Fig 1 - uploaded by Ghaddy Alsaty
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The borders of oropharyngeal airway space between the palatal plane (ANS-PNS) superiorly to the plane that passes from the most anteroinferior point of the third cervical vertebrae (CV3): A, sagittal view; B, coronal view.
Source publication
Introduction
This study aimed to evaluate the follow-up observation of patients with obstructive sleep apnea treated with maxillomandibular advancement (MMA) procedure with or without genial tubercle advancement (GTA).
Methods
A total of 25 patients (mean age 37.1 ± 17.3 years) were included in the study. Cone-beam computed tomography scans were t...
Context in source publication
Context 1
... measurements of OPAS, Dolphin (version 11.95, Dolphin Imaging and Management Solutions, Chatsworth, Calif) software was used to calculate the total airway volume (TAV), airway area (AA) and the minimal cross-sectional area (MCA) selected from predefined structures. The borders of OPAS were identified, similar as described in El and Palomo, 25 between the palatal plane (ANS-PNS) superiorly extending to the posterior wall of the pharynx and the plane parallel to the palatal plane that passes from the most anterior-inferior point of the third cervical vertebrae and the base of the epiglottis inferiorly (Fig 1). TAV, AA, and MCA measurements of the airway were then calculated by using a specific analysis tool in Dolphin (Fig 2) for each patient at all time points (Fig 3). ...
Citations
... The stability of improvement in airway parameters with MMA has been reported to be sustained significantly over a mean follow-up of 10 months. 68, level II-3 ...
... For example, orthognathic surgery [15] or mandibular advancement (MA) device [16] modifies the mandibular position, which leads to dimensional changes in the PAS. ...
... Some studies revealed that OSA patients had smaller airway volumes and minimal cross-sectional areas compared to healthy controls, with differences in volume from 400 to 3290 mm 3 and minimal cross-sectional areas between 31.7 and 110.6 mm 2 [45][46][47]. Furthermore, patients with OSA who underwent MMA or genial tubercle advancement (GTA) surgery showed significant improvements in their apnea-hypopnea index (AHI), decreasing by 23-41 events/h, accompanied by increases in airway volumes of 3000-9600 mm 3 , and minimal cross-sectional areas of 103-273 mm 2 [4,48,49]. In comparison, the discrepancies caused by precision errors in our study were unlikely to have any clinical implications; therefore, the errors may be negligible in clinical practice. ...
Objectives:
Upper airway assessment requires a fully-automated segmentation system for complete or sub-regional identification. This study aimed to develop a novel Deep Learning (DL) model for accurate segmentation of the upper airway and achieve entire and subregional identification.
Methods:
Fifty cone-beam computed tomography (CBCT) scans, including 24502 slices, were labelled as the ground truth by one orthodontist and two otorhinolaryngologists. A novel model, a lightweight multitask network based on the Swin Transformer and U-Net, was built for automatic segmentation of the entire upper airway and subregions. Segmentation performance was evaluated using Precision, Recall, Dice similarity coefficient (DSC) and Intersection over union (IoU). The clinical implications of the precision errors were quantitatively analyzed, and comparisons between the AI model and Dolphin software were conducted.
Results:
Our model achieved good performance with a precision of 85.88-94.25%, recall of 93.74-98.44%, DSC of 90.95-96.29%, IoU of 83.68-92.85% in the overall and subregions of three-dimensional (3D) upper airway, and a precision of 91.22-97.51%, recall of 90.70-97.62%, DSC of 90.92-97.55%, and IoU of 83.41-95.29% in the subregions of two-dimensional (2D) crosssections. Discrepancies in volume and area caused by precision errors did not affect clinical outcomes. Both our AI model and the Dolphin software provided clinically acceptable consistency for pharyngeal airway assessments.
Conclusion:
The novel DL model not only achieved segmentation of the entire upper airway, including the nasal cavity and subregion identification, but also performed exceptionally well, making it well suited for 3D upper airway assessment from the nasal cavity to the hypopharynx, especially for intricate structures.
Clinical significance:
This system provides insights into the aetiology, risk, severity, treatment effect, and prognosis of dentoskeletal deformities and obstructive sleep apnea. It achieves rapid assessment of the entire upper airway and its subregions, making airway management-an integral part of orthodontic treatment, orthognathic surgery, and ENT surgery-easier.
... The treatment of OSA with MMAS is effective and has good stability. A retrospective study on 25 patients found a significant increase in oropharyngeal space after MMAS, with mild relapse after 10 months of follow-up.56 A recent systematic review with meta-analysis indicated the superiority of MMAS over multilevel surgery in the treatment of OSA.57 ...
Introduction
Obstructive sleep apnea (OSA) affects an important part of the population and is characterized by recurrent total or partial obstruction of the upper airway (UA) during sleep, negatively affecting the quality of life of patients in the short and long terms, and constituting an important public health problem for the society. The field of expertise of orthodontists is closely related to the UA, placing them in a strategic position to diagnose air passage failures and intervene when necessary. Orthodontists, as health professionals, must know how to recognize respiratory problems and manage them appropriately, when indicated.
Objective
Thus, this paper aims to review and critically evaluate the related literature, to provide orthodontists with updated knowledge on the diagnosis and therapy related to OSA. Science and technology are constantly evolving; thus, the literature was also reviewed considering new technologies available in consumer-targeted applications and devices for the diagnosis, monitoring, and treatment of sleep-disordered breathing.
Keywords:
Obstructive sleep apnea; Sleep apnea syndromes; Airway obstruction; Orthodontics
... Las apneas pueden clasificarse en tres tipos según su esfuerzo inspiratorio: 15 Cirugía de avance realizarán en el paciente. 4,8,9,[29][30][31][32][33][34] Para la preparación pre quirúrgica se indica el protocolo de Stanford, el cual divide a la cirugía en dos fases: 9,13,32,33 1. Fase l: consiste en la úvulo palato faríngeo plastia y/o genioplastia. 2. Fase ll: cirugía de avance máxilo mandibular, o sólo de avance mandibular o maxilar, según sea el caso De acuerdo con el protocolo, la opción de la fase II es llevada a cabo en aquellos casos en que la fase I no alcanza resultados positivos. ...
... Si se desea mejorar el aspecto estético y armonizar el rostro, se puede incluir una mentoplastía de avance. 13,26,34,39,40 Existe evidencia científica suficiente que asegura que tras una cirugía de AMM, se obtendrá un aumento en el volumen de las vías aéreas superiores, mejor circulación de oxígeno y conciliación del sueño. Se consolida que la cirugía de AMM corrige las malformaciones craneofaciales, creando un espacio faríngeo posquirúrgico mayor al prequirúrgico, lo que determina una mejoría en la calidad de vida del paciente ya que disminuyen los episodios de apneas/hipoapneas a corto y largo plazo. ...
El Síndrome de Apnea Obstructiva del Sueño (SAOS) se define como un trastorno que representa episodios de obstrucción total del flujo aéreo (apnea) o parcial (hipopnea) de las vías respiratorias durante el sueño. El objetivo de esta revisión de la literatura fue analizar información de relevancia acerca de la cirugía de avance maxilo mandibular (AMM) como una alternativa en el tratamiento del síndrome de apnea obstructiva del sueño. En la que, se consultaron las bases de datos electrónicas como: Medline, PubMed, Scielo, ElSevier, Healey Library, Web of Science; entre otros, para identificar publicaciones sin límite de fecha, sin distinción de idioma, junto con una búsqueda manual. Como criterios de inclusión se seleccionaron las palabras clave: “Apnea Obstructiva del Sueño”, “Procedimientos Quirúrgicos Ortognáticos”, “Avance Mandibular”, “Dispositivos Oclusales”, en varias combinaciones usando los operadores boleanos OR, AND y NOT, para obtener referencias relevantes para su selección, se tomaron en cuenta varias revisiones de la literatura, casos, ensayos clínicos y estudios de cohortes. Se revisaron un total de 1583 artículos, 41 cumplieron los criterios de inclusión, 21 en idioma español y 20 en idioma inglés. La cirugía de avance maxilo mandibular es una de las mejores alternativas de tratamiento para el SAOS, tiene un promedio de éxito a corto y largo plazo, alrededor de un 98.8% ya que reduce significativamente los episodios de apneas e hipoapneas durante el sueño, mejorando la calidad de vida de los pacientes sometidos al tratamiento.
... As no studies were found correlating skeletal movement and relapse with PAS changes in isolated mandibular advancement cases at follow-up, a comparison with similar literature was not possible. Nevertheless, AlSaty et al. also did not find any correlation between skeletal relapse and change in airway space following maxillomandibular advancement with and without genial tubercle advancement [28]. ...
Lack of evidence exists related to the three-dimensional (3D) pharyngeal airway space (PAS) changes at follow-up after isolated bilateral sagittal split osteotomy (BSSO) advancement surgery. The present study assessed the 3D PAS changes following isolated mandibular advancement at a follow-up period of 1 year. A total of 120 patients (40 males, 80 females, mean age: 26.0 ± 12.2) who underwent BSSO advancement surgery were recruited. Cone-beam computed tomography (CBCT) scans were acquired preoperatively (T0), immediately following surgery (T1), and at 1 year of follow-up (T2). The volume, surface area, and minimal cross-sectional area (mCSA) of the airway were assessed. The total airway showed a 38% increase in volume and 13% increase in surface area from T0 to T1, where the oropharyngeal region showed the maximum immediate change. At T1-T2 follow-up, both volumetric and surface area showed a relapse of less than 7% for all sub-regions. The mCSA showed a significant increase of 71% from T0 to T1 (p < 0.0001), whereas a non-significant relapse was observed at T1-T2 (p = 0.1252). The PAS remained stable at a follow-up period of 1 year. In conclusion, BSSO advancement surgery could be regarded as a stable procedure for widening of the PAS with maintenance of positive space at follow-up.
... [6] However, recent studies substantiated that the maxillomandibular advancement procedure (MMA) is an effective treatment in improvement of OSA regardless of age, craniofacial anomalies, weight, body habitus, or medical history. [7,8] Continuous positive airway pressure (CPAP) therapy is the first line of treatment for patients with OSA syndrome. e use of CPAP prevents upper airway collapse, relieves symptoms, and decreases cardiovascular events. ...
... e three-dimensional increase in the pharyngeal airway (PA) after the MMA procedure agreed with the previous studies. [1,8,19] According to Holty and Guilleminault, MMA enlarges the PA space by expanding the skeletal framework that the soft-tissue pharyngeal structures and tongue attach to resulting in reduced pharyngeal collapsibility during negative-pressure inspiration, and a statistically significant and clinically relevant reduction in the ESS in all subjects after MMA. [21] Based on surgical success criteria, the results of surgical treatment of OSA are divided into "surgical success" and "surgical cure. ...
... [24] e MMA surgical movements were found to be stable with less than 1 mm of relapse during the follow-up period, which was not clinically significant. [8] According to Lee et al. surgical advancement of the maxillomandibular complex 10 mm for treatment, OSA remains stable at a mean followup period greater than 2 years and pre-operative orthodontic treatment does not appear to influence skeletal stability. [10] Another study by Conradt et al. demonstrated that MMA is successful by cephalometric and PSG investigation, and post-operative success has proved to be stable over 2 years. ...
This case report describes the successful surgical treatment of a patient diagnosed with obstructive sleep apnea (OSA). A 55-year-old Caucasian male patient with a body mass index (BMI) of 25.6 kg/m ² sought treatment with a chief concern of excessive daytime sleepiness and fatigue. An initial polysomnography report showed moderate OSA with an apnea-hypopnea index (AHI) of 21.2 events/h, and Epworth Sleepiness Score (ESS) of 12/24. The patient was initially prescribed with CPAP treatment but was unable to tolerate treatment after a few months. Clinical and radiographic examination revealed a concave facial profile with maxillary retrognathism. Intraoral examination revealed generalized gingival recession, missing upper lateral incisors and lower first premolars, anterior crossbite, and maxillary transverse deficiency with bilateral posterior crossbite. The lateral cephalogram showed a narrow posterior airway space at the level of the base of the tongue. The patient was treated with maxillomandibular advancement (MMA) surgery to improve airway obstruction. Results showed balanced facial esthetic and stable occlusion with a complete resolution of the patient’s OSA and a post-operative improvement of AHI from 21.2 to 0.7 events/h and ESS from 12/24 to 3/24. The lowest oxyhemoglobin saturation during sleep was improved to 97%, and the BMI decreased from 25.6 to 25.2 kg/m ² . These results suggest that MMA surgical procedure can be used as a definitive treatment for patients with maxillomandibular deficiency and OSA.
Aim of this systematic review was to assess the effects of orthopedic treatment for Class II malocclusion with Functional Appliances (FAs) on the dimensions of the upper airways. Eight databases were searched up to October 2020 for randomized or nonrandomized clinical studies on FA treatment of Class II patients with untreated control groups. After duplicate study selection, data extraction, and risk of bias assessment according to Cochrane guidelines, random effects meta-analyses of mean differences (MDs) and their 95% confidence intervals (CIs) were performed, followed by subgroup/meta-regression analyses and assessment of the quality of evidence. A total of 20 nonrandomized clinical studies (4 prospective/16 retrospective) including 969 patients (47.9% male; mean age 10.9 years) were identified. Orthopedic treatment with FAs was associated with increased oropharynx volume (MD = 2356.14 mm3; 95% CI = 1276.36 to 3435.92 mm3; p < 0.001) compared to natural growth. Additionally, significant increases in nasopharynx volume, minimal constricted axial area of pharyngeal airway, and airway were seen, while removable FAs showed considerably greater effects than fixed FAs (p = 0.04). Finally, patient age and treatment duration had a significant influence in the effect of FAs on airways, as had baseline matching and sample size adequacy. Clinical evidence on orthopedic Class II treatment with FAs is associated with increased upper airway dimensions. However, the quality of evidence is very low due to methodological issues of existing studies, while the clinical relevance of increases in airway dimensions remains unclear.
