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Patel S, Khalsa A, Casper DS. Does Anterior Cervical Spine Surgery Increase the Likelihood of Developing Obstructive Sleep Apnea? A Pearldiver Study. World Neurosurg 2024; 184:e72-e75. [PMID: 38224907 DOI: 10.1016/j.wneu.2024.01.045] [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: 12/24/2023] [Accepted: 01/08/2024] [Indexed: 01/17/2024]
Abstract
OBJECTIVES Literature is sparse on the development of obstructive sleep apnea (OSA) after anterior cervical spine surgery and includes few case reports. Our objective is to evaluate the role of anterior cervical spine surgery as a risk factor for developing OSA. METHODS A retrospective cohort study was performed utilizing the M157 subset of the PearlDiver national database. Two matched cohorts of patients were identified based on anterior cervical spine surgery using CPT codes. ICD-9 and 10 was used to identify patients who developed OSA within one year time frame in both the cohorts. Relative risk of OSA was calculated for the study and risk factors for developing OSA in the cohort of anterior cervical surgery were evaluated using logistic regression. RESULTS The 2 cohorts contained 277,475 patients each. The 1-year incidence rate of OSA in those who undergo anterior cervical spine surgery is 3.5% and is 3.1% in the control group. The relative risk of OSA in the surgery group is 1.13 times compared to the control. Multilevel cervical spine surgery and surgery performed for spondylosis had a higher risk of developing OSA. CONCLUSIONS Anterior cervical spine surgery is associated with an increased risk of developing OSA within one year of surgery. Timely diagnosis and management of OSA in patients who underwent anterior cervical spine surgery can help prevent morbidity and improve quality of life (QOL).
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Affiliation(s)
- Saral Patel
- Pennsylvania Hospital, Philadelphia, Pennsylvania, USA.
| | - Amrit Khalsa
- Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
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Alhazmi DM, Shi W, Allareddy V, Anamali S, Allareddy TV, Rengasamy Venugopalan S. A cone beam computed tomographic analysis of cervical vertebral nonsegmentation. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:67-72. [PMID: 37635010 DOI: 10.1016/j.oooo.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/27/2023] [Accepted: 07/03/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE Using cone beam computed tomography (CBCT), this study aimed to investigate the radiologic features of cervical vertebral nonsegmentation (CVN) in patients with no known syndromes or pathoses. STUDY DESIGN In this retrospective study, we examined CBCT scans of patients with CVN for the following parameters: type of nonsegmentation (partial or complete); laterality of partial nonsegmentation; level of vertebrae affected in nonsegmentation; anatomic parts of the vertebrae involved; and the presence or absence of degenerative joint disease (DJD). RESULTS From the structured reports of 13,458 CBCT scans, we found 110 CBCT scans (0.82%) with CVN. Of this total, 77.3% were partial and 22.7% were complete. Most were located at the level of the C2 and C3 vertebrae. The transverse process alone and the transverse process and body were most frequently involved in partial CVN, whereas most complete types occurred in the transverse process and body. Degenerative joint disease was present in 45.9% of partial CVN (clearly distinguishable from nonsegmentation in 36.5%) and 20% of complete CVN, with all cases clearly distinguishable. CONCLUSIONS Cervical vertebral nonsegmentation has a low prevalence. It is mostly partial, occurs most commonly in C2-C3, and usually involves the transverse process and body. Identification of CVN on CBCT images is important because this condition can lead to DJD in older age and may increase the risk for muscle weakness, head and neck pain, limited movement, and neurologic complications.
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Affiliation(s)
- Daniah M Alhazmi
- University of Iowa College of Dentistry; Department of Oral Pathology, Radiology and Medicine; Iowa City, IA, USA; Oral Diagnostic Sciences Department, Division of Oral and Maxillofacial Radiology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Wei Shi
- University of Iowa College of Dentistry, Iowa Institute for Oral Health Research, Iowa City, IA, USA
| | | | - Sindhura Anamali
- University of Iowa College of Dentistry; Department of Oral Pathology, Radiology and Medicine; Iowa City, IA, USA
| | - Trishul V Allareddy
- University of Iowa College of Dentistry; Department of Oral Pathology, Radiology and Medicine; Iowa City, IA, USA.
| | - Shankar Rengasamy Venugopalan
- University of Iowa, College of Dentistry, Department of Orthodontics, Iowa City, IA, USA; Tufts University School of Dental Medicine, Department of Orthodontics, Boston, MA, USA.
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Sun A, Fang R, Luo H. A case report of two obstructive sleep apnea patients with cervical spine abnormalities and relevant literature review. Clin Case Rep 2022; 10:e6582. [PMCID: PMC9702348 DOI: 10.1002/ccr3.6582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/08/2022] [Accepted: 10/15/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Anrong Sun
- ENT Institute and Department of Otorhinolaryngology Head & Neck Surgery, The Eye & ENT Hospital Fudan University Shanghai China
| | - Rui Fang
- ENT Institute and Department of Otorhinolaryngology Head & Neck Surgery, The Eye & ENT Hospital Fudan University Shanghai China
- The Therapy Center of Sleep‐Disordered Breathing, The Eye & ENT Hospital Fudan University Shanghai China
| | - Huiping Luo
- ENT Institute and Department of Otorhinolaryngology Head & Neck Surgery, The Eye & ENT Hospital Fudan University Shanghai China
- The Therapy Center of Sleep‐Disordered Breathing, The Eye & ENT Hospital Fudan University Shanghai China
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Abdalla Y, Kiliaridis S, Sonnesen L. Airway changes after fixed functional appliance treatment in children with and without morphologic deviations of the upper spine: A 3-dimensional CBCT study. Am J Orthod Dentofacial Orthop 2022; 161:791-797. [DOI: 10.1016/j.ajodo.2021.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 01/01/2021] [Accepted: 01/01/2021] [Indexed: 11/26/2022]
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Obstructive sleep Apnea's association with the cervical spine abnormalities, posture, and pain: a systematic review. Sleep Med 2020; 75:468-476. [PMID: 33007717 DOI: 10.1016/j.sleep.2020.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/27/2020] [Accepted: 09/03/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES While obstructive sleep apnea (OSA) is associated with several chronic health conditions such as hypertension, obesity, and chronic hypoxia, there is limited information on its association with neuromuscular and spinal pathologies that may be of interest to a musculoskeletal (MSK) medicine or pain management clinician. The objective of this study was to perform a systematic literature review to examine the association between OSA and cervical spine pathologies, postural changes, and pain. DESIGN We systematically reviewed PubMed and Embase databases up to 4/15/2019. We included studies that explored associations between OSA and a) pain, b) postural characteristics or changes, or c) cervical spine morphology. Systematic reviews, meta-analysis, randomized control trials, cohort studies, and case-control studies were included. Case reports, narrative reviews or expert opinion papers were excluded. From the articles that met selection criteria, information regarding type, direction and magnitude of such associations was extracted. The OSA-pain association studies were further divided into 3 subgroups: neuropathic, temporomandibular, and chronic pain. RESULTS 21 articles that met our study criteria were selected for this review. Two studies were on cervical spine pathologies, eight on postural changes, and eleven on pain associated with OSA. Exploring the association between OSA and cervical spine pathologies, postural changes, and pain in this systematic review we found: (1) Cervical spine lesions, fusions, and abnormalities that reduce retropharyngeal space are associated with OSA, likely by way of worsening posture and decreasing range of motion. (2) Head extension and anteriorization are associated with OSA likely as a compensatory mechanism. Extension may improve airway function, while anteriorization helps to maintain visual sense. (3) Head-of-bed-elevation may improve OSA symptoms and can possibly supplement other conservative treatment measures. (4) Neuropathic pain is associated with OSA, likely by way of inflammatory pathways. (5) Oral appliance use (eg mandibular advancement/protruding device) in OSA likely contributes to transient temporomandibular pain. (6) There is little association between OSA and chronic pain prevalence. (7) Increased pain intensity and decreased pain tolerance are somewhat associated with OSA, likely by way of hypoxemia and sleep fragmentation. CONCLUSIONS Clinicians in MSK and pain medicine need to consider these associations and consider obtaining imaging studies and/or making referrals for management of their OSA to better provide appropriate care to these patients.
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Comparison of cervical vertebral anomalies and sella turcica bridging in different growth stages with various vertical skeletal growth patterns. Surg Radiol Anat 2020; 43:117-125. [PMID: 32914225 DOI: 10.1007/s00276-020-02566-9] [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: 05/02/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare cervical vertebral anomalies and sella turcica bridging (STB) in different growth stages in orthodontic patients with different vertical skeletal growth patterns. METHODS Lateral cephalometric radiographs (LCR) of 270 patients in the preadolescent, adolescent, or postadolescent periods and having low angle [LA], normal angle [NA], or high-angle [HA] vertical skeletal growth patterns were evaluated retrospectively. STB was visualized using LCRs while evaluating the deficiency of ponticulus posticus (PP) and atlas posterior arch (PAA) associated with the atlas bone. The Pearson chi-square and Fisher's exact tests were used for categorical data and one-way ANOVA for numerical data. RESULTS The prevalence of fully calcified PP and STB increased from the preadolescent (PP, 10.0%; STB, 11.1%) to the postadolescent period (PP, 24.4; STB, 21.1%); they did not differ from vertical skeletal growth patterns (p > 0.05). The prevalence of PAA deficiency is significantly higher in individuals with LA (46.7%) than with other angles (NA, 27.8%; HA, 26.7%). The vertical skeletal growth pattern was significantly related to STB in the preadolescent period and PAA in the postadolescent period. CONCLUSIONS Different anomalies during different growth periods correlate with the vertical skeletal growth pattern. It will be useful to evaluate a different anomaly according to the relevant growth period.
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Association between Anatomical Variations and Maxillary Canine Impaction: A Retrospective Study in Orthodontics. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10165638] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims to evaluate whether or not there is a higher prevalence of skeletal abnormalities in subjects with maxillary canine impaction (MCI). This retrospective study was performed on 67 subjects with maxillary canine impaction (test group) and on 67 patients without dental displacement (control group). Sella turcica bridging (SB), ponticulus posticus (PP), atlas posterior arch deficiency (APAD) and the morphology of sella turcica and pterygopalatine fissure were evaluated on lateral cephalometric radiographs. Statistical analysis was performed using chi-square, Mann–Whitney test and multivariate logistic models; the level of significance was p < 0.05. Results showed that in the test and control groups 87% and 62.7% of patients had SB, respectively. PP was observed in 60% of patients in the test group and in 16.4% of patients in the control group. APAD was observed in 9% of test group and in 4.5% of the control group. Skeletal anomalies were significantly increased (p < 0.05) in subjects with MCI. A significant difference between the groups was observed in regards to the shape of the pterygopalatine fissure, found to be less wide and longer in the test group. SB, PP and APAD were higher in subjects with MCI; furthermore, an elongated pterygopalatine fissure was significantly associated with MCI.
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Yang TH, Xirasagar S, Cheng YF, Wu CS, Kao YW, Shia BC, Lin HC. Association of cervical spondylosis with obstructive sleep apnea. Sleep Med 2020; 71:54-58. [PMID: 32502850 DOI: 10.1016/j.sleep.2020.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The study objective was to evaluate the association between cervical spondylosis (CS) and a subsequent diagnosis of obstructive sleep apnea (OSA) in light of the expected constricting impact of CS-associated cervical spine changes on the pharyngeal airway space, a key contributor to OSA. METHODS Data were retrieved from the Taiwan National Health Insurance Research Dataset. A total of 98,234 patients who newly received a diagnosis of OSA were identified. We identified four propensity score-matched controls per OSA patient (n = 392,936). Chi-square tests were used to compare cases and controls on sociodemographic characteristics, and multivariable logistic regression modelling to examine the association of OSA with prior CS. RESULTS Of the 98,234 sampled patients, 18,070 (18.4%) patients had a prior CS diagnosis, significantly different among cases compared to controls, being 18.4% and12.1%, respectively, p < 0.001. Logistic regression analysis showed an adjusted odds ratio (OR) of prior CS of 1.778 (95% confident interval (CI): 1.744-1.814) relative to controls. The adjusted odds of prior CS without myelopathy was 1.764 for cases relative to controls (95% CI: 1.727-1.801), and for prior CS with myelopathy (adjusted OR: 1.778, 95% CI: 1.721-1.837). Analysis stratified by age showed that in the 45-64- and >64-year age groups, the adjusted ORs of CS were 1.803 (95% CI: 1.758-1.850) and 1.634 (95% CI: 1.568-1.703), respectively, for cases relative to controls. CONCLUSIONS Our results suggest that OSA is associated with prior CS. The results call for professionals to be alert to the possibility of subsequent development of OSA among patients with CS.
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Affiliation(s)
- Tzong-Hann Yang
- Department of Otorhinolaryngology, Taipei City Hospital, Taipei, Taiwan; Department of Speech, Language and Audiology, National Taipei University of Nursing and Health, Taipei, Taiwan; Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sudha Xirasagar
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Yen-Fu Cheng
- Department of Speech, Language and Audiology, National Taipei University of Nursing and Health, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chuan-Song Wu
- Department of Otorhinolaryngology, Taipei City Hospital, Taipei, Taiwan
| | - Yi-Wei Kao
- Big Data Research Center, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ben-Chang Shia
- Big Data Research Center, Taipei Medical University, Taipei, Taiwan
| | - Herng-Ching Lin
- Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan; School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.
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Kim JR, Jo JH, Chung JW, Park JW. Upper cervical spine abnormalities as a radiographic index in the diagnosis and treatment of temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 129:514-522. [PMID: 31780398 DOI: 10.1016/j.oooo.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 10/04/2019] [Accepted: 10/12/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the clinical characteristics and treatment outcomes of patients with temporomandibular disorders (TMD) according to the presence of upper cervical spine abnormalities and craniofacial morphology. STUDY DESIGN Clinical examinations were conducted on 43 patients with TMD. Upper cervical spine characteristics (fusion, posterior arch deficiency [PAD], and craniofacial morphology) reflecting head-and-neck posture were evaluated on lateral cephalograms. Condylar bone changes in the temporomandibular joint were evaluated by using cone beam computed tomography. Clinical characteristics and treatment outcomes after 1 year of conservative therapy were statistically analyzed between groups, according to the presence of upper cervical spine abnormalities. RESULTS Pain on neck muscle palpation was more frequent in patients with cervical fusion (P = .019) and with either fusion or PAD (P = .004) before treatment. Patients with PAD had smaller comfortable mouth opening ranges compared with those without the deficiency (P = .044) before treatment and smaller comfortable (P = .020) and maximum (P = .021) mouth opening ranges after treatment. Patients with PAD also had mouth opening limitation (P = .028) and pain on masticatory muscle palpation (P = .014) more frequently after treatment compared with patients without the deficiency. CONCLUSIONS Associations exist between upper cervical spine characteristics and treatment outcomes in patients with TMD, suggesting such parameters as a possible radiographic index in TMD diagnosis and treatment.
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Affiliation(s)
- Ji Rak Kim
- Department of Dentistry and Oral Medicine, School of Medicine, Daegu Catholic University, Daegu, Korea
| | - Jung Hwan Jo
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Korea
| | - Jin Woo Chung
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | - Ji Woon Park
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea.
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Khachatryan T, Robinson JS. The possible impact of cervical stenosis on cephalad neuronal dysfunction. Med Hypotheses 2018; 118:13-18. [PMID: 30037601 DOI: 10.1016/j.mehy.2018.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 06/07/2018] [Indexed: 12/25/2022]
Abstract
Earlier observers have speculated on the causal relationships between abnormal CSF circulation and a variety of neurological dysfunctions. Such speculations have been at least partially validated by recent evidence and inquiries contravening the traditional static viewpoint of CSF circulation. More contemporary inquiries establish a number of factors which influence both CSF production and absorption (sleep disturbance, neck position, cerebral metabolism, brain atrophy, medications, etc.). Thus, transient periods of abnormality are possibly mingled with periods of normality. Such episodic alterations suggest that the physiological arrangements which underpin CSF circulation may be in some ways likened to blood pressure alterations, in that long-standing CSF abnormalities may be both unappreciated and gradual, though virulent enough to cause substantial neurological injury. We suggest that cervical stenosis (blocking an important CSF decompressive pathway into the vertebral canal) is among the largely unappreciated causes of abnormal CSF circulation and may play a role in cephalad neuronal dysfunction. Such a blockage is correlated with age and easily assessed by cine MRI study. Indeed, episodic disturbances can diminish CSF cerebral flow circulation increasing deposition in cerebral parenchyma of contrary metabolic products (e.g. beta Amyloid), possibly having a causal influence on senile dementia. Additionally, cervical stenosis, by increasing posterior fossa cerebral pressure, could play a causal role in a number of afflictions, among them sleep apnea, concomitant respiratory and circulatory dysfunction, hypertension, chronic occipital headaches, tinnitus, etc. We further suggest that among those patients with substantial cervical stenosis (extensive enough to block CSF circulation in the cervical area as identified by cine MRI) appropriate comparative clinical studies could be undertaken to demarcate associations with presenile dementia, sleep disturbance and posterior fossa dysfunction. Additionally, we suggest that an intracranial monitoring implant be perfected to chronically monitor both intracranial pressure and CSF flow - a monitoring device comparable to the rather less invasive sphygmometric evaluation of blood pressure. If such speculations prove correct, different therapeutic regimens which might improve outcome could be imagined. Among them better sleep hygiene (to by position maximize CSF flow) and possibly more aggressive operative decompressive intervention to diminish cervical obstruction.
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Affiliation(s)
- Tigran Khachatryan
- Georgia Neurosurgical Institute, 840 Pine Street, Suite 880, Macon, GA 31210, United States.
| | - Joe Sam Robinson
- Georgia Neurosurgical Institute, 840 Pine Street, Suite 880, Macon, GA 31210, United States
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Oh E, Ahn SJ, Sonnesen L. Ethnic differences in craniofacial and upper spine morphology in children with skeletal Class II malocclusion. Angle Orthod 2018; 88:283-291. [PMID: 29337630 DOI: 10.2319/083017-584.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To analyze differences in upper cervical spine and craniofacial morphology, including posterior cranial fossa and growth prediction signs, between Danish and South Korean pre-orthodontic skeletal Class II children and to analyze associations between upper cervical spine morphology and craniofacial characteristics. MATERIALS AND METHODS One hundred forty-six skeletal Class II children-93 Danes (54 boys and 39 girls, mean age 12.2 years) and 53 Koreans (27 boys and 26 girls, mean age 10.8 years)-were included. Upper spine morphology, Atlas dimensions, and craniofacial morphology, including posterior cranial fossa and growth prediction signs, were assessed on lateral cephalograms. Differences and associations were analyzed by multiple linear and logistic regression analyses adjusted for age and gender. RESULTS Significant differences between the ethnic groups were found in the sagittal and vertical craniofacial dimensions ( P < .001), mandibular shape ( P < .01), dental relationship ( P < .01), posterior cranial fossa ( P < .05), and growth prediction signs ( P < .001). No significant differences were found in upper spine morphology and Atlas dimensions between the groups. Upper spine morphology/dimensions were significantly associated with the cranial base angle ( P < .01), sagittal craniofacial dimensions ( P < .001), posterior cranial fossa ( P < .001), and growth prediction signs ( P < .05). CONCLUSIONS Upper spine morphology/dimensions may be valuable as predictive factors in treatment planning for growing Class II children.
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Sonnesen L, Petersson A, Berg S, Svanholt P. Pharyngeal Airway Dimensions and Head Posture in Obstructive Sleep Apnea Patients with and without Morphological Deviations in the Upper Cervical Spine. J Oral Maxillofac Res 2017; 8:e4. [PMID: 29142656 PMCID: PMC5676314 DOI: 10.5037/jomr.2017.8304] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 09/26/2017] [Indexed: 11/16/2022]
Abstract
Objectives The aim of the study was to analyse differences in pharyngeal airway dimensions and head posture between obstructive sleep apnea patients with and without morphological deviations in the upper cervical spine and to analyse associations between pharyngeal airway dimensions and head posture in the total sample. Material and Methods The sample comprised 53 obstructive sleep apnea (OSA) patients of which 32.1% had upper spine morphological deviations. Accordingly two groups were defined: 17 OSA patients with morphological deviations in the upper spine and 36 without upper spine deviations. Pharyngeal airway dimensions in terms of distances, cross-sectional areas and volume and upper spine morphological deviations were evaluated on cone-beam computed tomography. Head posture was evaluated on two-dimensional generated lateral cephalograms. Differences were analysed and adjusted for age and gender by multiple linear regression analysis. Results OSA patients with upper spine morphological deviations had a significantly more backward and curved neck posture (OPT/HOR, P < 0.01; OPT/CVT, P < 0.05) compared to OSA patients without spine deviations. No significant differences were found in airway dimensions between patients with and without upper spine deviations. In the total group significant associations were found between head posture and pharyngeal airway distances and cross-sectional area at the nasal floor, epiglottis and hyoid bone level (P < 0.05, P < 0.01, P < 0.001). No significant association was found between head posture and airway volume. Conclusions The results may contribute to differentiate obstructive sleep apnea patients and thereby may prove valuable in diagnosis and treatment planning of obstructive sleep apnea patients.
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Affiliation(s)
- Liselotte Sonnesen
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of CopenhagenDenmark
| | - Arne Petersson
- Department of Oral and Maxillofacial Radiology, Malmö University, MalmöSweden
| | - Søren Berg
- Clinic for Infant and Adult Sleep Medicine, Lovisenberg Diakonale Sykehus, OsloNorway
| | - Palle Svanholt
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of CopenhagenDenmark
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Alsufyani NA. Cone beam computed tomography incidental findings of the cervical spine and clivus: retrospective analysis and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:e197-e217. [PMID: 28411008 DOI: 10.1016/j.oooo.2017.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 02/14/2017] [Accepted: 02/20/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this study was to analyze and describe incidental findings in the cervical spine (C-spine) and the clivus encountered in cone beam computed tomography (CBCT) imaging. The wide range of possible anatomic variants and pathoses is discussed in the context of the medical and dental literature to clarify their radiographic appearance and clinical implications as a guide for the oral and maxillofacial radiologist. STUDY DESIGN A retrospective analysis of radiographic reports was conducted based on CBCT images from 2 oral and maxillofacial imaging centers. Reports documenting incidental findings in the C-spine or the clivus were selected. Data on patient age and sex were collected, and each incidental finding was categorized as degenerative, congenital, or developmental/pathologic. Each finding is discussed with clinical importance and is pictorially presented. RESULTS From a total of 7689 CBCT reports, there were 732 incidental findings (9.5%) in the C-spine or the clivus. Most findings were in the C-spine (92.3%), were degenerative in nature (78.7%), and occurred in females in their sixth decade. Logistic regression analysis showed that the odds of presenting with a degenerative incidental finding in the C-spine or the clivus did not differ based on sex but were 5.5 times (95% confidence interval, 3.77-8.04) higher if the patient was aged 50 years or older. CONCLUSIONS This review is the largest and the first to characterize incidental findings in the C-spine and the clivus. Such findings were reported in 9.5% of radiographic reports. Several presented as uncommon congenital variants that are not usually spotlighted during oral and maxillofacial radiology training.
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Affiliation(s)
- Noura A Alsufyani
- Assistant Professor, Oral & Maxillofacial Radiology, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Canada; Assistant Professor, College of Dentistry, King Saud University, Saudi Arabia.
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Osseous osteoarthritic-like changes and joint mobility of the temporomandibular joints and upper cervical spine: is there a relation? Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:273-279. [DOI: 10.1016/j.oooo.2016.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 10/03/2016] [Accepted: 10/29/2016] [Indexed: 12/27/2022]
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Aranitasi L, Tarazona B, Zamora N, Gandía JL, Paredes V. Influence of skeletal class in the morphology of cervical vertebrae: A study using cone beam computed tomography. Angle Orthod 2016; 87:131-137. [PMID: 27513029 DOI: 10.2319/041416-307.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To quantify the prevalence of cervical vertebrae anomalies and to analyze any association between them and skeletal malocclusions or head posture positions in the same study. MATERIALS AND METHODS Two hundred forty patients who were attending the Department of Orthodontics of the University of Valencia for orthodontic treatment were selected and divided into three groups: skeletal Class I (control group, 0° <ANB < 4°), Class II (ANB ≥ 4°), and Class III (ANB ≤ 0°) according to ANB Steiner angle. The morphology of the first five cervical vertebrae was analyzed with cone beam computed tomography to identify any anomalies. Intra- and interobserver error methods were calculated. RESULTS Dehiscence and fusion of one unit (both 23.3%) and partial cleft (11.7%) were the most frequent anomalies, while occipitalization was the least common (3.3%). Dehiscence anomaly was observed when the control group was compared with Classes II and III and partial cleft anomaly when Class I was compared with Class III. Furthermore, NSBa and ss-N-sm/ANB angles were associated with partial cleft anomaly, while NSL/NL angle and extended head posture were associated with fusion anomaly. CONCLUSIONS Fusion, dehiscence, and partial cleft were the most frequent cervical vertebrae anomalies. Dehiscence and partial cleft were found to present statistically significant differences between Class I and Classes II and III. Cervical vertebrae anomalies and head posture were associated with fusion.
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Buchanan A, Cohen R, Looney S, Kalathingal S, De Rossi S. Cone-beam CT analysis of patients with obstructive sleep apnea compared to normal controls. Imaging Sci Dent 2016; 46:9-16. [PMID: 27051634 PMCID: PMC4816775 DOI: 10.5624/isd.2016.46.1.9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 10/20/2015] [Accepted: 10/31/2015] [Indexed: 12/03/2022] Open
Abstract
Purpose To evaluate the upper airway dimensions of obstructive sleep apnea (OSA) and control subjects using a cone-beam computed tomography (CBCT) unit commonly applied in clinical practice in order to assess airway dimensions in the same fashion as that routinely employed in a clinical setting. Materials and Methods This was a retrospective analysis utilizing existing CBCT scans to evaluate the dimensions of the upper airway in OSA and control subjects. The CBCT data of sixteen OSA and sixteen control subjects were compared. The average area, average volume, total volume, and total length of the upper airway were computed. Width and anterior-posterior (AP) measurements were obtained on the smallest axial slice. Results OSA subjects had a significantly smaller average airway area, average airway volume, total airway volume, and mean airway width. OSA subjects had a significantly larger airway length measurement. The mean A-P distance was not significantly different between groups. Conclusion OSA subjects have a smaller upper airway compared to controls with the exception of airway length. The lack of a significant difference in the mean A-P distance may indicate that patient position during imaging (upright vs. supine) can affect this measurement. Comparison of this study with a future prospective study design will allow for validation of these results.
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Affiliation(s)
- Allison Buchanan
- Division of Radiology, Department of Oral Health and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Ruben Cohen
- Park Avenue Oral and Facial Surgery, New York, NY, USA
| | - Stephen Looney
- Department of Biostatistics and Epidemiology, Augusta University Medical College of Georgia, Augusta, GA, USA.; Department of Oral Health and Diagnostic Sciences, Georgia Regents University, Dental College of Georgia, Augusta, GA, USA
| | - Sajitha Kalathingal
- Division of Radiology, Department of Oral Health and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Scott De Rossi
- Division of Oral Medicine, Department of Oral Health and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, USA
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Svanholt P, Petri N, Wildschiødtz G, Sonnesen L. Influence of craniofacial and upper spine morphology on mandibular advancement device treatment outcome in patients with obstructive sleep apnoea: a pilot study. Eur J Orthod 2014; 37:391-7. [PMID: 25351571 DOI: 10.1093/ejo/cju064] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND/OBJECTIVES The aim of the study was to assess cephalometric predictive markers in terms of craniofacial morphology including posterior cranial fossa and upper spine morphology for mandibular advancement device (MAD) treatment outcome in patients with obstructive sleep apnoea (OSA). MATERIAL/METHODS Twenty-seven OSA patients were treated with MAD for 4 weeks. Apnoea-hypopnoea index (AHI) was recorded before and after MAD treatment. The criteria of treatment success were 75 per cent reduction of AHI. Accordingly, two groups occurred: the success treatment group of 8 patients and the no success treatment group of 19 patients. Before MAD treatment lateral cephalograms were taken and analyses of the craniofacial morphology including the posterior cranial fossa and upper spine morphology were performed. Differences between the groups were analysed by Fisher's exact test, t-test, and multiple regression analysis. RESULTS Upper spine morphological deviations occurred non-significantly in 25 per cent in the success treatment group and in 42.1 per cent in the no success treatment group. Body mass index (BMI; P < 0.05), maxillary prognathism (S-N-Ss; P < 0.01), mandibular prognathism (S-N-Pg; P < 0.05 and S-N-Sm; P < 0.01), and the distance between sella turcica and the deepest point in posterior cranial fossa (S-D; P < 0.05) was significantly smaller in the success treatment group. The maxillary prognathism (P < 0.05) was the most important factor for the MAD treatment outcome (R (2) = 0.47). LIMITATIONS Relatively small sample size. CONCLUSIONS The results indicate that BMI, posterior cranial fossa morphology, and retrognathia of the jaws are factors related to MAD treatment outcome. Furthermore, OSA patients with upper spine morphological deviations may respond poorer to MAD treatment.
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Affiliation(s)
- Palle Svanholt
- *Section for Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Niels Petri
- **Department of Clinical Neurophysiology, Sleep Medicine Danish Epilepsy Centre, Filadelfia, Dianalund, and
| | | | - Liselotte Sonnesen
- *Section for Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen,
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Kim P, Sarauw MT, Sonnesen L. Cervical vertebral column morphology and head posture in preorthodontic patients with anterior open bite. Am J Orthod Dentofacial Orthop 2014; 145:359-66. [PMID: 24582027 DOI: 10.1016/j.ajodo.2013.11.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Cervical vertebral column morphology and head posture were examined and related to craniofacial morphology in preorthodontic children and adolescents with anterior open bite. METHODS One hundred eleven patients (ages, 6-18 years) with an anterior open bite of more than 0 mm were divided into 2 groups of skeletal or dentoalveolar open bite. The skeletal open-bite group comprised 38 subjects (19 girls, 19 boys). The dentoalveolar open-bite group comprised 73 subjects (43 girls, 30 boys). Visual assessment of the cervical column and measurements of craniofacial morphology and head posture were made on profile radiographs. RESULTS Deviations in the cervical vertebral column morphology occurred in 23.7% of the subjects in the skeletal open-bite group and in 19.2% in the dentoalveolar open-bite group, but the difference was not significant. Head posture was significantly more extended in the skeletal open-bite group compared with the dentoalveolar open-bite group (craniovertical angle [Mx/VER], P <0.05; craniocervical angles [Mx/OPT, Mx/CVT], P <0.01. Only head posture was associated with craniofacial morphology: extended posture was associated with a large cranial base angle (P <0.01, P <0.001), large vertical craniofacial dimensions (P <0.05; P <0.01; P <0.001), and retrognathia of the jaws (P <0.001). CONCLUSIONS Cervical column morphology is described for the first time in children and adolescents with open bite. No significant differences in the cervical vertebral column's morphologic deviations were found between the skeletal and the dentoalveolar open-bite groups. Significant differences were found in head posture between the groups and with regard to associations with craniofacial dimensions. This might indicate a respiratory etiologic component in children with anterior open bite.
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Affiliation(s)
- Phong Kim
- Dental student. Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - Martin Toft Sarauw
- Dental student. Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - Liselotte Sonnesen
- Associate professor, Department of Odontology, University of Copenhagen, Copenhagen, Denmark.
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Gjørup H, Sonnesen L, Beck-Nielsen SS, Haubek D. Upper spine morphology in hypophosphatemic rickets and healthy controls: a radiographic study. Eur J Orthod 2013; 36:217-25. [PMID: 23882087 DOI: 10.1093/ejo/cjt050] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND/OBJECTIVES The aim of this study was to describe upper spine morphology in adult patients with hypophosphatemic rickets (HR) compared with controls to assess differences in spine morphology in terms of severity of skeletal impact and to study associations between spine morphology and craniofacial morphology. MATERIAL/METHODS The study population comprised 36 HR patients and 49 controls. The atlas and axis dimensions were measured on cephalograms, and the differences between the groups were estimated by regression analysis. The upper spine morphology was visually assessed to estimate the prevalence of cervical vertebral anomalies. RESULTS The dimensions of the atlas and the axis were larger in HR patients than in controls (P ≤ 0.001), and fusions (FUS) occurred more often in HR patients (39%) than in controls (6%; P ≤ 0.001). In HR patients, the length of the atlas correlated positively (P = 0.008) and the height of the dens correlated negatively (P = 0.043) with the severity of skeletal impact. The height of the posterior arch of the atlas and the length of the axis correlated negatively with the cranial base angle (P ≤ 0.017), and the vertical dimensions of the atlas correlated positively with the thickness of the occipital skull (P ≤ 0.015). The length of the atlas correlated positively with mandibular prognathism (P = 0.042). FUS correlated positively with the frontal and parietal thickness (P = 0.034 and P = 0.003, respectively). CONCLUSIONS The dimension of the atlas and the axis and the prevalence of the FUS were increased in HR patients compared with controls. Upper spine dimensions were associated with craniofacial dimensions, primarily in relation to the posterior cranial fossa.
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Affiliation(s)
- Hans Gjørup
- Section of Oral Health in Rare Diseases, Department of Maxillofacial Surgery, Aarhus University Hospital
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