Surgical management of obstructive sleep apnea

Cephalometric and three-dimensional assessment of the posterior airway space and imaging software reliability analysis before and after orthognathic surgery

PURPOSE

This study aimed to compare the reliability of three different imaging software programs for measuring the PAS and concurrently to investigate the morphological changes in oropharyngeal structures in mandibular prognathic patients before and after orthognathic surgery by using 2D and 3D analyzing technique.

MATERIAL AND METHODS

The study consists of 11 randomly chosen patients (8 females and 3 males) who underwent maxillomandibular treatment for correction of Class III anteroposterior mandibular prognathism at the University Hospital in Zurich. A set of standardized LCR and CBCT-scans were obtained from each subject preoperatively (T0), 3 months after surgery (T1) and 3 months to 2 years postoperatively (T2). Morphological changes in the posterior airway space (PAS) were evaluated longitudinally by two different observers with three different imaging software programs (OsiriX(®) 64-bit, Switzerland; Mimics(®), Belgium; BrainLab(®), Germany) and manually by analyzing cephalometric X-rays.

RESULTS

A significant increase in the upper airway dimensions before and after surgery occurred in all measured cases. All other cephalometric distances showed no statistically significant alterations. Measuring the volume of the PAS showed no significant changes in all cases. All three software programs showed similar outputs in both cephalometric analysis and 3D measuring technique.

CONCLUSION

A 3D design of the posterior airway seems to be far more reliable and precise phrasing of a statement of postoperative gradients than conventional radiography and is additionally higher compared to the corresponding manual method. In case of Class III mandibular prognathism treatment with bilateral split osteotomy of the mandible and simultaneous maxillary advancement, the negative effects of PAS volume decrease may be reduced and might prevent a developing OSAS.

Surgical management of obstructive sleep apnea

Obstructive sleep apnea (OSA) syndrome is a common disorder that has recently received much attention by the medical community due to its potentially serious physiological consequences. The clinical significance of OSA results from hypoxemia and sleep fragmentation caused by collapse of the airway, which leads to apnea or hypopnea during sleep. This paper reviews common surgical techniques used for clinical management of OSA patients, with emphasis on jaw advancement surgical procedures.

Diagnosing and comanaging patients with obstructive sleep apnea syndrome

BACKGROUND

Obstructive sleep apnea syndrome, or OSAS, is a common, but underdiagnosed, disorder that potentially is fatal. It is characterized by repetitive episodes of complete or partial upper airway obstruction leading to absent or diminished airflow into the lungs. These episodes usually last 10 to 30 seconds and result in loud snoring, a decrease in oxygen saturation, and chronic daytime sleepiness and fatigue. The obstruction is caused by the soft palate, base of the tongue or both collapsing against the pharyngeal walls because of decreased muscle tone during sleep. Potentially fatal systemic illnesses frequently associated with this disorder include hypertension, pulmonary hypertension, heart failure, nocturnal cardiac dysrhythmias, myocardial infarction and ischemic stroke.

CLINICAL IMPLICATIONS

The classic signs and symptoms of OSAS may be recognizable by dental practitioners. Common findings in the medical history include daytime sleepiness, snoring, hypertension and type 2 diabetes mellitus. Common clinical findings include obesity; a thick neck; excessive fat deposition in the palate, tongue (enlarged) and pharynx; a long soft palate; a retrognathic mandible; and calcified carotid artery atheromas on panoramic and lateral cephalometric radiographs.

CONCLUSIONS

Dentists cognizant of these signs and symptoms have an opportunity to diagnose patients with occult OSAS. After confirmation of the diagnosis by a physician, dentists can participate in management of the disorder by fabricating mandibular advancement appliances and performing surgical procedures that prevent recurrent airway obstruction.

Obesity: prevalence and considerations in oral and maxillofacial surgery

PURPOSE

This article examines the prevalence of obesity in an urban hospital-based office population and describes the associated health risks and systemic complications.

PATIENTS AND METHODS

A total of 225 randomly selected patient charts were reviewed. The patients' height and weight were recorded, and a body mass index (BMI) was calculated. Patients were considered to have a normal weight with a BMI between 20 and 24.9 kg/m2, to be overweight with a BMI between 25 and 29.9 kg/m2, and to be obese with a BMI of 30 kg/m2 or greater. Comparisons between sex, age, and race were examined.

RESULTS

Eighty-five males and 140 females were included in the study. The ages ranged from 9 to 86 years, with a mean age of 37.4+/-16.4 years. The BMIs ranged from 13.9 to 57.7 kg/m2, with a mean BMI of 26.5+/-6.8 kg/m2. Over half (51%) of the population studied was overweight, and 23% were obese. Forty-three percent of males were considered overweight, and 18.8% of males were obese. Women tended to be more overweight: 55.7% of women were overweight and 25.7% were obese. The African-American females had mean BMIs that were considered overweight in all age-groups and obese in most age-groups, which included the less than 29-year-old and over 50-year-old groups. Caucasian females had normal mean BMIs at all ages except for the 30- to 39-year-old and 40- to 49-year-old groups.

CONCLUSION

The increasing prevalence of overweight and obese populations has several considerations in oral and maxillofacial surgery. The associated health risks and increased morbidity and mortality pose a serious threat to the patient being treated in an outpatient setting.

Sleep disorders and the dental patient: an overview

This article is intended to briefly describe common sleep disorders of interest to the dental profession and to render general management guidelines. Topics include sleep-related bruxism, xerostomia, hypersalivation, gastroesophageal reflux, apnea, and the effect of orofacial pain on sleep quality. The term sleep-related is used instead of the term nocturnal because some of the activities described can occur with daytime sleep.