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Bellon M, Boutin F, Haddad R, Frapier L. Effectiveness of orthopaedic treatments on the enlargement of the upper airways: Overview of systematic reviews. Int Orthod 2023; 21:100745. [PMID: 36871416 DOI: 10.1016/j.ortho.2023.100745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE The aims of this overview are to evaluate the three-dimensional effects of orthopaedic treatment (OT) and myofunctional therapy (MT) on the enlargement of the upper airways (UA). METHODS A search of the MEDLINE/PubMed and EMBASE databases was conducted up to July 2022 and completed by hand search. After selection of the title and abstract, systematic reviews (SR) dealing with the impact of OT and/or MT on UA containing only controlled studies were included. The methodological quality of the SR was assessed by the AMSTAR-2, Glenny and ROBIS tools. A quantitative analysis was done with Review Manager 5.4.1. RESULTS Ten SR were included. The risk of bias was judged low for one SR according to ROBIS. Two SR presented a high level of evidence according to AMSTAR-2. In the quantitative analysis and about the orthopaedic mandibular advancement therapies (OMA), while a significant increase in superior (SPS) [(Mean difference (MD): 1.19; CI 95% [0.59; 1.78]; P<0.0001)] and middle (MPS) pharyngeal space [(MD: 1.10; CI 95% [0.22; 1.98]; P=0.01)] existed in the short-term for both OMA, it was greater for removable. On the other hand, there was no significant change in the inferior pharyngeal space (IPS). Four other SR targeted the short-term efficacy of class III OT. Only treatments with face mask (FM) or face mask+rapid maxillary expansion (FM+RME) allowed a significant increase in SPS [(MD FM: 0.97; CI 95% [0.14; 1.81]; P=0.02/MD FM+RME: 1.54; CI 95% [0.43; 2.66]; P=0.006)]. This was neither the case for chin cup nor in all cases in IPS. The last two SR explored the effectiveness of RME, whether or not associated with bone anchorage, on the dimensions of the UA or on the reduction of the apnoea/hypopnea index (AHI). A significant superiority of the effects of the devices with mixed or only bone anchorages existed concerning the width of the nasal cavity, the nasal airflow and the reduction of the nasal resistance. But, the qualitative analysis showed no significant reduction in AHI after RME. CONCLUSIONS Despite the heterogeneity of the included systematic reviews and their unfortunately not always low risk of bias, this synthesis showed that orthopaedics could provide some short-term improvement in AU dimensions, mainly in the upper and middle areas. Indeed, no devices improved the IPS. Class II orthopaedics improved SPS and MPS; class III orthopaedics, except for the chin cup, improved only SPS. RME, optimised with bone or mixed anchors, mostly improved the nasal floor.
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Ganesh G, Tripathi T. Effect of fixed functional appliances on pharyngeal airway dimensions in Skeletal Class II individuals - A scoping review. J Oral Biol Craniofac Res 2021; 11:511-523. [PMID: 34377659 PMCID: PMC8327667 DOI: 10.1016/j.jobcr.2021.07.004] [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: 04/06/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Skeletal Class II malocclusion due to a retrognathic mandible produces a backwardly positioned tongue and soft palate, emanating compromised upper airway dimensions and breathing difficulties. AIMS The present review aims to explore and concise the findings of the existing studies assessing the effects of fixed functional appliances on pharyngeal airway dimensions by advancing the mandible. DESIGN A literature search was carried out on MEDLINE/PubMed, Cochrane Library, Science direct, Semantic Scholar and Google Scholar databases for studies up to December 2020, resulting in 1037 studies. Specified inclusion/exclusion criteria guided the selection of 18 relevant articles. The sample size, type of the appliance, method of assessment and outcomes of these articles were assessed in detail and tabulated. RESULTS Out of 18 studies included, 12 were retrospective longitudinal and the remaining were clinical trials. Majority of the studies (72%) reported a positive influence of the fixed functional appliances on the dimensions of the oropharyngeal and hypopharyngeal airways with minimal effects on nasopharyngeal airway. CONCLUSION Thus, it can be concluded that fixed functional appliances have a beneficial effect on the middle and lower pharyngeal airway dimensions by advancing the mandible.
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Affiliation(s)
- Gayatri Ganesh
- Department of Orthodontics and Dentofacial Orthopaedics. Maulana Azad Institute of Dental Sciences, Bahadur Shah Zafar Marg, New Delhi, 110002, India
| | - Tulika Tripathi
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, Bahadur Shah Zafar Marg, New Delhi, 110002, India
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Li J, Ge X, Guan H, Zhang S, Qiao X, Chang W, Ma W. Three-dimensional changes of the upper airway in patients with Class II malocclusion treated with functional appliances: a systematic review and meta-analysis. Eur J Orthod 2021; 43:415-423. [PMID: 33681980 DOI: 10.1093/ejo/cjaa080] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND/OBJECTIVE To evaluate the three-dimensional (3D) changes of the upper airway in patients with Class II malocclusion treated with functional appliances (FAs). SEARCH METHODS AND ELIGIBILITY CRITERIA A comprehensive search of seven electronic databases was conducted from the date of inception to 12 July 2020. Manual search was also performed in relevant Chinese and English periodicals. Prospective and retrospective studies evaluating the 3D airway changes after FAs applied on growing patients with skeletal Class II malocclusion were included. DATA COLLECTION AND ANALYSIS Risk of bias assessment of each included study was performed referring to ROBINS-I. The effects of FAs on upper airway were evaluated by meta-analysis using STATA software. The outcome variables were the changes of oropharyngeal airway volumes (OAVs), nasopharyngeal airway volumes (NAVs), minimum cross-sectional area (MCA) and antero-posterior position of hyoid bone (HB). The overall quality of evidence for each outcome was rated based on Grading of Recommendations Assessment, Development and Evaluation recommendations. RESULTS Nine studies were ultimately included in the systematic review and five were included and analyzed in meta-analysis. The results indicated that the pooled mean differences among these studies were 2162.80 [95 per cent confidence interval (CI): 1264.97, 3060.62), 382.20 (95 per cent CI: 140.95, 623.44), 59.91 (95 per cent CI: 41.45, 78.38), and 0.63 (95 per cent CI: -1.97, 3.23) for changes of OAVs, NAVs, MCA, and antero-posterior position of HB, respectively. CONCLUSION Weak evidence suggests that FAs can increase OAVs, NAVs, and MCA in growing patients with Class II malocclusion. Weak evidence also suggests that antero-posterior position of HB cannot be affected by FAs. Further studies are necessary to assess the stability of its effect on the upper airway in the long term. REGISTRATION The review protocol was not registered prior to the study.
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Affiliation(s)
- Jie Li
- Department of Orthodontics, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang 050017, PR China
| | - Xiaolei Ge
- Department of Orthodontics, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang 050017, PR China
| | - Huibo Guan
- Graduate Research Associate at West Virginia University, Department of Psychology, Morgantown, WV 26505, USA
| | - Shilong Zhang
- Department of Orthodontics, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang 050017, PR China
| | - Xing Qiao
- Department of Orthodontics, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang 050017, PR China
| | - Weiwei Chang
- Department of Orthodontics, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang 050017, PR China
| | - Wensheng Ma
- Department of Orthodontics, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang 050017, PR China
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Takahashi T, Sakai N, Iwasaki T, Doyle TC, Mobley WC, Nishino S. Detailed evaluation of the upper airway in the Dp(16)1Yey mouse model of Down syndrome. Sci Rep 2020; 10:21323. [PMID: 33288820 PMCID: PMC7721723 DOI: 10.1038/s41598-020-78278-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022] Open
Abstract
A high prevalence of obstructive sleep apnea (OSA) has been reported in Down syndrome (DS) owing to the coexistence of multiple predisposing factors related to its genetic abnormality, posing a challenge for the management of OSA. We hypothesized that DS mice recapitulate craniofacial abnormalities and upper airway obstruction of human DS and can serve as an experimental platform for OSA research. This study, thus, aimed to quantitatively characterize the upper airway as well as craniofacial abnormalities in Dp(16)1Yey (Dp16) mice. Dp16 mice demonstrated craniofacial hypoplasia, especially in the ventral part of the skull and the mandible, and rostrally positioned hyoid. These changes were accompanied with a shorter length and smaller cross-sectional area of the upper airway, resulting in a significantly reduced upper airway volume in Dp16 mice. Our non-invasive approach, a combination of computational fluid dynamics and high-resolution micro-CT imaging, revealed a higher negative pressure inside the airway of Dp16 mice compared to wild-type littermates, showing the potential risk of upper airway collapse. Our study indicated that Dp16 mice can be a useful model to examine the pathophysiology of increased upper airway collapsibility of DS and to evaluate the efficacy of therapeutic interventions for breathing and sleep anomalies.
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Affiliation(s)
- Tatsunori Takahashi
- Sleep and Circadian Neurobiology Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 3155 Porter Drive, Room 2141, Palo Alto, CA, 94304, USA.,Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Noriaki Sakai
- Sleep and Circadian Neurobiology Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 3155 Porter Drive, Room 2141, Palo Alto, CA, 94304, USA.
| | - Tomonori Iwasaki
- Department of Pediatric Dentistry, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, Kagoshima, 8908544, Japan
| | - Timothy C Doyle
- The Neuroscience Community Labs, Wu Tsai Neurosciences Institute, Stanford University, 318 Campus Drive, Suite S170, Stanford, CA, 94305, USA
| | - William C Mobley
- Department of Neurosciences, University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Seiji Nishino
- Sleep and Circadian Neurobiology Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 3155 Porter Drive, Room 2141, Palo Alto, CA, 94304, USA
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Rongo R, Martina S, Bucci R, Festa P, Galeotti A, Alessandri Bonetti G, Michelotti A, D'Antò V. Short-term effects of the Sander bite-jumping appliance on the pharyngeal airways in subjects with skeletal Class II malocclusion: A retrospective case-control study. J Oral Rehabil 2020; 47:1337-1345. [PMID: 32813880 DOI: 10.1111/joor.13078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/18/2020] [Revised: 08/02/2020] [Accepted: 08/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Skeletal Class II subjects present often a retruded mandible that might increase the probability of breathing disorders. OBJECTIVE To evaluate the effects of functional treatment by means of the Sander bite-jumping appliance (BJA) on the upper airways of growing subjects. METHODS Thirty-four subjects (21 males, 13 females; mean age 11.1 ± 1.2 years) with skeletal Class II malocclusion due to mandibular retrusion were treated with the Sander BJA (BJA group). The control group consisted of thirty-four untreated subjects with skeletal Class II malocclusion (25 males, 9 females; 10.4 ± 1.2 years; CTR group). The effect of the Sander BJA appliance on the airway dimensions was evaluated by comparing lateral cephalograms recorded before (T0) and after (T1) the period of observation/treatment. Within- and between-group comparisons were statistically evaluated according to the distribution of the data (P < .05). RESULTS The oropharyngeal region (ph_pph) increased in the BJA group (1.8 ± 3.2; P = .001) but the difference respect to the CTR group was not statistically significant (0.73 ± 4.0; P = .314; P = .077). The tongue height (th) increased in the BJA group (2.8 ± 3.7; P < .001), and this increase was statistically significant respect to the CTR group (0.6 ± 4.7; P = .461; P = .038). In the BJA, the Ans_Pns_P angle showed a statistically significant decrease (-3.8 ± 7.8; P = .007) compared to the CTR group (-0.1 ± 5.4; P = .705; P = .026). CONCLUSIONS The airway dimensions increased for both control subjects and Class II patients treated with Sander BJA due to physiological growth. The Sander BJA induced a statistically significant change in the tongue and soft palate position, but the clinically relevant of these changes is questionable.
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Affiliation(s)
- Roberto Rongo
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, School of Orthodontics, University of Naples 'Federico II', Naples, Italy
| | - Stefano Martina
- Medicine, Surgery and Dentistry 'Schola Medica Salernitana' Department, University of Salerno, Salerno, Italy
| | - Rosaria Bucci
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, School of Orthodontics, University of Naples 'Federico II', Naples, Italy.,Medicine, Surgery and Dentistry 'Schola Medica Salernitana' Department, University of Salerno, Salerno, Italy
| | - Paola Festa
- Unit of Odontology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angela Galeotti
- Unit of Odontology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Ambrosina Michelotti
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, School of Orthodontics, University of Naples 'Federico II', Naples, Italy
| | - Vincenzo D'Antò
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, School of Orthodontics, University of Naples 'Federico II', Naples, Italy
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Gul Amuk N, Kurt G, Baysal A, Turker G. Changes in pharyngeal airway dimensions following incremental and maximum bite advancement during Herbst-rapid palatal expander appliance therapy in late adolescent and young adult patients: a randomized non-controlled prospective clinical study. Eur J Orthod 2020; 41:322-330. [PMID: 30892615 DOI: 10.1093/ejo/cjz011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES This was a parallel, assessor-blinded, randomized, non-controlled prospective trial with the objective to evaluate and compare the effects of maximum advancement (MA) and incremental advancement (IA) of mandible with cast-splint-type Herbst-rapid palatal expander (RPE) appliance on pharyngeal airway dimensions and hyoid bone position in skeletal Class II late adolescents and young adults. MATERIALS AND METHODS A total of 48 patients (19 male and 29 female, mean age: 15.45 ± 1.42 years) with skeletal Class II malocclusion were treated with cast-splint Herbst-RPE appliance. Inclusion criteria were skeletal Class II malocclusion, mandibular retrognathia, bilateral Class II molar and canine relationship, increased overjet, normal or decreased vertical dimensions, minimal crowding, and no missing teeth. Enrolled subjects were randomly allocated into two groups according to mandibular advancement type: IA and MA Herbst-RPE therapy. The outcome assessor was blinded. Advancement in MA group was adjusted until tête-à-tête incisor relationship or super Class I molar relationship was obtained. Initial forward movement in IA group was 4-5 mm and followed by bimonthly 2 mm of subsequent advancements. Skeletal, pharyngeal airway, and hyoid measurements were performed using lateral cephalometric films. Statistical significance was set at P value of less than 0.05. RESULTS Hypopharyngeal airway dimensions (P < 0.000), oropharyngeal airway dimensions (P < 0.001, P < 0.007), and PASmin values (P < 0.010, P < 0.009) were increased and soft palate angle (P < 0.018, P < 0.007) was decreased in MA and IA groups significantly. Hyoid bone measurements revealed a significant difference in H-Cv2 distance (MA: P < 0.002-P < 0.002; IA: P < 0.001-P < 0.043) and H-Cv3 distance (P < 0.005, P < 0.001) for both groups. However, all these changes did not differ among the MA and IA activation groups. ANB°, Wits, overjet, and overbite measurements decreased and SNB°, Co-Gn, Na-Me, ANS-Me, and S-Go increased with the treatment significantly in both mandibular advancement groups (P < 0.000-P < 0.040). CONCLUSIONS Herbst-RPE appliance provided a similar improvement in the oropharyngeal and hypopharyngeal airway dimensions and similar changes in sagittal and vertical hyoid position for both maximum and IA protocols in patients with skeletal Class II malocclusion. TRIAL REGISTRATION ISRCTN69743543.
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Affiliation(s)
- Nisa Gul Amuk
- Department of Orthodontics, Faculty of Dentistry, Erciyes University, Kayseri
| | - Gokmen Kurt
- Department of Orthodontics, Faculty of Dentistry, Bezmialem University, Istanbul
| | - Asli Baysal
- Department of Orthodontics, Faculty of Dentistry, Izmir Katip Çelebi University, Izmir
| | - Gokhan Turker
- Department of Orthodontics, Faculty of Dentistry, Mersin University, Turkey
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Oliveira PM, Cheib-Vilefort PL, de Pársia Gontijo H, Melgaço CA, Franchi L, McNamara JA, Souki BQ. Three-dimensional changes of the upper airway in patients with Class II malocclusion treated with the Herbst appliance: A cone-beam computed tomography study. Am J Orthod Dentofacial Orthop 2020; 157:205-211. [PMID: 32005472 DOI: 10.1016/j.ajodo.2019.03.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 03/01/2019] [Accepted: 03/01/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION This study aimed to determine the volumetric effects on the upper airways of growing patients with Class II malocclusion treated with the Herbst appliance (HA). METHODS Volumetric measurements of the upper airways of 42 skeletal Class II malocclusion patients (mean age: 13.8 ± 1.2 years; ranging from 12.0 to 16.9 years) were assessed using cone-beam computed tomography scans acquired before treatment (T0) and approximately 1 year later (T1). The sample comprised a Herbst appliance group (HA group [HAG]; n = 24), and a comparison group (comparison group [CG]; n = 18) of orthodontic patients who had received dental treatments other than mandibular advancement with dentofacial orthopedics. RESULTS In CG, nasopharynx and oropharynx volumes decreased slightly during the observation period (9% and 3%, respectively), whereas the nasal cavity volume increased significantly (12%; P = 0.046). In HAG, there was an increase in the volume of all regions (nasal cavity, 5.5%; nasopharynx, 11.7%; and oropharynx, 29.7%). However, only the oropharynx showed a statistically significant increase (P = 0.003), presenting significant volumetric changes along the time (T1-T0) in HAG. CONCLUSION Mandibular advancement with the HA significantly increased the volume of the oropharynx, but no significant volumetric modifications were observed in the nasal cavity and nasopharynx.
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Affiliation(s)
- Paula Moreira Oliveira
- Graduate Program in Orthodontics, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Camilo Aquino Melgaço
- School of Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Lorenzo Franchi
- Department of Surgery and Translational Medicine, Section of Dentistry, The University of Florence, Florence, Italy; Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, Mich
| | - James A McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, Mich; Cell and Developmental Biology, School of Medicine, Center for Human Growth and Development, The University of Michigan; and Private practice, Ann Arbor, Mich
| | - Bernardo Quiroga Souki
- Graduate Program in Orthodontics, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil.
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Shirazawa Y, Iwasaki T, Ooi K, Kobayashi Y, Yanagisawa-Minami A, Oku Y, Yokura A, Ban Y, Suga H, Kawashiri S, Yamasaki Y. Relationship between pharyngeal airway depth and ventilation condition in mandibular setback surgery: A computational fluid dynamics study. Orthod Craniofac Res 2020; 23:313-322. [PMID: 32056328 DOI: 10.1111/ocr.12371] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/11/2019] [Revised: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES This study aimed to determine the anteroposterior depth (APD) of the pharyngeal airway (PA) where post-operative PA obstruction was predicted, using computer fluid dynamics (CFD), in order to prevent obstructive sleep apnoea after mandibular setback surgery. SETTINGS AND SAMPLE POPULATION Nineteen skeletal Class III patients (8 men; mean age, 26.7 years) who required mandibular setback surgery had computed tomography images taken before and 6 months after surgery. METHODS The APD of each site of the four cross-sectional reference planes (retropalatal airway [RA], second cervical vertebral airway, oropharyngeal airway and third cervical vertebral airway) were measured. The Maximum negative pressure (Pmax) of the PA was measured at inspiration using CFD, based on a three-dimensional PA model. Intersite differences were determined using analysis of variance and the Friedman test with Bonferroni correction. The relationship between APD and Pmax was evaluated by Spearman correlation coefficients and non-linear regression analysis. RESULTS The smallest PA site was the RA. Pmax was significantly correlated with the APD of the RA (rs = .628, P < .001). The relationship between Pmax and the APD-RA was fitted to a curve, which showed an inversely proportional relationship of Pmax to the square of the APD-RA. Pmax substantially increased even with a slight reduction of the APD-RA. In particular, when the APD-RA was 7 mm or less, Pmax increased greatly, suggesting that PA obstruction was more likely to occur. CONCLUSIONS The results of this study suggest that APD-RA is a useful predictor of good PA ventilation after surgery.
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Affiliation(s)
- Yoshito Shirazawa
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Tomonori Iwasaki
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Kazuhiro Ooi
- Department of Oral and Maxillofacial Surgery, School of Medical Science, Kanazawa University Graduate, Kanazawa-City, Japan
| | - Yutaka Kobayashi
- Department of Oral and Maxillofacial Surgery, School of Medical Science, Kanazawa University Graduate, Kanazawa-City, Japan
| | - Ayaka Yanagisawa-Minami
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Yoichiro Oku
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Anna Yokura
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Yuusuke Ban
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Hokuto Suga
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Shuichi Kawashiri
- Department of Oral and Maxillofacial Surgery, School of Medical Science, Kanazawa University Graduate, Kanazawa-City, Japan
| | - Youichi Yamasaki
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
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Taherian S, Rahai H, Lopez S, Shin J, Jafari B. Evaluation of human obstructive sleep apnea using computational fluid dynamics. Commun Biol 2019; 2:423. [PMID: 31799426 PMCID: PMC6872714 DOI: 10.1038/s42003-019-0668-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 10/28/2019] [Indexed: 11/21/2022] Open
Abstract
Obstructive sleep apnea (OSA) severity might be correlated to the flow characteristics of the upper airways. We aimed to investigate the severity of OSA based on 3D models constructed from CT scans coupled with computational fluid dynamics (CFD) simulations. The CT scans of seven adult patients diagnosed with OSA were used to reconstruct the 3D models of the upper airways and CFD modeling and analyses were performed. Results from the fluid simulations were compared with the apnea-hypopnea index. Here we show a correlation between a CFD-based parameter, the adjusted pressure coefficient (Cp*), and the respective apnea-hypopnea index (Pearson's r = 0.91, p = 0.004), which suggests that the anatomical-based model coupled with CFD could provide functional and localized information for different regions of the upper airways.
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Affiliation(s)
- Shahab Taherian
- Center for Energy and Environmental Research and Services, California State University Long Beach, Long Beach, CA USA
- Department of Internal Medicine, University of California Irvine School of Medicine, Irvine, CA USA
| | - Hamid Rahai
- Center for Energy and Environmental Research and Services, California State University Long Beach, Long Beach, CA USA
| | - Samuel Lopez
- Center for Energy and Environmental Research and Services, California State University Long Beach, Long Beach, CA USA
| | - Jamie Shin
- Center for Energy and Environmental Research and Services, California State University Long Beach, Long Beach, CA USA
| | - Behrouz Jafari
- Department of Internal Medicine, University of California Irvine School of Medicine, Irvine, CA USA
- Section of Pulmonary, Critical Care, and Sleep Medicine, Veterans Affairs Long Beach Healthcare System, Long Beach, CA USA
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V A, Jena AK, Sharan J. Effects of functional appliance treatment on pharyngeal airway passage dimensions in Class II malocclusion subjects with retrognathic mandibles: A systematic review. APOS 2019. [DOI: 10.25259/apos_59_2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective:The objective of this study was to assess the pharyngeal airway passage (PAP) dimension changes following functional appliance treatment in Class II malocclusion subjects with retrognathic mandibles.Materials and Methods:Two authors independently searched various electronic databases such as PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus, NCBI, and Google Scholar for the available literature within the period from January 1, 2001, to December 31, 2018. On the basis of population, intervention, comparison, and outcome, “changes in PAP dimensions following functional appliance therapy in skeletal Class II malocclusion subjects associated with mandibular retrusion” was considered as search question of the study. After the selection and removal of duplicate articles, assessment for risk of bias was calculated and the data from the included articles were extracted by two authors independently.Results:From six databases and additional hand searching, a total of 5784 articles were extracted. Of 5784 articles, 3754 articles were screened after removal of 2030 duplicates. After going through the title and abstract, 3197 articles were excluded and 40 articles were assessed for full text. From these 40 articles, eight articles fulfilled our inclusion and exclusion criteria for the qualitative synthesis review.Conclusions:The correction of mandibular deficiency by functional appliances has minimum effect on the nasopharynx. Functional appliance treatment has a significant effect on the improvement of the oropharyngeal airway. Changes of hypopharyngeal airway passage need to be studied further among Class II malocclusion subjects with retrognathic mandibles.
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Iwasaki T, Suga H, Minami-Yanagisawa A, Hashiguchi-Sato M, Sato H, Yamamoto Y, Shirazawa Y, Tsujii T, Kanomi R, Yamasaki Y. Upper airway in children with unilateral cleft lip and palate evaluated with computational fluid dynamics. Am J Orthod Dentofacial Orthop 2019; 156:257-265. [PMID: 31375236 DOI: 10.1016/j.ajodo.2018.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 09/01/2018] [Accepted: 09/01/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Children with unilateral cleft lip and palate (UCLP) exhibit snoring and mouth breathing. They are also reported to show obstructive sleep apnea syndrome. However, their upper airway ventilation condition is not clearly understood. Therefore, this study was performed to evaluate upper airway ventilation condition in children with UCLP with the use of computational fluid dynamics. METHODS Twenty-one children (12 boys, 9 girls; mean age 9.1 years) with UCLP and 25 children (13 boys, 12 girls; mean age 9.2 years) without UCLP who required orthodontic treatment underwent cone-beam computed tomography (CBCT). Nasal resistance and upper airway ventilation condition were evaluated with the use of computational fluid dynamics from CBCT data. The groups were compared with the use of Mann-Whitney U tests and Student t tests. RESULTS Nasal resistance of the UCLP group (0.97 Pa/cm3/s) was significantly higher than that of the control group (0.26 Pa/cm3/s; P < 0.001). Maximal pressure of the upper airway (335.02 Pa) was significantly higher in the UCLP group than in the control group (67.57 Pa; P < 0.001). Pharyngeal airway (from choanae to base of epiglottis) pressure in the UCLP group (140.46 Pa) was significantly higher than in the control group (15.92 Pa; P < 0.02). CONCLUSIONS Upper airway obstruction in children with UCLP resulted from both nasal and pharyngeal airway effects.
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Affiliation(s)
- Tomonori Iwasaki
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan.
| | - Hokuto Suga
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Ayaka Minami-Yanagisawa
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Makiko Hashiguchi-Sato
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Hideo Sato
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Yuushi Yamamoto
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Yoshito Shirazawa
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Toshiya Tsujii
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | | | - Youichi Yamasaki
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
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Suga H, Iwasaki T, Mishima K, Nakano H, Ueyama Y, Yamasaki Y. Evaluation of the effect of oral appliance treatment on upper-airway ventilation conditions in obstructive sleep apnea using computational fluid dynamics. Cranio 2019; 39:209-217. [DOI: 10.1080/08869634.2019.1596554] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Hokuto Suga
- Department of Pediatric Dentistry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Tomonori Iwasaki
- Department of Pediatric Dentistry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Katsuaki Mishima
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hiroyuki Nakano
- Department of Dentistry and Oral Surgery, Division of Medicine for Function and Morphology of Sensory Organs, Faculty of Medicine, Osaka Medical College, Osaka, JAPAN
| | - Yoshiya Ueyama
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Youichi Yamasaki
- Department of Pediatric Dentistry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Mukaihara K, Hasegawa-Moriyama M, Iwasaki T, Yamasaki Y, Kanmura Y. Evaluation of the pharyngeal airway using computational fluid dynamics in patients with acromegaly. Laryngoscope Investig Otolaryngol 2018; 3:133-138. [PMID: 29721547 PMCID: PMC5915828 DOI: 10.1002/lio2.151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 01/04/2018] [Revised: 02/06/2018] [Accepted: 03/01/2018] [Indexed: 12/11/2022] Open
Abstract
Objectives Perioperative airway management may be particularly challenging in patients with acromegaly undergoing trans‐sphenoidal pituitary surgery (TSS). Management for airway obstruction is required prior to pituitary surgery to minimize perioperative hypoxia. The purpose of this retrospective study was to evaluate airway obstruction by simulation of computational fluid dynamics (CFD) using computed tomography (CT) images in patients who had undergone TSS. Methods CT images of the nasopharyngeal airways of patients with acromegaly (n = 5) or nonfunctional pituitary adenoma (n = 6) undergoing TSS from April 2012 to January 2017 were used to construct these airways in three dimensions. Estimated airflow pressure and velocity in the retropalatal airway (RA), oropharyngeal airway (OA), and hypopharyngeal airway (HA) were simulated using CFD. Results Estimated pharyngeal airflow pressure in the HA, OA, and RA was significantly greater in patients with acromegaly than in those with nonfunctional pituitary adenomas whereas the estimated pharyngeal airflow velocity was significantly impaired only in the RA of patients with acromegaly. Minimum postoperative SpO2 both within 3 hours and from 3 to 12 hours after the end of anesthesia was significantly lower in the patients with acromegaly. Additionally, estimated volume of tongue and pharyngeal airflow pressure in the HA, OA, and RA correlated with minimum postoperative SpO2. Conclusion Pharyngeal airflow pressure estimated from CT images is high in patients with acromegaly, and these values correlate with postoperative minimum values for SpO2. Preoperative evaluation of CT images by CFD can predict difficulty in airway management and perioperative hypoxia. Level of Evidence 4.
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Affiliation(s)
- Keika Mukaihara
- Department of Anesthesiology and Critical Care Medicine Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima Japan
| | - Maiko Hasegawa-Moriyama
- Department of Anesthesiology and Critical Care Medicine Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima Japan
| | - Tomonori Iwasaki
- Department of Pediatric Dentistry Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima Japan
| | - Youichi Yamasaki
- Department of Pediatric Dentistry Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima Japan
| | - Yuichi Kanmura
- Department of Anesthesiology and Critical Care Medicine Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima Japan
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