Predicting the pharyngeal airway space after mandibular setback surgery.
TL;DR: In patients who have other risk factors, such as obesity, short neck, macroglossia, large uvula, and excessive soft tissue around the nasopharyngeal region, a mandibular setback surgery could possibly predispose to the development of sleep apnea syndrome.
About: This article is published in Journal of Oral and Maxillofacial Surgery.The article was published on 2005-10-01. It has received 49 citations till now.
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TL;DR: It is suggested that bimaxillary surgery can prevent narrowing of the upper airway in the correction of Class III deformities in comparison with mandibular setback surgery used as the sole treatment.
Abstract: Objective The purpose of this study was to compare the morphologic changes of the upper airway space in Class III patients who underwent mandibular setback or bimaxillary surgery (maxillary advancement and mandibular setback) by computed tomography at 2 levels: soft palate and base of tongue. Methods The sample consisted of 47 subjects in 2 groups who had been diagnosed as having Class III skeletal deformities and had been treated by mandibular setback or bimaxillary surgery (maxillary advancement and mandibular setback). Anteroposterior, lateral, and cross-sectional area dimensions of the airway at the level of soft palate and base of tongue were measured pre- and postoperatively on computed tomography images. Results Anteroposterior dimensions of the airway decreased in both groups ( P P P P > .05). Conclusions This study suggests that bimaxillary surgery can prevent narrowing of the upper airway in the correction of Class III deformities in comparison with mandibular setback surgery used as the sole treatment. Computed tomography was valuable in determining the effects of surgical treatment on pharyngeal airway dimensions.
117 citations
TL;DR: Mandibular distraction osteogenesis is a viable option for the pediatric patient with upper airway obstruction due to mandibular deficiency to avoid a tracheostomy or other surgical intervention.
98 citations
TL;DR: Moderate evidence was found to support a significant decrease in the oropharyngeal airway in mandibular setback surgery, a milder decrease in bimaxillary surgery to correct Class III and an increase in maxillomandibular advancement surgery.
92 citations
TL;DR: A significant decrease only for lower and total pharyngeal airway volumes in males and a significant decrease in the volume of the maxillary sinuses was observed after mandibular setback surgery combined with maxillary advancement and/or impaction surgery.
Abstract: Objective: To evaluate the pharyngeal airway and maxillary sinus volume changes after mandibular setback surgery combined with maxillary advancement and/or impaction surgery. Materials and Methods: Seventeen Class III skeletal patients (11 females, 6 males) who required bimaxillary orthognathic surgery were selected. Volumetric measurements were performed using cone beam computed tomography (CBCT) scans preoperatively and 3.9 ± 0.87 months postoperatively. All the CBCT scans were assessed and analyzed using MIMICS 14.0 software. Preoperative and postoperative volumes of pharyngeal airway and maxillary sinuses and the relationship between the amounts of surgical movement of the jaws and the above volumes were statistically evaluated. Results: The pharyngeal airway area presented no significant change except for the lower and total pharyngeal airway volumes in males, in whom a significant decrease was observed (4196.27 ± 2061.11 mm3 and 3375.53 ± 3624.67 mm3, respectively). No significant change wa...
67 citations
TL;DR: Results show that mandibular setback surgery markedly decreases the PAS and changes the morphology of the soft palate.
64 citations
References
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Book•
01 Oct 1993
TL;DR: Here is absolutely everything medical students need to know about biostatistics and quantitative methods as applied to medicine, clinical practice, and research.
Abstract: Introduction to Medical Research. Study Designs in Medical Research. Summarizing Data & Presenting Data in Tables & Graphs. Probability & Related Topics for Making Inferences About Data. Research Questions About One Group Research Questions About Two Separate or Independent Groups. Research Questions About Means in Three or More Groups. Research Questions About Relationships Among Variables. Analyzing Research Questions About Survival. Statistical Methods for Multiple Variables. Methods of Evidence-Based Medicine. Clinical Decision Making. Reading the Medical Literature.
2,199 citations
TL;DR: Flow-volume loops were unable to detect extrathoracic airway obstruction in six out of 12 OSAS patients and cephalograms were very useful in demonstrating mandibular deficiencies inOSAS patients.
Abstract: Fifteen patients with obstructive sleep apnea syndrome (OSAS) and 10 controls were studied. Polygraphic monitoring during sleep confirmed the presence or absence of OSAS. Ten OSAS patients and five controls had cephalometric analysis and 12 OSAS patients and five controls had a flow-volume loop study during wakefulness. Seven OSAS patients were submitted to both analyses. Flow-volume loops were unable to detect extrathoracic airway obstruction in six out of 12 OSAS patients. One control was found with positive results. Six out of seven subjects with positive flow-volume loops were overweight (greater than or equal to 30% ideal weight). Cephalograms were very useful in demonstrating mandibular deficiencies in OSAS patients. The length of the soft palate and the position of the hyoid bone, together with the measurement of the posterior airway space, are criteria of great interest in OSAS patients. Cephalometric analysis is recommended in all OSAS patients scheduled for surgical procedure. None of these tests, however, whether alone or in combination, is capable of identifying all cases of OSAS.
454 citations
TL;DR: It is concluded that weight loss is associated with decreases in upper airway collapsibility in obstructiveSleep apnea, and that the resolution of sleep apnea depends on the absolute level to which Pcrit falls.
Abstract: Previous investigators have demonstrated in patients with obstructive sleep apnea that weight reduction results in a decrease in apnea severity. Although the mechanism for this decrease is not clear, we hypothesize that decreases in upper airway collapsibility account for decreases in apnea severity with weight loss. To determine whether weight loss causes decreases in collapsibility, we measured the upper airway critical pressure (Pcrit) before and after a 17.4 ± 3.4% (mean ± SD) reduction in body mass index in 13 patients with obstructive sleep apnea. Thirteen weight-stable control subjects matched for age, body mass index, gender (all men), and non-REM disordered breathing rate (DBR) also were studied before and after usual care intervention. During non-REM sleep, maximal inspiratory airflow was measured by varying the level of nasal pressure and Pcrit was determined by the level of nasal pressure below which maximal inspiratory airflow ceased. In the weight loss group, a significant decrease in DBR fr...
452 citations
TL;DR: Reductions in general intellectual measures, as well as in executive and psychomotor tasks were all attributable to the severity of hypoxemia, while other attention and memory deficits were related to vigiance impairment.
Abstract: Neuropsychological deficits have been documented in patients with obstructive sleep apnea syndrome (OSSA). Both nocturnal hypoxemia and impairment of daytime vigilance have been suggested as the pathogenesis of these deficits, yet it remains difficult to find good correlations between cognitive deficits and either of these physiological parameters. In the present study, 10 normal controls were compared to 10 moderately and 10 severely apneic patients, all recorded in a sleep laboratory for two consecutive nights, with a vigilance and neuropsychological assessment made during the intervening day. Relative to the controls, moderate and severe OSAS showed differences in many cognitive functions, although the severely affected showed the greater differences. Moreover, severe apneics were also worse than moderate apneics on tests that were found to be normal in the latter group. This suggests a discontinuity in the appearance of neuropsychological deficits as OSAS progresses. Further analyses revealed...
369 citations
TL;DR: Results indicated that subjects with high total, upper and lower face heights, elongated maxillary and mandibular teeth, and proclined lower incisors were observed to have large tongue, soft palate, and upper airway volumes, to have a higher apnea index and to be obese.
307 citations