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Chen YJ, Chen HH, Hsu LF, Wang SH, Chen YJ, Lai EHH, Chang JZC, Yao CCJ. Airway increase after open bite closure with temporary anchorage devices for intrusion of the upper posteriors: Evidence from 2D cephalometric measurements and 3D magnetic resonance imaging. J Oral Rehabil 2018; 45:939-947. [PMID: 30133810 DOI: 10.1111/joor.12712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/15/2018] [Accepted: 08/17/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to analyse morphological changes in the upper airways in patients with anterior open bite treated with temporary anchorage devices for intrusion of upper posterior teeth. MATERIALS AND METHODS Twelve nonobese (body mass index: <25) anterior open bite patients between the ages of 19 and 44 years (mean age: 22.83 ± 8.19 years) were recruited for this study. Cephalometric radiographs and magnetic resonance imaging (MRI) scans before and after anterior bite closure without bracketing on anterior teeth were used to measure the upper airway, which was divided into retropalatal and retroglossal regions. RESULTS The mandibular plane angle and lower facial height were significantly reduced by intrusion of the upper posteriors and autorotation of the mandible. The retroglossal airway width (AW2) and retroglossal area (RG area) measured on cephalometric radiographs both increased significantly after treatment. Retroglossal volume increased and the retroglossal width/length ratio decreased significantly in MRI analysis. All other measurements were not significantly changed. However, no statistically significant correlations were observed between all measurements in 2D and 3D images, with the exception of the AW2 linear measurement in 2D images correlating with the AP length in MRI axial view images (r = 0.56, P = 0.0430). CONCLUSION Counterclockwise rotation of the mandible after anterior open bite closed using orthodontic treatment changed the airway morphology. Retroglossal volume significantly increased and the airway shape became less elliptical after bite closure.
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Affiliation(s)
- Yunn-Jy Chen
- Division of Prosthodontics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsin-Ho Chen
- Division of Orthodontics, Dental Department, Taoyuan Armed Forces General Hospital, Lungtan, Taiwan
| | - Li-Fang Hsu
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Shin-Huei Wang
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Jane Chen
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Eddie Hsiang-Hua Lai
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Jenny Zwei-Chieng Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Chen Jane Yao
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
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Furuya J, Tamada Y, Sato T, Hara A, Nomura T, Kobayashi T, Sakai M, Kondo H. Wearing complete dentures is associated with changes in the three-dimensional shape of the oropharynx in edentulous older people that affect swallowing. Gerodontology 2016; 33:513-521. [PMID: 25939853 DOI: 10.1111/ger.12197] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the effects of wearing complete dentures on pharyngeal shape for swallowing in edentulous older people. BACKGROUND In the absence of complete dentures, edentulous older people often lose the occlusal support necessary to position the mandible, which leads to an anterosuperior shift of the mandible during swallowing. This may result in pharyngeal shape changes effecting swallowing function in older people. However, the details of this phenomenon are currently unclear. MATERIALS AND METHODS Participants were 17 older edentulous volunteers. Cone-beam computed tomography imaging was performed with the participant in the seated position and wearing (i) both maxillary and mandibular dentures, (ii) maxillary dentures only and (iii) no dentures. During imaging, participants were instructed to keep their mouth closed to the mandibular position determined in advance during swallowing for each denture-wearing condition. The volume, height and average cross-sectional area of the velopharynx and oropharynx were measured, and the positions of the epiglottis and mandible were recorded. RESULTS While the vertical height of the oral cavity and pharynx significantly decreased, the volume and average cross-sectional area of the oropharynx significantly increased when dentures were not worn (p < 0.01). The absence of dentures caused an anterosuperior shift of the mandible when swallowing and drew the epiglottis forward, resulting in expansion of the oropharynx where the tongue base forms the anterior wall. CONCLUSION The absence of dentures results in anatomical changes in oropharyngeal shape that may exacerbate the pharyngeal expansion caused by ageing and reduce the swallowing reserve.
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Affiliation(s)
- Junichi Furuya
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Iwate, Japan.
| | - Yasushi Tamada
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Iwate, Japan
| | - Tomohide Sato
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Iwate, Japan
| | - Atsushi Hara
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Iwate, Japan
| | - Taro Nomura
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Iwate, Japan
| | - Takuya Kobayashi
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Iwate, Japan
| | - Maiko Sakai
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA, USA
| | - Hisatomo Kondo
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Iwate, Japan
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Feng X, Todd T, Hu Y, Lintzenich CR, Carr JJ, Browne JD, Kritchevsky SB, Butler SG. Age-related changes of hyoid bone position in healthy older adults with aspiration. Laryngoscope 2013; 124:E231-6. [PMID: 24227680 DOI: 10.1002/lary.24453] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 09/20/2013] [Accepted: 09/25/2013] [Indexed: 02/03/2023]
Abstract
OBJECTIVES/HYPOTHESIS Aspiration, the passage of a bolus below the vocal folds, increases morbidity and mortality in the elderly by increasing the risk of aspiration pneumonia and other conditions. We hypothesized that altered position of the hyoid bone associated with aging may negatively affect airway protection during swallowing (i.e., aspiration) in older adults. STUDY DESIGN Retrospective study. METHODS We re-reviewed computed tomography (CT) scans of the head from 40 older adults (65-80 years old), comprised of 20 aspirators and 20 nonaspirators, obtained from a previous cohort study. In addition, CT scans of the head from 40 young adults (20-40 years old) were retrieved from a medical records database. Three-dimensional reconstruction and 2-dimensional sagittal views were used to measure the distance between the mandible and hyoid bone. Comparisons between age groups, genders, and aspiration status were made. RESULTS Older adults had a larger distance between the hyoid and mandible in both latitude and longitudinal positions compared to the young adults. Among older males, there was evidence that the hyoid bone in the aspirators tended to be positioned more posterior compared to the nonaspirators. CONCLUSIONS The distance between the hyoid and mandible is increased with aging, and a more posterior position of the hyoid bone is correlated with aspiration in older males. These findings suggest that age-related changes in hyoid bone position may be a component of decreased swallowing safety and aspiration in older adults and warrant further investigation. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Xin Feng
- Department of Otolaryngology, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
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Yamamoto H, Furuya J, Tamada Y, Kondo H. Impacts of wearing complete dentures on bolus transport during feeding in elderly edentulous. J Oral Rehabil 2013; 40:923-31. [PMID: 24237359 DOI: 10.1111/joor.12107] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2013] [Indexed: 11/30/2022]
Abstract
Prosthetic treatment with dentures is often required for the elderly who have reduced swallowing function. Therefore, it is important to understand the relationship between denture-wearing and feeding function from the perspective of swallowing. To clarify changes in bolus transport during feeding in elderly edentulous patients with or without complete dentures. Subjects were 15 elderly edentulous volunteers who were treated with maxillary and mandibular complete dentures. The test food was 10 g of minced agar jelly containing barium sulphate with a particle diameter of 4·0-5·6 mm. Lateral videofluoroscopy was performed to assess the position of the leading edge of the bolus, the bolus volume in each area at swallow onset, bolus transit time and the mandibular position during pharyngeal swallowing. There were significant changes between the bolus transport with and without dentures. Without dentures, the leading edge of the bolus at swallow onset fell from the valleculae area to the hypopharynx, and the bolus volume in the hypopharynx increased. Bolus transit time increased in the oral cavity, valleculae and hypopharynx. The mandibular position shifted anterosuperior direction. The results arose owing to anatomical changes in the oral and pharyngeal structure and the following functional changes: poor food manipulation, poor bolus formation and delayed swallowing reflex. Removing dentures in elderly edentulous individuals influences bolus transport during feeding, resulting in the exacerbation of the reduced swallowing reserve capacity that accompanies ageing, and may increase the risk of dysphagia.
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Affiliation(s)
- H Yamamoto
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Japan
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Abstract
STUDY DESIGN A cross-sectional study. OBJECTIVE The purpose of this study was to investigate the effect of reduction of anterior atlantoaxial subluxation (AAS) on the oropharyngeal airway space. SUMMARY OF BACKGROUND DATA Our previous studies have shown that reduction of the occipito-C2 angle (O-C2A) makes the mandible shift posteriorly, resulting in oropharyngeal airway stenosis, which occasionally causes postoperative dysphagia after occipitocervical fusion. Based on this background, we hypothesized that reduction of AAS would also cause oropharyngeal airway stenosis independent of the O-C2A, because it also shifts the mandible posteriorly. To our knowledge, there are no data demonstrating an association between reduction of AAS and the oropharyngeal airway space. METHODS The authors prospectively evaluated 64 patients with rheumatoid arthritis. We analyzed lateral cervical plain radiographs of 5 different positions (neutral, flexion, extension, retraction, and protrusion), and measured the O-C2A, C2-C6 angle, anterior atlantodental interval, anteroposterior distance of the narrowest oropharyngeal airway space (nPAS), and so on. The subjects were classified into 2 groups: group R comprised patients with a "reducible AAS" in dynamic cervical movement, and group N comprised "patients without AAS" patients. RESULTS In the multiple regression analysis, the change in the O-C2A was the only significant independent variable related to the percentage change in the nPAS from the neutral position in group N. On the contrary, the change in the anterior atlantodental interval and change in the O-C2A were significantly related to the percentage change in the nPAS in group R. No cases in group N and 7 cases (28%) in group R showed a paradoxical decrease in the nPAS in extension, in which the O-C2A is largest and reduction of AAS is obtained. CONCLUSION Reduction of AAS has a negative effect on the oropharyngeal airway space. Therefore, reduction of AAS during occipitocervical fusion may cause postoperative dysphagia despite maintenance of the O-C2A.
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