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Parekh MH, Thuler E, Triantafillou V, Seay E, Sehgal C, Schultz S, Keenan BT, Schwartz AR, Dedhia RC. Physiologic and anatomic determinants of hyoid motion during drug-induced sleep endoscopy. Sleep Breath 2024:10.1007/s11325-024-03101-5. [PMID: 38987507 DOI: 10.1007/s11325-024-03101-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/31/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE To examine factors accounting for differences in hyoid motion during obstructive breathing events amongst obstructive sleep apnea (OSA) patients. METHODS This was a prospective cohort study from June 2022 to October 2022. Patients with OSA undergoing evaluation for PAP alternative therapies with drug-induced sleep endoscopy with positive airway pressure titration (DISE-PAP). All patients underwent DISE-PAP and concurrent hyoid-focused ultrasound. DISE-PAP enabled measurement of airway physiology (flow, respiratory effort) and airway collapsibility (pharyngeal opening pressure, PhOP). Hyoid-ultrasound enabled hyoid bone movement during obstructive breathing. Respiratory effort was measured using a retro-epiglottic pressure-sensitive catheter. Hyoid position was measured using a standardized, awake, CT protocol. Regression analyses adjusted for age, race, sex, and BMI were performed to associate indices of respiratory effort and CT data with hyoid motion. RESULTS On average, the 26 patients in this cohort were older (63.9 ± 10.5 years), male (69%), overweight (29.6 ± 3.99 kg/m2), and with moderate-to-severe OSA (26.8 ± 10.4 events/hour). Greater respiratory effort was associated with increased hyoid motion (β [95% CI] = 0.034 [0.016,0.052], standardized β = 0.261,p = 0.0003). Higher hyoid position was associated with greater hyoid displacement (β [95% CI] = -0.20 [-0.38,-0.01], Standardized β = -0.57, p = 0.036). CONCLUSION Our data demonstrate that greater respiratory effort, higher hyoid position, and higher airway collapsibility, but not airflow, are associated with greater hyoid motion during obstructive breathing in DISE. These findings suggest that downward hyoid movement represents a compensatory response to upper airway obstruction. Further studies should investigate the vectors of hyoid motion to better understand its role in sleep-related airway collapse.
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Affiliation(s)
- Manan H Parekh
- Department of Otorhinolaryngology - Head & Neck Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Eric Thuler
- Department of Otorhinolaryngology - Head & Neck Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Vasiliki Triantafillou
- Department of Otorhinolaryngology - Head & Neck Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Everett Seay
- Department of Otorhinolaryngology - Head & Neck Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Chandra Sehgal
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Susan Schultz
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Brendan T Keenan
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Alan R Schwartz
- Department of Otorhinolaryngology - Head & Neck Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Raj C Dedhia
- Department of Otorhinolaryngology - Head & Neck Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania, Philadelphia, USA
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Inchingolo AD, Dipalma G, Ferrara I, Viapiano F, Netti A, Ciocia AM, Mancini A, Malcangi G, Palermo A, Inchingolo AM, Inchingolo F. Clear Aligners in the Growing Patient: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:385. [PMID: 38671602 PMCID: PMC11049164 DOI: 10.3390/children11040385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
Mixed dentition represents a critical phase in the oral development of pediatric patients, characterized by the simultaneous presence of primary and permanent teeth. This article proposes a comprehensive systematic review of the application of aligners as an innovative methodology in managing mixed dentition. The primary objective is to explore the efficacy, safety, and acceptability of this emerging orthodontic technology in the evolving age group. This systematic review focuses on randomized controlled trials, cohorts, and observational studies investigating the use of aligners in patients with mixed dentition. Clinical, radiographic, and psychosocial parameters will be considered to assess the overall impact of aligner therapy in this critical phase of dental development. An in-depth analysis of such data aims to provide a comprehensive overview of the potential of this technology in pediatric orthodontics. Expected outcomes may contribute to outlining practical guidelines and targeted therapeutic strategies for orthodontists involved in managing mixed dentition. Furthermore, this article aims to identify gaps in the current research and suggest future directions for studies exploring the use of transparent aligners in patients with mixed dentition, thereby contributing to the ongoing evolution of evidence-based orthodontic practices.
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Affiliation(s)
- Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Irene Ferrara
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Fabio Viapiano
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Anna Netti
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Anna Maria Ciocia
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Antonio Mancini
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Giuseppina Malcangi
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Andrea Palermo
- College of Medicine and Dentistry, Birmingham B4 6BN, UK
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
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Rusu MC, Tudose RC, Vrapciu AD, Popescu ŞA. Lowered hyoid bone overlapping the thyroid cartilage in CT angiograms. Surg Radiol Anat 2024; 46:333-339. [PMID: 38315210 DOI: 10.1007/s00276-024-03300-5] [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: 06/11/2023] [Accepted: 01/04/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND The ventral enclosure of the thyroid cartilage by a collapsed hyoid bone (CHB) is poorly encountered in previous research. It was aimed to observe whether or not these malformations could be found and detailed anatomically in a consistent lot of computed tomography (CT) files. METHODS Two hundred archived CT angiograms were explicitly observed for the CHB anatomical variant. RESULTS Different possibilities of CHB were found in 6/200 cases, five males and one female. The symmetrical overlap of the thyroid cartilage by the hyoid body was found in one male case. In three cases, two males and one female, there was asymmetrical overlapping due to tilted hyoid bones. In one male case with such asymmetrical CHD, an ossified anterior longitudinal ligament was noted: the tips of the superior horns of the thyroid cartilage reached lateral to it, thus being retropharyngeal. A different male case had a lowered hyoid with a greater horn fused to the superior horn of the thyroid cartilage, with an interposed ossified triticeal cartilage. In the last male case, the right greater horn collapsed laterally to an ossified triticeal cartilage fused with the thyroid cartilage's superior horn. CONCLUSIONS The CHB is an undeniable anatomical possibility of an atavism that alters conventional anatomical and surgical landmarks. Different anatomical components of the hyoid bone can descend uni- or bilaterally.
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Affiliation(s)
- Mugurel Constantin Rusu
- Division of Anatomy, Department 1, Faculty of Dentistry, "Carol Davila", University of Medicine and Pharmacy, 8 Eroilor Sanitari Blvd, 050474, Bucharest, Romania.
| | - Răzvan Costin Tudose
- Division of Anatomy, Department 1, Faculty of Dentistry, "Carol Davila", University of Medicine and Pharmacy, 8 Eroilor Sanitari Blvd, 050474, Bucharest, Romania
| | - Alexandra Diana Vrapciu
- Division of Anatomy, Department 1, Faculty of Dentistry, "Carol Davila", University of Medicine and Pharmacy, 8 Eroilor Sanitari Blvd, 050474, Bucharest, Romania
- University Emergency Hospital Bucharest, 050098, Bucharest, Romania
| | - Şerban Arghir Popescu
- Department 11 of Plastic and Reconstructive Surgery and Pediatric Surgery, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Parekh MH, Thuler E, Triantafillou V, Seay E, Sehgal C, Schultz S, Keenan BT, Schwartz AR, Dedhia RC. The Application of Ultrasound to Quantify Hyoid Motion During Drug-Induced Sleep Endoscopy. Laryngoscope 2023; 133:3221-3227. [PMID: 37283467 PMCID: PMC10592545 DOI: 10.1002/lary.30805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/18/2023] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The significance of hyoid dynamics in OSA pathophysiology remains unclear. Drug-induced sleep endoscopy (DISE) is often used for evaluating patients intolerant to positive airway pressure (PAP) therapy. We performed DISE with concurrent hyoid-focused ultrasonography to quantify hyoid dynamics during obstructive and non-obstructive breathing. METHODS A cross-sectional analysis from a prospective cohort of patients undergoing DISE with PAP titration (DISE-PAP) and hyoid-focused ultrasound was conducted. Hyoid ultrasound was performed during obstructive breathing, and non-obstructive breathing after PAP administration. Motion was quantified by generating displacement curves based on echo-tracking hyoid movement. The image analysis protocol for quantifying hyoid displacement was performed independently by two researchers, and reliability of measures was assessed. Univariate and multivariate regressions were performed for various clinical data and hyoid displacement during obstructive breathing. RESULTS Twenty patients met inclusion criteria. On average, the cohort was male (75%), elderly (65.9 ± 10 years), overweight (29.3 ± 3.99 kg/m2 ), and with moderate-to-severe OSA (29.3 ± 12.5 events/h). Mean hyoid displacement during obstructive breathing was 5.81 mm (±3.48). In all patients, hyoid displacement decreased after PAP administration (-3.94 mm [95% CI: -5.10, -2.78]; p < 0.0001). Inter-rater reliability for measures of hyoid displacement was excellent. After multivariate regression, hyoid displacement at baseline was associated with higher AHI (β [95% CI] = 0.18 [0.03, 0.33], p = 0.020). CONCLUSION During DISE, hyoid displacement is greater during obstructive breathing with significant variability amongst patients. Further, these ultrasonographic measurements had excellent intra- and inter-rater reliability. Additional, larger studies are needed to understand contributors to hyoid mobility. LEVEL OF EVIDENCE 4 Laryngoscope, 133:3221-3227, 2023.
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Affiliation(s)
- Manan H. Parekh
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
| | - Eric Thuler
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
| | | | - Everett Seay
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
| | | | | | - Brendan T. Keenan
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania
| | - Alan R. Schwartz
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
| | - Raj C. Dedhia
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania
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Yue Z, Yi Z, Liu X, Chen M, Yin S, Liu Q, Chen X, Hu J. Comparison of invisalign mandibular advancement and twin-block on upper airway and hyoid bone position improvements for skeletal class II children: a retrospective study. BMC Oral Health 2023; 23:661. [PMID: 37705022 PMCID: PMC10500932 DOI: 10.1186/s12903-023-03295-2] [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: 06/15/2023] [Accepted: 08/09/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND This study is to evaluate and compare the improvement of upper airway morphology and hyoid bone position in children with Class II mandibular retrusion treated with Invisalign mandibular advancement (MA) and Twin-Block (TB) appliances, utilizing cone beam computed tomography (CBCT). METHODS 32 children aged between 8 and 11.5 years old were included in this study, with an average age of 10.2 years old. These children were divided into two groups, MA and TB, with 16 children in each group. Changes in upper airway morphology and hyoid bone position before and after treatment were analyzed using CBCT. RESULTS (1) Changes in upper airway before and after treatment: the oropharynx volume (Or-V), the oropharynx minimum cross-sectional area (Or-mCSA), the hypopharynx volume (Hy-V), and the hypopharynx minimum cross-sectional area (Hy-mCSA) in both the MA and TB groups increased after treatment, and the differences were statistically significant (P < 0.05) compared to pre-treatment status. (2) Changes in hyoid bone position before and after treatment: The distances between H point and third cervical vertebra (H-C3), H point and pogonion (H-RGN), H point and mandibular plane (H-MP), H point and Frankfort horizontal plane (H-FH), H and S point (H-S), and H point and palatal plane (H-PP) in both the MA and TB groups increased after treatment, and the differences were statistically significant (P < 0.05). CONCLUSION Both MA and TB appliances effectively improved the structural narrowness of the upper airway and reduced respiratory resistance, thus improving breath quality. However, MA showed more effectiveness in improving the narrowest part of the hypopharynx compared to TB. Both appliances also promoted anterior downward movement of the hyoid bone, which opens the upper airway of the oropharynx and hypopharynx and helps the upper airway morphology return to normal range.
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Affiliation(s)
- Zheng Yue
- Department of Orthodontics, Kunming Medical University School and Hospital of Stomatology, Kunming, 650031, Yunnan, China
- Department of Orthodontics, Lianbang Institute of Stomatological Technology and Hospital of Stomatology, Xi'an, 710032, Shaanxi, China
| | - Zian Yi
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Key Laboratory of Stomatology, Department of Orthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Xinyi Liu
- Department of Orthodontics, Kunming Medical University School and Hospital of Stomatology, Kunming, 650031, Yunnan, China
| | - Mengting Chen
- Department of Orthodontics, Kunming Medical University School and Hospital of Stomatology, Kunming, 650031, Yunnan, China
| | - Shuhui Yin
- Department of Orthodontics, Kunming Medical University School and Hospital of Stomatology, Kunming, 650031, Yunnan, China
| | - Qianqian Liu
- Department of Orthodontics, Kunming Medical University School and Hospital of Stomatology, Kunming, 650031, Yunnan, China
| | - Xuefeng Chen
- Xuefeng Dental Care, Huaian, 223000, Jiangsu, China.
| | - Jiangtian Hu
- Department of Orthodontics, Kunming Medical University School and Hospital of Stomatology, Kunming, 650031, Yunnan, China.
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