São Paulo, Brazil
| | - Shirley Shizue Nagata Pignatari
- Universidade Federal de São Paulo (UNIFESP/EPM), Department of Otorhinolaryngology and Head and Neck Surgery, São Paulo, Brazil
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Nomura T, Ushio M, Kondo K, Kikuchi S. Effects of nasal septum perforation repair on nasal airflow: An analysis using computational fluid dynamics on preoperative and postoperative three-dimensional models. Auris Nasus Larynx 2018; 45:1020-1026. [PMID: 29548523 DOI: 10.1016/j.anl.2018.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 01/20/2018] [Accepted: 02/27/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this research is to examine the changes in nasal airflow dynamics before and after the nasal perforation repair. METHODS Three dimensional (3D) models of the nasal cavity before and after septal perforation repair was reconstructed using preoperative and postoperative computed tomography (CT) images of a patient. The numerical simulation was carried out using ANSYS CFX V15.0. Pre- and post-operative models were compared by their velocity, pressure (P), pressure gradient (PG), wall shear (WS), shear strain rate (SSR) and turbulence kinetic energy (TKE) in three plains. RESULTS In the post-operative state, the cross flows disappeared. In preoperative state, there were areas showing high PG, WS, SSR at the posterior border of the perforation, which exactly correspond to the area showing erosive mucosa on endoscopic inspection of the patient. In postoperative state, such high PG, WS and SSR areas disappeared. High TKEs also disappeared after surgery. CONCLUSION The effects of septal perforation repair on airflow dynamics were evaluated using computer fluid dynamics (CFD). High WS, PG and SSR observed at the edge of the septal perforation may be related to the clinical symptom such as nasal bleeding and pain. TKE was considered to cause nasal symptom.
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Affiliation(s)
- Tsutomu Nomura
- Department of Otolaryngology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama, 380-8550, Japan.
| | - Munetaka Ushio
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kenji Kondo
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Shigeru Kikuchi
- Department of Otolaryngology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama, 380-8550, Japan
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Sprenger R, Martins LAC, Dos Santos JCB, de Menezes CC, Venezian GC, Degan VV. A retrospective cephalometric study on upper airway spaces in different facial types. Prog Orthod 2017; 18:25. [PMID: 28762153 PMCID: PMC5563502 DOI: 10.1186/s40510-017-0180-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/03/2017] [Indexed: 11/17/2022] Open
Abstract
Background Craniofacial growth pattern has been correlated with variations in size of the upper airway spaces. The objective of this study was to evaluate the nasopharyngeal, oropharyngeal, and hypopharyngeal airway spaces variations according to the craniofacial growth pattern, by comparing brachyfacial, mesofacial, and dolichofacial in Angle Class I individuals. Methods To measure the spaces, 45 lateral teleradiographs were used and divided into 3 groups per the craniofacial growth pattern, determined by the Tweed cephalometry angular measurements: FMA and Y-axis. To evaluate the airways, sleep apnea cephalometry was used, containing 28 points that compose 14 factors. Three groups were compared relative to each of the 14 sleep apnea cephalometry measurements. Adherence test to the normal curve was performed. For the non-normally distributed data—measurement of the inferior pharyngeal space—the Kruskal-Wallis test was used for comparison between the groups. For the remaining data, the distribution was normal and ANOVA test was used. Results Statistically significant difference was verified among the groups for the measurement of the median posterior-palatal space, with the difference being pointed out by the post hoc test between the brachyfacial and dolichofacial groups. For the other measurements, there was no statistically significant difference. Conclusions It could be concluded that there was difference in the median posterior-palatal space measurement, in the oropharynx region, which was reduced for individuals with a dolichofacial pattern.
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Maruo IT, Maruo H, Saga AY, de Oliveira DD, Argenta MA, Tanaka OM. Tridimensional finite element analysis of teeth movement induced by different headgear forces. Prog Orthod 2016; 17:18. [PMID: 27264500 PMCID: PMC4893458 DOI: 10.1186/s40510-016-0130-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 05/15/2016] [Indexed: 11/29/2022] Open
Abstract
Background This study aimed to simulate the actions of low-pull (LP), high-pull (HP), and combined pull (CP) headgears (HGs) and to analyze tooth movement tendencies through finite element analysis. Methods Tomographic slices of a human maxilla with complete permanent dentition were processed by reconstruction software, and the triangular surface mesh was converted into non-uniform rational B-spline (NURBS) curves. An HG facial bow was also modulated in 3D. The teeth and bone were considered to have isotropic and linear behavior, whereas the periodontal ligament was considered to have non-linear and hyperelastic behavior. Data regarding the application points, directions and magnitudes of forces were obtained from the literature and from a dolichofacial patient with class II, division 1 malocclusion, who was treated with a CP HG. Results The CP HG promoted 37.1 to 41.1 %, and the HP HG promoted 19.1 to 31.9 % of LP distalization. The HP HG presented the highest intrusion, and the LP HG presented the highest extrusion of the first molar. The LP HG contracted the distal side, and the HP and CP HGs contracted the lingual and distobuccal roots of the second molar to a lesser degree. Conclusions The LP HG promotes the greatest distalization, followed by the CP and HP HGs; the LP HG causes greater extrusion of the first molar, and the HP HG causes greater intrusion of the first molar. The LP HG causes greater contraction of the second molar than the HP HG.
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Affiliation(s)
- Ivan Toshio Maruo
- Orthodontic Graduation Program, Brazilian Dental Association (ABO) and Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Hiroshi Maruo
- Orthodontic Graduation Program, Brazilian Dental Association (ABO), Ponta Grossa, Paraná, Brazil
| | - Armando Yukio Saga
- Orthodontic Graduation Program, Brazilian Dental Association (ABO) and Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Dauro Douglas de Oliveira
- Orthodontic Graduation Program, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marco André Argenta
- Post Graduation Program in Numerical Methods in Engineering, Federal University of Paraná, Curitiba, Brazil
| | - Orlando Motohiro Tanaka
- Graduate Program in Orthodontics, Pontifícia Universidade Católica do Paraná, School of Life Sciences, R. Imaculada Conceição, 1155, Curitiba, Brazil. .,Post-Doctoral fellowship at The Center for Advanced Dental Education, Saint Louis University, Saint Louis, MO, USA.
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McNamara JA, Lione R, Franchi L, Angelieri F, Cevidanes LHS, Darendeliler MA, Cozza P. The role of rapid maxillary expansion in the promotion of oral and general health. Prog Orthod 2015; 16:33. [PMID: 26446931 PMCID: PMC4596248 DOI: 10.1186/s40510-015-0105-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 09/20/2015] [Indexed: 11/10/2022] Open
Abstract
Rapid maxillary expansion (RME) is an effective orthopedic procedure that can be used to address problems concerned with the growth of the midface. This procedure also may produce positive side effects on the general health of the patient. The aim of the present consensus paper was to identify and evaluate studies on the changes in airway dimensions and muscular function produced by RME in growing patients. A total of 331 references were retrieved from a database search (PubMed). The widening of the nasal cavity base after midpalatal suture opening in growing patients allows the reduction in nasal airway resistance with an improvement of the respiratory pattern. The effects of RME on the upper airway, however, have been described as limited and local, and these effects become diminished farther down the airway, possibly as a result of soft-tissue adaptation. Moreover, limited information is available about the long-term stability of the airway changes produced by RME. Several studies have shown that maxillary constriction may play a role in the etiology of more severe breathing disorders such as obstructive sleep apnea (OSA) in growing subjects. Early orthodontic treatment with RME is able to reduce the symptoms of OSA and improve polysomnographic variables. Finally, early orthopedic treatment with RME also is beneficial to avoid the development of facial skeletal asymmetry resulting from functional crossbites that otherwise may lead to functional and structural disorders of the stomatognathic system later in life.
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Affiliation(s)
- James A McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
- Cell and Developmental Biology, School of Medicine, The University of Michigan, Ann Arbor, MI, USA
- Center for Human Growth and Development, The University of Michigan, Ann Arbor, MI, USA
| | - Roberta Lione
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Lorenzo Franchi
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA.
- Department of Surgery and Translational Medicine, University of Florence, Via del Ponte di Mezzo, 46-48, Florence, 50127, Italy.
| | - Fernanda Angelieri
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
- Department of Orthodontics, São Paulo Methodist University, São Bernardo do Campo, Brazil
| | - Lucia H S Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
| | - M Ali Darendeliler
- Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney, Australia
- Sydney Dental Hospital, Sydney South West Area Health Service, Sydney, Australia
| | - Paola Cozza
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Dentistry, UNSBC, Tirana, Albania
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