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Spille J, Conrad J, Sengebusch A, Wiltfang J, Dörfer C, Naujokat H. Preferences and experiences regarding the treatment of obstructive sleep apnea with mandibular advancement splints - a cross-sectional pilot survey. Cranio 2024; 42:298-304. [PMID: 34338613 DOI: 10.1080/08869634.2021.1962148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To obtain a current overview of the use of mandibular advancement splints (MAS) as a therapeutic option for obstructive sleep apnea (OSA) in the dental profession in Northern Germany. METHODS A questionnaire was mailed to 2431 dental professionals, and 8.3% responded. Descriptive data analysis was performed on each question separately. RESULTS Most of the surveyed dentists (51.7%) estimated the success rate of MAS therapy to be higher than 75%. Analysis of the relationship between the number of splints prescribed annually and the dental specialization (p = 0.22), work experience (p = 0.14), estimated success rate of MAS therapy (p = 0.96), and discontinuation of MAS therapy (p = 0.57) revealed no significant correlations. CONCLUSION Mandibular advancement splints seem to be a safe and successful therapy for OSA. There seems to be a lack of information on the patient side and a lack of education on the dentist side.
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Affiliation(s)
- Johannes Spille
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jonas Conrad
- Department of Conservative Dentistry and Periodontology, School of Dental Medicine, Kiel University, Kiel, Germany
| | - André Sengebusch
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christof Dörfer
- Department of Conservative Dentistry and Periodontology, School of Dental Medicine, Kiel University, Kiel, Germany
| | - Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Chandrika PS, Alla R, Duddu Y, Adarsh K, Varma PK, Mandava P. Evaluation of Glenoid Fossa Position in Class II Malocclusion Associated with Mandibular Retrusion and Class III Malocclusion Associated with Mandibular Protrusion. J Pharm Bioallied Sci 2024; 16:S349-S352. [PMID: 38595524 PMCID: PMC11000916 DOI: 10.4103/jpbs.jpbs_564_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/26/2023] [Accepted: 09/17/2023] [Indexed: 04/11/2024] Open
Abstract
Objective This study examined the glenoid fossa in Class II and Class III malocclusions with mandibular retrusion and protrusion. Materials and Methods A retrospective investigation examined 60 Class II and 60 Class III cephalometric radiographs. Cephalometric landmarks and glenoid fossa measurements were taken. Statistical analysis contrasted the two malocclusion groups' glenoid fossas. Results Class II malocclusion had a much lower mean Sella-Nasion-Condylion (SNCd) angle (glenoid fossa sagittal position) than Class III (14.6° ± 1.9). Class II malocclusion had a lower mean Sella-Nasion-Gonion (SNGo) angle (32.5° ± 4.3) than Class III (36.2° ± 3.9). The SNCd angle and SNGo angle in both groups demonstrated a negative correlation, demonstrating a relationship between the glenoid fossa and the mandibular sagittal axis. Conclusion The glenoid fossa location differs significantly between Class II malocclusion with mandibular retrusion and Class III with protrusion. Class II malocclusion has a posterior glenoid fossa, while Class III has a less posterior one. Understanding these links may help patients receive more personalized treatment.
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Affiliation(s)
- P. Sindhu Chandrika
- Department of Orthodontics and Dentofacial Orthopaedics, Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India
| | - Ramya Alla
- Department of Orthodontics and Dentofacial Orthopaedics, Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India
| | - Yesuratnam Duddu
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Kadapa, Andhra Pradesh, India
| | - Kumar Adarsh
- Department of Orthodontics and Dentofacial Orthopaedics, Narsinhbhai Patel Dental College and Hospital, Sankalchand Patel University, Visnagar, Gujarat, India
| | - Praveen K. Varma
- Department of Orthodontics, Vishnu Dental College, Vishnupur, Bhimavaram, Andhra Pradesh, India
| | - Prasad Mandava
- Department of Orthodontics and Dentofacial Orthopedics, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
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Langaliya A, Alam MK, Hegde U, Panakaje MS, Cervino G, Minervini G. Occurrence of Temporomandibular Disorders among patients undergoing treatment for Obstructive Sleep Apnoea Syndrome (OSAS) using Mandibular Advancement Device (MAD): A Systematic Review conducted according to PRISMA guidelines and the Cochrane handbook for systematic reviews of interventions. J Oral Rehabil 2023; 50:1554-1563. [PMID: 37644889 DOI: 10.1111/joor.13574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Patients undergoing mandibular advancement device (MAD) therapy for obstructive sleep apnea (OSA) may experience changes in jaw position and altered occlusion. This could potentially contribute to the development or exacerbation of TMD symptoms. The literature on the long-term impact of MAD treated for OSA on TMD is scarce. Hence, this review was undertaken to ascertain the occurrence of TMD in MAD users. METHODS A comprehensive search protocol was implemented across several online databases using MeSH keywords and Boolean operators. A standardised data extraction form was developed specifically for this review. Two reviewers independently extracted the data. RoB-2 was used to evaluate the methodological quality of the included studies. RESULTS A total of 13 clinical studies were selected for this review. Some studies reported a significant reduction in the severity and frequency of TMD symptoms following MAD treatment. However, other studies did not observe significant changes in TMD symptoms or TMJ-related parameters from baseline to follow-up intervals. Temporary increases in TMJ-related pain or symptoms at the beginning of the follow-up period, which later subsided, were reported in some studies. Overall, MAD was not discontinued in any OSA patient due to TMDs. CONCLUSION The findings reveal that different outcomes associated with TMD are affected differently by MAD treatment for OSAS. According to a few studies, MAD therapy significantly reduced the severity and frequency of TMD symptoms. Other research, however, found no appreciable modifications in TMD symptoms or TMJ-related indicators. Although the overall results point to no significant effect of MAD treatment on TMD symptoms, the disparity in results between studies highlights the need for additional studies using standardised approaches.
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Affiliation(s)
- Akshayraj Langaliya
- Department of Conservative Dentistry and Endodontics AMC Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Mohammad Khursheed Alam
- Orthodontic Division, Preventive Dentistry Department, Orthodontic Division, College of Dentistry, Jouf University, Sakakah, Saudi Arabia
| | - Usha Hegde
- Department of Oral Pathology and Microbiology JSS Dental College & Hospital Mysore JSS Academy of Higher Education & Research, Mysore, India
| | - Mangesh Shenoy Panakaje
- Department of Oral & Maxillofacial Pathology and Oral Microbiology, Affiliated College, A B Shetty Memorial Institute of Dental Sciences (A Constituent College of Nitte Deemed to be University) Karnataka, Mangalore, India
| | - Gabriele Cervino
- School of Dentistry, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giuseppe Minervini
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
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Chen L, Jiang J, Li X, Ding J, Paterson KB, Rao LL. Beyond Smiles: Static Expressions in Maxillary Protrusion and Associated Positivity. Front Psychol 2021; 12:514016. [PMID: 33859586 PMCID: PMC8042222 DOI: 10.3389/fpsyg.2021.514016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/10/2021] [Indexed: 11/28/2022] Open
Abstract
Smiles play an important role in social perception. However, it is unclear whether a similar role is played by static facial features associated with smiles (e.g., stretched mouth and visible teeth). In dental science, maxillary dental protrusions increase the baring of the teeth and thus produce partial facial features of a smile even when the individual is not choosing to smile, whereas mandibular dental protrusions do not. We conducted three experiments to assess whether individuals ascribe positive evaluations to these facial features, which are not genuine emotional expressions. In Experiment 1, participants viewed facial photographs of maxillary and mandibular protrusions and indicated the smiling and emotional status of the faces. The results showed that, while no difference was observed in participants’ perception of the presence of a smile across both types of dental protrusion, participants felt more positive to faces with maxillary than mandibular protrusions. In Experiment 2, participants completed an Implicit Association Test (IAT) test measuring implicit attitudes toward faces with maxillary vs. mandibular protrusions. The results showed that participants had more positive attitude toward faces with maxillary than mandibular protrusions. In Experiment 3, individuals with either maxillary or mandibular protrusions completed the same IAT test to assess whether any preference would be affected by in-group/out-group preferences. The results showed both groups had more positive attitudes toward faces with maxillary protrusion, indicating that this preference is independent of the group effect. These findings suggest that facial features associated with smiles are viewed positively in social situations. We discuss this in terms of the social-function account.
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Affiliation(s)
- Lijing Chen
- School of Psychology, Fujian Normal University, Fuzhou, China.,CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Jiuhui Jiang
- School of Stomatology, Peking University, Beijing, China
| | - Xingshan Li
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Jinfeng Ding
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Kevin B Paterson
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
| | - Li-Lin Rao
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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Sakamoto Y, Furuhashi A, Komori E, Ishiyama H, Hasebe D, Sato K, Yuasa H. The Most Effective Amount of Forward Movement for Oral Appliances for Obstructive Sleep Apnea: A Systematic Review. Int J Environ Res Public Health 2019; 16:ijerph16183248. [PMID: 31487920 PMCID: PMC6765823 DOI: 10.3390/ijerph16183248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 01/02/2023]
Abstract
This systematic review clarifies the amount of effective protrusion in mandibular advancement devices of oral appliances required for obstructive sleep apnea (OSA). The systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Review Manager 5 and GRADEpro were used to combine trials and analyze data. The present review included three studies. In mild to moderate OSA cases, measured using the apnea–hypopnea index (AHI), 50% protrusion was more effective than 75% protrusion. However, 75% protrusion was more effective for severe cases. Sleep stage, Epworth Sleepiness Scale (ESS), snoring index, and side effects significantly differed between the groups. Additionally, 75% protrusion was more effective (AHI: 0.38, 95% CI: −0.89 to 1.65, p = 0.56; sleep stage 3: −1.20, 95% CI: 9.54–7.14, p = 0.78; ESS: 1.07, 95% CI: −0.09 to 2.24, p = 0.07; snoring index: 0.09, 95% CI: 0.05–0.13, p < 0.05; side effects: RR: 1.89, 95% CI: 0.36–9.92, p = 0.45). As per the AHI, 75% protrusion was effective in severe cases, whereas 50% protrusion was effective in moderate cases. Analysis of different surrogate outcomes indicated that 75% protrusion was more effective. Further, well-designed, larger trials should determine the benefits for patients. Additionally, investigations of adherence and side effects with long-term follow-up are needed.
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Affiliation(s)
- Yuki Sakamoto
- Department of Oral Surgery, Hironokogen Hospital, 3-1-1 Kitayamadai Nishi-ku Kobe-shi, Hyogo 6512215, Japan.
| | - Akifumi Furuhashi
- Department of Oral and Maxillofacial Surgery, Aichi Medical University, 1-1 Yazakokarimata Nagakute-shi, Aichi 4801103, Japan.
| | - Eri Komori
- Division of Medicine for Function and Morphology of Sensor Organ, Dentistry and Oral Surgery, Osaka Medical College. 2-7 Daigaku-machi Takatsuki-shi, Osaka 5698686, Japan.
| | - Hiroyuki Ishiyama
- Orofacial Pain Management, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima Bunkyo-ku, Tokyo 1138510, Japan.
| | - Daichi Hasebe
- Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Tissue Regeneration and Reconstruction, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-Dori, Cyuo-ku, Nigata-shi, Nigata 9518514, Japan.
| | - Kazumichi Sato
- Department of Oral Medicine, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13 Sugano Ichikawa-shi, Chiba 2728513, Japan.
| | - Hidemichi Yuasa
- Department of Oral and Maxillofacial Surgery, National Hospital Organization Toyohashi Medical Center, 50 Imure-chou Aza Hamamichi-Ue, Toyohashi-shi, Aichi 4408510, Japan.
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Shimada Y, Kawasaki Y, Maruoka Y. Peripheral facial palsy after bilateral sagittal split ramus osteotomy: case report. Br J Oral Maxillofac Surg 2019; 57:260-264. [PMID: 30910414 DOI: 10.1016/j.bjoms.2018.10.290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/22/2018] [Indexed: 11/29/2022]
Abstract
Bilateral sagittal split ramus osteotomy (BSSRO) is commonly used in orthognathic surgery. Although abnormal sensation in areas that are innervated by the inferior alveolar nerve is a well-known neurological complication of mandibular osteotomy, facial palsy is rare postoperatively. We present a case of peripheral facial palsy that developed the day after BSSRO to correct a mandibular protrusion in a 42-year-old man. Oral prednisolone was begun on the second day postoperatively, and was gradually tapered off over time. One month after operation, he had gradually recovered all movements in his right facial muscle and, after two months, had completely recovered without residual asymmetry. Possible causes of the palsy were compression of the facial nerve as a result of the insertion of a retractor around the posterior border of the ramus, and postoperative oedema. Peripheral facial palsy after BSSRO should be considered a rare, but possible, complication and as such, should be mentioned in consent forms.
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Affiliation(s)
- Y Shimada
- Department of Oral and Maxillofacial Surgery, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Y Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Y Maruoka
- Department of Oral and Maxillofacial Surgery, National Center for Global Health and Medicine, Tokyo, Japan; Department of Oral and Maxillofacial Surgery, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Kastoer C, Dieltjens M, Op de Beeck S, Braem MJ, Van de Heyning PH, Vanderveken OM. Remotely Controlled Mandibular Positioning During Drug-Induced Sleep Endoscopy Toward Mandibular Advancement Device Therapy: Feasibility and Protocol. J Clin Sleep Med 2018; 14:1409-1413. [PMID: 30092892 DOI: 10.5664/jcsm.7284] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/05/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The potential of a remotely controlled mandibular positioner (RCMP) during sleep studies in individual patients suffering from obstructive sleep apnea (OSA) for the determination of the effective target protrusive position (ETPP) of the mandible has been demonstrated. The research goal of this study was to assess the feasibility of the application of RCMP during drug-induced sleep endoscopy (DISE) for the determination of ETPP. METHODS Ten patients in whom OSA was diagnosed (50% male; age 54 ± 9.5 years; body mass index 26.9 ± 2.1 kg/m2; apnea-hypopnea index 28.4 ± 13.2 events/h) were enrolled prospectively. Dental RCMP trays were fitted during wakefulness. Maximal protrusion and edge-to-edge positions were measured. Upper airway collapsibility was scored during DISE, including full-range mandibular RCMP titration within 45 minutes. ETPP was defined as the mandibular threshold protrusion yielding a stable upper airway in the absence of snoring, oxygen desaturation and apneas. RESULTS RCMP trays were retentive and no adverse reactions occurred. RCMP was fitted intraorally prior to sedation with maxillary and mandibular trays in edge-to-edge position. Upon sedation, progressive protrusion was performed followed by reversed titration until ETPP was noted. In one patient ETPP was not within the mandibular range of motion. In one patient RCMP needed to be removed because of clenching. CONCLUSIONS The results of this study illustrate that it is feasible to use RCMP during DISE and to determine ETPP within 45 minutes. Comparative research with polysomnography would be useful to further validate the therapy outcome upon use of RCMP during DISE.
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Affiliation(s)
- Chloé Kastoer
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium.,Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Marijke Dieltjens
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium.,Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Special Dentistry Care, Antwerp University Hospital, Antwerp, Belgium
| | - Sara Op de Beeck
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Marc J Braem
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Special Dentistry Care, Antwerp University Hospital, Antwerp, Belgium
| | - Paul H Van de Heyning
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium.,Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Antwerp, Belgium
| | - Olivier M Vanderveken
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium.,Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Antwerp, Belgium
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Kastoer C, Dieltjens M, Oorts E, Hamans E, Braem MJ, Van de Heyning PH, Vanderveken OM. The Use of Remotely Controlled Mandibular Positioner as a Predictive Screening Tool for Mandibular Advancement Device Therapy in Patients with Obstructive Sleep Apnea through Single-Night Progressive Titration of the Mandible: A Systematic Review. J Clin Sleep Med 2016; 12:1411-1421. [PMID: 27568892 PMCID: PMC5033744 DOI: 10.5664/jcsm.6202] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/18/2016] [Indexed: 01/06/2023]
Abstract
STUDY OBJECTIVES To perform a review of the current evidence regarding the use of a remotely controlled mandibular positioner (RCMP) and to analyze the efficacy of RCMP as a predictive selection tool in the treatment of obstructive sleep apnea (OSA) with oral appliances that protrude the mandible (OAm), exclusively relying on single-night RCMP titration. METHODS An extensive literature search is performed through PubMed.com, Thecochranelibrary.com (CENTRAL only), Embase.com, and recent conference meeting abstracts in the field. RESULTS A total of 254 OSA patients from four full-text articles and 5 conference meeting abstracts contribute data to the review. Criteria for successful RCMP test and success with OAm differed between studies. Study populations were not fully comparable due to range-difference in baseline apneahypopnea index (AHI). However, in all studies elimination of airway obstruction events during sleep by RCMP titration predicted OAm therapy success by the determination of the most effective target protrusive position (ETPP). A statistically significant association is found between mean AHI predicted outcome with RCMP and treatment outcome with OAm on polysomnographic or portable sleep monitoring evaluation (p < 0.05). CONCLUSIONS The existing evidence regarding the use of RCMP in patients with OSA indicates that it might be possible to protrude the mandible progressively during sleep under poly(somno)graphic observation by RCMP until respiratory events are eliminated without disturbing sleep or arousing the patient. ETPP as measured by the use of RCMP was significantly associated with success of OAm therapy in the reported studies. RCMP might be a promising instrument for predicting OAm treatment outcome and targeting the degree of mandibular advancement needed.
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Affiliation(s)
- Chloé Kastoer
- Antwerp University Hospital, Department of ENT, Head and Neck Surgery, Edegem, Antwerp, Belgium
- University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk, Antwerp, Belgium
| | - Marijke Dieltjens
- Antwerp University Hospital, Department of ENT, Head and Neck Surgery, Edegem, Antwerp, Belgium
- Antwerp University Hospital, Department of Special Dentistry Care, Antwerp, Belgium
- University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk, Antwerp, Belgium
| | - Eline Oorts
- Antwerp University Hospital, Department of ENT, Head and Neck Surgery, Edegem, Antwerp, Belgium
| | - Evert Hamans
- University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk, Antwerp, Belgium
| | - Marc J. Braem
- Antwerp University Hospital, Department of Special Dentistry Care, Antwerp, Belgium
- University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk, Antwerp, Belgium
| | - Paul H. Van de Heyning
- Antwerp University Hospital, Department of ENT, Head and Neck Surgery, Edegem, Antwerp, Belgium
- Antwerp University Hospital, Multidisciplinary Sleep Disorders Centre, Antwerp, Belgium
- University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk, Antwerp, Belgium
| | - Olivier M. Vanderveken
- Antwerp University Hospital, Department of ENT, Head and Neck Surgery, Edegem, Antwerp, Belgium
- Antwerp University Hospital, Multidisciplinary Sleep Disorders Centre, Antwerp, Belgium
- University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk, Antwerp, Belgium
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Abstract
INTRODUCTION The mouth, the pharynx and the larynx are potential sites of aerosol deposition in the upper airway during inhalation of aerosolized drugs. The right angle bend of the lumen at the back of the mouth, the position of the tongue, the variable size and shape of the lumen in the pharynx and the larynx, and the breathing pattern could increase aerosol deposition in the upper airway and decrease lung deposition. Areas covered: In this review, the anatomy of the upper airway from the oral cavity to the glottis and the impact of mandibular protrusion and incisal opening on the size of the upper airway are highlighted. In addition, the impact of inhalation maneuvers, inhaler mouthpiece geometries and a stepped mouthpiece on the size of the upper airway are discussed. Expert opinion: The structure of the upper airway lumen does not have a fixed cross sectional area and is susceptible to both constriction and distension during inhalation. The size of the upper airway can be enlarged through mandibular protrusion and/or incisal opening which might decrease aerosol deposition in the upper airway and increase lung deposition.
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Affiliation(s)
| | - Dirk von Hollen
- b Respironics Inc., a Philips Healthcare Company , Murrysville , PA , USA
| | - Hassan Larhrib
- c Department of Pharmacy and Pharmaceutical Sciences , University of Huddersfield , Huddersfield , UK
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