Upper Airway 3D Changes of Patients With Cleft Lip and Palate After Orthognathic Surgery

2018 ◽  
Vol 56 (3) ◽  
pp. 314-320 ◽  
Author(s):  
Marilia Sayako Yatabe-Ioshida ◽  
Letícia Dominguez Campos ◽  
Renato Yassukata Yaedu ◽  
Ivy Kiemle Trindade-Suedam
Keyword(s):  
Orthognathic Surgery ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Upper Airway ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Class Iii ◽  
Linear Measurements ◽  
Cross Sectional ◽  
Skeletal Class

Objectives: The purpose of this study was to 3-dimensionally assess the airway characteristics of patients with unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) who underwent orthognathic surgery. Design: This was a retrospective study. Setting: The study took place at a national referral center for cleft lip and palate rehabilitation. Patients and Participants: The sample comprised cone-beam computed tomography (CBCT) scans obtained before and after orthognathic surgery of 15 individuals (30 CBCT scans), divided into 2 groups: UCLP group (n = 9 patients/18 CBCT scans) and BCLP group (n = 6/12 CBCT scans). All patients had a nonsyndromic UCLP or BCLP and a skeletal class III malocclusion at the preoperative period. Interventions: Airway volume, pharyngeal minimal cross-sectional area (mCSA), location of mCSA, sella-nasion-A point (SNA) and sella-nasion-B point (SNB) angles, and condylion-A point and condyloid-gnathion linear measurements were assessed in open-source software (ITK-SNAP and SlicerCMF). Main Outcome Measure: Airway dimensions of patients with UCLP and BCLP increase after orthognathic surgery. Results: After orthognathic surgery, UCLP group showed a significant 20% increase in nasopharynx volume. Although not significant, BCLP group also showed an increase of 18% in the same region. Minimal cross-sectional area remained dimensionally stable after surgery and was all located in the oropharynx region, on both groups. Additionally, a positive correlation was observed between volume and mCSA on both groups. Conclusion: Overall, individuals with UCLP and BCLP showed an increase in the upper airway after orthognathic surgery and this might explain the breathing and sleep improvements reported by the patients after the surgery.

scholarly journals Effect of posterior impaction and setback of the maxilla on retropalatal airway and velopharyngeal dimensions after two-jaw surgery in skeletal Class III patients

2015 ◽  
Vol 85 (4) ◽  
pp. 625-630 ◽  
Author(s):  
Taeyun Kim ◽  
Seung-Hak Baek ◽  
Jin-Young Choi
Keyword(s):  
Soft Palate ◽  
Cross Sectional Area ◽  
T Test ◽  
Sectional Area ◽  
Class Iii ◽  
Cross Sectional ◽  
Skeletal Class ◽  
Group 2 ◽  
Jaw Surgery ◽  
Group 1

ABSTRACT Objective:  To evaluate the changes in retropalatal airway and velopharyngeal dimensions after posterior impaction (PI) only or PI and setback (PI/SB) of the maxilla in patients with skeletal Class III undergoing two-jaw surgery. Materials and Methods:  Subjects consisted of 60 Class III patients treated with two-jaw surgery. They were divided into two groups: group 1 (n  = 30; PI of the maxilla; mean  =  2.6 mm) and group 2 (n = 30; PI/SB of the maxilla; mean  =  2.8 mm and 1.8 mm, respectively). Using three dimensional computed tomography images taken 1month before surgery (T0) and at least 6 months after surgery (T1), retropalatal airway volume, minimum cross-sectional area, and lateral and anteroposterior (AP) dimensions of minimum cross-sectional area, soft palate angle, soft palate length, and pharyngeal depth were measured. A paired t-test and independent t-test were used for statistical analysis. Results:  Group 1 showed increase in retropalatal airway volume and minimum cross-sectional area (P < .01 and P < .05, respectively). Group 2 exhibited decrease in retropalatal airway volume, minimum cross-sectional area, and lateral and AP dimensions of minimum cross-sectional area (all P < .01). Although groups 1 and 2 showed an increase in soft palate length (P < .01 and P < .001, respectively), pharyngeal depth significantly increased only in group 1 (P < .01). Groups 1 and 2 were significantly different in retropalatal airway volume, minimum cross-sectional area, and AP dimension (P < .05, P < .001, and P < .05, respectively). Conclusion:  Because the direction of surgical movement in the maxilla can determine the changes in the retropalatal airway and velopharyngeal dimensions, it is recommended that clinicians investigate whether patients suffer from sleep-related breathing disorders before performing PI/SB of the maxilla.

Cone-Beam Computed Tomography Analysis of the Nasopharyngeal Airway in Nonsyndromic Cleft Lip and Palate Subjects

2017 ◽  
Vol 54 (2) ◽  
pp. 202-209 ◽  
Author(s):  
Mahmood Abd Al-Fahdawi ◽  
Mary Medhat Farid ◽  
Mona Abou El-Fotouh ◽  
Marwa Abdelwahab El-Kassaby
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Cross Sectional Area ◽  
Cone Beam ◽  
Sectional Area ◽  
Cross Sectional ◽  
Nasopharyngeal Airway ◽  
Bilateral Cleft Lip

Objective To assess the nasopharyngeal airway volume, cross-sectional area, and depth in previously repaired nonsyndromic unilateral cleft lip and palate versus bilateral cleft lip and palate patients compared with noncleft controls using cone-beam computed tomography with the ultimate goal of finding whether cleft lip and palate patients are more liable to nasopharyngeal airway obstruction. Design A retrospective analysis comparing bilateral cleft lip and palate, unilateral cleft lip and palate, and control subjects. Significance at P ≤ .05. Setting Cleft Care Center and the outpatient clinic that are both affiliated with our faculty. Participants Cone-beam computed tomography data were selected of 58 individuals aged 9 to 12 years: 14 with bilateral cleft lip and palate and 20 with unilateral cleft lip and palate as well as 24 age- and gender-matched noncleft controls. Variables Volume, depth, and cross-sectional area of nasopharyngeal airway were measured. Results Patients with bilateral cleft lip and palate showed significantly larger nasopharyngeal airway volume than controls and patients with unilateral cleft lip and palate ( P < .001). Patients with bilateral cleft lip and palate showed significantly larger cross-sectional area than those with unilateral cleft lip and palate ( P < .001) and insignificant cross-sectional area compared with controls ( P > .05). Patients with bilateral cleft lip and palate showed significantly larger depth than controls and those with unilateral cleft lip and palate ( P < .001). Patients with unilateral cleft lip and palate showed insignificant nasopharyngeal airway volume, cross-sectional area, and depth compared with controls ( P > .05). Conclusions Unilateral and bilateral cleft lip and palate patients did not show significantly less volume, cross-sectional area, or depth of nasopharyngeal airway than controls. From the results of this study we conclude that unilateral and bilateral cleft lip and palate patients at the studied age and stage of repaired clefts are not more prone to nasopharyngeal airway obstruction than controls.

Changes in the parameters of nasal breathing and parameters of the upper respiratory tract during orthognathic operations in patients with II and III skeletal class of jaw anomalies

2020 ◽  
pp. 22-27
Author(s):  
S.Sh. Gammadaeva ◽  
M.I. Misirkhanova ◽  
A.Yu. Drobyshev
Keyword(s):  
Respiratory Tract ◽  
Nasal Cavity ◽  
Nasal Septum ◽  
Cross Sectional Area ◽  
Upper Respiratory Tract ◽  
Sectional Area ◽  
Nasal Breathing ◽  
Cross Sectional ◽  
Skeletal Class ◽  
Upper Respiratory

The study analyzed the functional parameters of nasal breathing, linear parameters of the nasal aperture, nasal cavity and nasopharynx, volumetric parameters of the upper airways in patients with II and III skeletal class of jaw anomalies before and after orthognathic surgery. The respiratory function of the nose was assessed using a rhinomanometric complex. According to rhinoresistometry data, nasal resistance and hydraulic diameter were assessed. According to the data of acoustic rhinometry, the minimum cross-sectional area along the internal valve, the minimum cross-sectional area on the head of the inferior turbinate and nasal septum and related parameters were estimated. According to the CBCT data, the state of the nasal septum, the inferior turbinates, the nasal aperture, the state of the nasal cavity, and the linear values of the upper respiratory tract (nasopharynx) were analyzed. The patients were divided into 4 groups according to the classification of the patency of the nasal passages by

A Simple Endoscopic Technique for Measuring the Cross-Sectional Area of the Upper Airway in a Rabbit Model

2018 ◽  
Vol 127 (4) ◽  
pp. 275-281 ◽  
Author(s):  
Paul R. Wistermayer ◽  
Wesley R. McIlwain ◽  
Nicholas Ieronimakis ◽  
Derek J. Rogers
Keyword(s):  
Rabbit Model ◽  
Upper Airway ◽  
Cross Sectional Area ◽  
Endoscopic Technique ◽  
Sectional Area ◽  
Cross Sectional ◽  
The Cross

Guideline Values for Minimum Nasal Cross-Sectional Area in Children

2018 ◽  
Vol 55 (8) ◽  
pp. 1043-1050
Author(s):  
Maija T. Laine-Alava ◽  
Siiri Murtolahti ◽  
Ulla K. Crouse ◽  
Donald W. Warren
Keyword(s):  
Cleft Lip ◽  
Cross Sectional Area ◽  
Adult Size ◽  
Nasal Airway ◽  
Sectional Area ◽  
Cross Sectional ◽  
Age Cohorts ◽  
Guideline Values ◽  
Significant Difference ◽  
Research Criteria

Objective: The purpose was to determine age-specific values of the minimum cross-sectional area of the nasal airway in children without cleft lip or palate and to assess whether gender differences occur with growth in order to develop guidelines for assessment in children with clefts. Participants: All schoolchildren aged 8 to 17 years who met the research criteria were studied during rest breathing using the pressure-flow technique. The children came from a rural area of 3800 inhabitants. Consecutive age cohorts were used for comparisons. Results: Nasal cross-sectional area increased in females from 0.38 cm2 in 8-year-olds to 0.58 cm2 in 17-year-olds. There was a decrease in size at ages 10 to 11 and 14 to 15 years. In males, the area increased from 0.40 to 0.68 cm2 and decreased slightly from 9 to 10 and 14 to 15 years. The annual changes were statistically significant in females between 8 and 9 and 11 to 13 years of age, and in males from 11 to 12, 13 to 14, and 15 to 17 years of age. Across gender, the only significant difference occurred at age 16. Conclusions: Our results indicate that the increase in nasal airway size is not consistent during growth. Nasal airway size showed almost equal values for both genders in young children but was systematically larger in boys from 14 years of age on. The results refer that by 17 years of age nasal airway may not have reached adult size in males.

Upper Airway Effective Compliance during Wakefulness and Sleep in Obese Adolescents Studied via 2-Dimensional Dynamic MRI and Semi-automated Image Segmentation

2021 ◽  
Author(s):  
Kok Ren Choy ◽  
Sanghun Sin ◽  
Yubing Tong ◽  
Jayaram K. Udupa ◽  
Dirk M. Luchtenburg ◽  
...  
Keyword(s):  
Upper Airway ◽  
Dynamic Mri ◽  
Cross Sectional Area ◽  
Apnea Hypopnea Index ◽  
Morphological Operations ◽  
Sectional Area ◽  
Cross Sectional ◽  
Automated Method ◽  
Obstructive Sleep ◽  
Effective Compliance

Novel biomarkers of upper airway biomechanics may improve diagnosis of Obstructive Sleep Apnea Syndrome (OSAS). Upper airway effective compliance (EC), the slope of cross-sectional area versus pressure estimated using computational fluid dynamics (CFD), correlates with apnea-hypopnea index (AHI) and critical closing pressure (Pcrit). The study objectives are to develop a fast, simplified method for estimating EC using dynamic MRI and physiological measurements, and to explore the hypothesis that OSAS severity correlates with mechanical compliance during wakefulness and sleep. Five obese children with OSAS and five obese control subjects age 12-17 underwent anterior rhinomanometry, polysomnography and dynamic MRI with synchronized airflow measurement during wakefulness and sleep. Airway cross-section in retropalatal and retroglossal section images was segmented using a novel semi-automated method that uses optimized singular-value decomposition (SVD) image filtering and k-means clustering combined with morphological operations. Pressure was estimated using rhinomanometry Rohrer coefficients and flow rate, and EC calculated from the area-pressure slope during five normal breaths. Correlations between apnea-hypopnea index (AHI), EC, and cross-sectional area (CSA) change were calculated using Spearman rank correlation. The semi-automated method efficiently segmented the airway with average Dice Coefficient above 89% compared to expert manual segmentation. AHI correlated positively with EC at the retroglossal site during sleep (rs=0.74, p=0.014), and with change of EC from wake to sleep at the retroglossal site (rs=0.77, p=0.01). CSA change alone did not correlate significantly with AHI. EC, a mechanical biomarker which includes both CSA change and pressure variation, is a potential diagnostic biomarker for studying and managing OSAS.

Quality of Life and Temporomandibular Disorders in Patients With Skeletal Class III Malocclusion With Cleft Lip and Palate

2021 ◽  
pp. 105566562110434
Author(s):  
Bernardo Olsson ◽  
Isabela Polesi Bergamaschi ◽  
Erika Calvano Küchler ◽  
Aline Monise Sebastiani ◽  
Guilherme dos Santos Trento ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Temporomandibular Disorders ◽  
Psychological Factors ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Class Iii ◽  
Class Iii Malocclusion ◽  
Skeletal Class ◽  
Better Than

Objective The aim of the study was to assess the quality of life (QOL), oral health-related QOL (OHRQOL), temporomandibular disorders (TMDs), and psychological factors in patients with skeletal Class III malocclusion with cleft lip and palate (CLP) and without CLP. Design Case–control. Setting Primary care, institutional practice. Patients One hundred thirty-six patients with skeletal Class III malocclusion with CLP (n = 68) and without CLP (n = 68). Main outcome measures QOL and OHRQOL were assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire and the Oral Health Impact Profile-14 questionnaire, respectively. TMDs and psychological factors were assessed using the Research Diagnostic Criteria for TMD (RDC/TMD). Results No differences in QOL were found between the groups ( P >  0.05). Patients with CLP reported a better OHRQOL ( P = 0.025) in the physical pain, physical disability, and psychological disability domains ( P <  0.05). Patients with CLP presented with less myofascial pain (OR, 0.28; 95% CI, 0.11-0.71] and other articular conditions (OR 0.24; 95% CI 0.06-0.90]. More patients with CLP reported no chronic pain ( P = 0.012). The QOL of patients with CLP with no depression or with no nonspecific physical symptoms including pain (NSPSIP) was better than that of patients without CLP. The OHRQOL of patients with CLP without TMDs or no psychological factors was better than that of patients without CLP. Conclusions Patients with skeletal Class III malocclusion who require orthognathic surgery with CLP have better OHRQOL and present with fewer TMDs than those patients without CLP.

Gender differences in upper airway compliance during NREM sleep: role of neck circumference

2002 ◽  
Vol 92 (6) ◽  
pp. 2535-2541 ◽  
Author(s):  
James A. Rowley ◽  
Carrie S. Sanders ◽  
Brian R. Zahn ◽  
M. Safwan Badr
Keyword(s):  
Gender Differences ◽  
Gender Difference ◽  
Upper Airway ◽  
Nrem Sleep ◽  
Neck Circumference ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Significant Difference ◽  
Upper Airway Structure

It has been proposed that the gender difference in sleep apnea prevalence is related to gender differences in upper airway structure and function. We hypothesized that men would have smaller retropalatal cross-sectional area and higher compliance during sleep compared with women. Using upper airway imaging, we measured upper airway cross-sectional area and retropalatal compliance in wakefulness and non-rapid eye movement (NREM) sleep in 15 men and 15 women without sleep-disordered breathing. Cross-sectional area at the beginning of inspiration tended to be larger in men compared with women in both wakefulness [194.5 ± 21.3 vs. 138.8 ± 12.0 (SE) mm2] and NREM sleep (111.1 ± 17.6 vs. 83.3 ± 11.9 mm2; P = 0.058). There was no significant difference, however, after correction for body surface area. Retropalatal compliance also tended to be higher in men during both wakefulness (5.9 ± 1.4 vs. 3.1 ± 1.4 mm2/cmH2O; P = 0.006) and NREM sleep (12.6 ± 2.7 vs. 4.7 ± 2.6 mm2/cmH2O; P = 0.055). However, compliance was similar in men relative to women after correction for neck circumference. We conclude that the gender difference in retropalatal compliance is more accurately attributed to differences in neck circumference between the genders.

An Oral Health-Related Quality of Life Comparison Between Adults With Unilateral Cleft Lip and Palate and Class III Malocclusion

2019 ◽  
Vol 56 (10) ◽  
pp. 1359-1365
Author(s):  
Leandro Almeida Nascimento Barros ◽  
Flávia Aline Silva Jesuino ◽  
João Batista de Paiva ◽  
José Rino-Neto ◽  
José Valladares-Neto
Keyword(s):  
Oral Health ◽  
Orthognathic Surgery ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Health Related Quality ◽  
Class Iii ◽  
Class Iii Malocclusion ◽  
Related Quality ◽  
Health Related

Objective: To compare oral health-related quality of life (OHRQoL) before treatment of adults with unilateral cleft lip and palate (UCLP) and surgical Class III malocclusion, and to consider if clefts needing different orthodontic treatment protocols could influence people’s self-perception. Design: Cross sectional. Setting: Cleft Lip and Palate Center and Clinic of Orthognathic Surgery from a School of Dentistry. Participants: A sample of adults with repaired nonsyndromic UCLP (n = 52) which was age- and sex-matched with a noncleft Class III malocclusion sample seeking orthognathic surgery (n = 51). In turn, the cleft group was subdivided according to treatment planning into nonsurgical orthodontic and surgical orthodontic approaches. Main Outcome Measure: The whole sample was assessed using the short-form oral health impact profile (OHIP-14), with higher scores indicating a poorer OHRQoL. Statistical comparisons were performed with Mann-Whitney U and Kruskal-Wallis tests, and effect size. Bonferroni adjustment was used for post hoc tests ( P < .017). Results: The OHIP-14 scores of the UCLP and Class III groups were significantly different ( P = .001, η2 = 0.108), and higher in Class III. The largest commitment was in the physical disability, physical pain, and psychological disability domains. In addition, no differences were found when the UCLP treatment planning was considered. Conclusion: Surgical Class III malocclusion have a poorer OHRQoL when compared to patients with UCLP, irrespective of whether they are treated surgically or orthodontically. Therefore, the greater commitment of OHRQoL appears to be influenced by the etiology of Class III, and not by treatment plan.

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