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SUMMARY: Subjects with maxillary skeletal classes II and III not only express alterations in the hard and soft maxillofacial tissues, but also in the morphology and dimensions of the upper airway. A small space in the upper airway has been associated with sleep disorders, such as snoring and mainly obstructive sleep apnea/hypopnea syndrome (OSAHS). Consequently, interest has increased due to the influence of orthognathic surgery in the airway space. Although there are studies in the literature that have compared upper airway spaces, most have evaluated the changes using two-dimensional images, mainly lateral skull X-rays. The present study aimed to determine the airway volume in subjects with skeletal classes II and III who underwent bimaxillary orthognathic surgery. 80 CBCT exams from 40 subjects obtained before and 6 months after surgery were used. There were 20 class II and 20 class III subjects. For the volumetric analysis, a 3D rendering of the upper airway was made in previously established segments, and then the airway volume was calculated using the 3D Slicer® software version 4.11 (Slicer, USA). The statistical analysis by t-test of related samples revealed statistically significant volumetric increases in the nasopharynx, laryngopharynx, and total volume in class II patients. However, in class III patients, there were significant increases in the nasopharynx and total volume, while the volume was maintained in the oropharynx and laryngopharynx.
Sujetos con clases esqueletales II y III maxilares, no solamente expresan alteraciones en los tejidos duros y blandos maxilofaciales, sino también en la morfología y dimensiones de la vía aérea superior. Un espacio reducido a nivel de la vía aérea superior se asocia a trastornos del sueño como ronquidos y principalmente el síndrome de apnea/hipoapnea obstructiva del sueño (AOS); debido a esto, ha aumentado el interés por la influencia de la cirugía ortognática en el espacio de la vía aérea. Si bien existen en la literatura estudios que han comparado los espacios de la vía aérea superior, la mayoría de los estudios han evaluado los cambios utilizando imágenes bidimensionales, principalmente radiografías laterales de cráneo. El objetivo del presente estudio fue determinar el volumen de la vía aérea en sujetos con clases esqueletales II y III sometidos a cirugía ortognática bimaxilar. Se utilizaron 80 exámenes CBCT pertenecientes a 40 sujetos obtenidos previo a la cirugía y 6 meses después de realizada. Veinte sujetos clase II y 20 clase III. Para el análisis volumétrico se realizó un renderizado 3D de la vía área superior en segmentos previamente establecidos y posteriormente se calculó el volumen de dicha vía aérea con la utilización del software 3D Slicer ®versión 4.11 (Slicer, USA). El análisis estadístico realizado por t-test de muestras relacionadas, arrojó en pacientes clase II aumentos volumétricos estadísticamente significativos en nasofaringe, laringofaringe y volumen total. Mientras que en pacientes clase III, se observó aumentos significativos en Nasofaringe y volumen total y mantención de volumen en orofaringe y laringofaringe.
Subject(s)
Humans , Pharynx/diagnostic imaging , Orthognathic Surgical Procedures , Pharynx/anatomy & histology , Cone-Beam Computed Tomography , Malocclusion, Angle Class II/surgery , Malocclusion, Angle Class III/surgeryABSTRACT
Abstract Introduction Temporomandibular joint disorders (TMD) present with a multitude of symptoms that can range from headaches to shoulder pain. Patients frequently present with pain in the ear, dizziness, and vertigo. It is noted that some patients who report TMDs also have a history of sleep disturbances, which is noted in cone beam computed tomography (CBCT) as a reduction in the oropharyngeal airway volume. Objective To evaluate the airway volume in pre- and posttreatment of TMD with the use of neuromuscular orthotics made with ultra-low frequency transcutaneous electrical nerve stimulation (ULF-TENS). Methods A total of 15 patients were evaluated for TMDs using the related criteria. Those included were treated with ULF-TENS with evaluation of the airway volume both pre- and posttreatment using CBCT and the Dolphin 3D volume analysis software. Results While the symptoms were shown to be significantly reduced in patients who were treated with this particular modality, the airway volume varied in those who reported a reduction after a period of 3 months and those that reported after a period of 6 months. Conclusion Posttreatment evaluation of the airway should be done after a period of 6 months for a more objective evaluation. A multidisciplinary evaluation of the patient is required in such cases.
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Objective @#To evaluate the morphology of the upper airway of children with obstructive sleep apnea-hypopnea syndrome (OSAHS) using cone-beam computed tomography (CBCT) combined with polysomnography (PSG) and provide references for clinical practice.@*Methods@# CBCT data of 45 OSAHS children and 45 normal children and PSG data of the OSAHS group were retrospectively collected. Three-dimensional reconstructions were performed using NNT 9.0 software. The total upper airway volume, nasopharyngeal volume, palatopharyngeal volume, glossopharyngeal volume, laryngopharyngeal volume, minimum cross-sectional area, anterior-posterior diameter of the minimum cross-section, and lateral diameter of the minimum cross-section were measured and recorded. According to PSG monitoring results, patients with an obstructive apnea hypopnea index (OAHI) and lowest oxygen saturation (LSaO2) were assessed. Body mass index (BMI) was recorded. The correlation between airway volume parameters, BMI and PSG test results was analyzed. @*Results@#The total upper airway volume, nasopharyngeal volume, palatopharyngeal volume, glossopharyngeal volume, laryngopharyngeal volume, minimum cross-sectional area, anterior-posterior diameter of the minimum cross-section, and lateral diameter of the minimum cross-section of the OSAHS group were significantly reduced compared with those of the control group (P<0.05). In the OSAHS group, the total upper airway volume, the minimum cross-sectional area and the lateral diameter of the minimum cross-section showed moderate negative correlations with the obstructive apnea hypopnea index (OAHI) (P<0.05). Moreover, the total upper airway volume, minimum cross-sectional area, anterior-posterior diameter of the minimum cross-section and lateral diameter of the minimum cross-section showed no correlation with the minimum blood oxygen saturation (P>0.05). No significant correlation was noted between BMI and PSG in the OSAHS group (P>0.05).@*Conclusion @#The morphology of the upper airway of children with OSAHS was significantly smaller than that of normal children. CBCT three-dimensional technology for analyzing the upper airway has a certain value in evaluating the morphology and degree of obstruction of the upper airway in children with OSAHS.
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RESUMEN Introducción: El síndrome de apnea obstructiva del sueño provoca somnolencia diurna; incide negativamente sobre el sistema cardiovascular y disminuye la calidad de vida. La cirugía ortognática provoca cambios en el espacio aéreo faríngeo, por lo que ha sido empleada en el tratamiento de dicho síndrome. Objetivo: Caracterizar las técnicas en cirugía ortognática más empleadas en el tratamiento del síndrome de apnea obstructiva del sueño, sus influencias sobre la vía aérea faríngea y efectividad terapéutica. Métodos: Se realizó una revisión de la literatura científica desde diciembre del 2016 a junio del 2017 a través de los buscadores de información y plataformas SciELO, Medline, Pubmed y Hinari. Los descriptores empleados para la búsqueda fueron cirugía ortognática, síndrome de apnea obstructiva del sueño, vía aérea faríngea, avance máxilo mandibular y sus combinaciones. Se obtuvieron 127 artículos de los que se seleccionaron 28 por su contenido, actualidad y objetividad. Análisis e integración de la información: El adelanto quirúrgico del maxilar, mandíbula, mentón o sus combinaciones minimiza los efectos del síndrome de apnea obstructiva del sueño. Es recomendable la cirugía bimaxilar en la corrección de las clases III esqueletales para atenuar posibles efectos perjudiciales sobre la vía aérea por la retroposición mandibular aislada. Conclusiones: La cirugía ortognática de avance, incrementa el espacio faríngeo y mejora la calidad del sueño. Los movimientos de retroposición pueden tener efecto inverso, aspecto importante en la corrección de las clases III esqueletales(AU)
ABSTRACT Introduction: Obstructive sleep apnea syndrome causes daytime sleepiness, affects the cardiovascular system and reduces the quality of life. Since orthognathic surgery brings about changes in the pharyngeal airway space, it has been used to treat this syndrome. Objective: Characterize the orthognathic surgery techniques most commonly used to treat obstructive sleep apnea syndrome, their impact on the pharyngeal airway and their therapeutic effectiveness. Methods: A bibliographic review was conducted from December 2016 to June 2017 using the search engines and platforms SciELO, Medline, Pubmed and Hinari. The search words used were orthognathic surgery, obstructive sleep apnea syndrome, pharyngeal airway, maxillomandibular advancement, and combinations thereof. Of the 127 papers obtained, 28 were selected based on their content, topicality and objectivity. Data analysis and integration: Surgical advancement of the maxilla, mandible, chin or combinations thereof minimizes the effects of obstructive sleep apnea syndrome. Bimaxillary surgery is recommended to correct skeletal class III malocclusion so as to lessen potential damaging effects on the airway caused by isolated mandibular retroposition. Conclusions: Advancement orthognathic surgery broadens the pharyngeal airway space and improves the quality of sleep. The fact that retroposition movements may have an opposite effect is an important aspect to be considered in the correction of skeletal class III malocclusions(AU)
Subject(s)
Humans , Retrognathia/etiology , Sleep Apnea, Obstructive/diagnosis , Orthognathic Surgery/methods , Quality of Life , Review Literature as TopicABSTRACT
Objective To measure the upper airway of obstructive sleep apnea hypopnea syndrome by 256 slice spiril CT, and to access the airway obstruction plane with the airway plane data in OSAHS patients.Through these measurements, we can provide assistance for clinical diagnosis and treatment.Methods This study randomly selected 178 patients diagnosed with OSAHS and 110 cases non-snoring healthy people as the control group by the Philips 256 slice CT.Under the nasopharyngeal area, velopharyngeal area, glossopharyngeal area, epiglottis area, we measured the cross-sectional area and volume of the narrowest plane in the two groups of quiet respiration and Müller status.Results The OSAHS group underwent quiet respiration and Müller status during CT scanning, and the two states about epiglottis area in cross-sectional area and volume had no significant difference, Other groups had differences between the parameters.There was a significant difference in the volume about velopharyngeal area and glossopharyngeal area. In the control group undergoing quiet respiration and Müller status during CT scanning, there was difference in velopharyngeal cross-sectional area.Other parameters had no significant difference.Conclusions The obstruction plate of OSAHS patients with 256-slice spiril CT measurement is mostly in the velopharyngeal area and glossopharyngeal area. The volume measurement of upper airway by CT can predict airway obstruction plate in patients with OSAHS.
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Aim: To find the correlation between nasal airway volume and the craniofacial morphology using cone beam computed tomography (CBCT). Materials and Methods: This study consisted of preorthodontic anonymized CBCT scans of 34 healthy adults in the age span of 18–28 years. The volume was calculated using Dolphin 3DR software 11.5 version using semiautomatic segmentation method to calculate nasal volume after determining the nasal airway boundary. The subjects were grouped according to sagittal skeletal relation, craniofacial width, facial index, and facial form. Results: There was statistically significant correlation between nasal volume and craniofacial width (P = 0.009). Conclusion: Nasal volume was correlated only with width of the face and not with width/length ratio of face that could have affected the nasal volume.