THE EFFECT OF ISOLATED SEGMENTAL CHIN OSTEOTOMY (SCO) ON THE PHARYNGEAL AIRWAY SPACE

The chin affects facial esthetics and the harmony between frontal and lateral views and is one of the most important anatomic structures of the lower third of the face. Chin osteotomy is aimed at ensuring the harmonization of the facial profile by balancing the size and form of the lower third of the face. It is assumed that the isolated genioplasty surgery will improve the pharyngeal airway space (PAS) by promoting muscle changes, specifically by pulling forward the hyoid bone and decompressing the hypopharynx region. Two patients without obstructive sleep apnea syndrome (OSAS) underwent isolated chin osteotomy for esthetic purposes. Forward movement of the chin by the Pg point was 7 mm in one case and 11 mm in another case. They were evaluated by preoperative and postoperative cone-beam computed tomography scans. The upper airway space was subdivided into retropalatal and retroglossal spaces. After this, the upper airway space was analyzed through the following criteria: 1) three-dimensional, high-altitude, cross-sectional surfaces; 2) transverse and anteroposterior diameter changes. Isolated segmental genioplasty was used after precise virtual planning and resulted in the PAS increase only in one case. There was a relevant correlation between the vertical and horizontal chin change and the hypopharynx. There was an average of a 1.6-fold increase in the total volume of the upper airway space. The retroglossal space was increased 1.5-fold. In another case, there was no relevant correlation between the vertical and horizontal chin change and the PAS. Isolated segmental chin osteotomy provides predictable esthetic results in the correction of different mandible anterior deformities and may contribute to an increased volume and a morphologic airway change. Further studies should be conducted to evaluate the effect of isolated segmental genioplasty on the pharyngeal airway space.

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Computational Fluid Dynamics Modeling of Upper Airway During Tidal Breathing Using Volume-Gated MRI in OSAS and Control Subjects

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53311 ◽

2011 ◽

Author(s):

Steven C. Persak ◽

Sanghun Sin ◽

Raanan Arens ◽

David M. Wootton

Keyword(s):

Fluid Dynamic ◽

Sleep Apnea Syndrome ◽

Three Dimensional ◽

Upper Airway ◽

Magnetic Resonance Images ◽

Dynamics Modeling ◽

Tidal Breathing ◽

Pharyngeal Airway ◽

Cross Section Area ◽

Obstructive Sleep

Three-dimensional (3D) computational fluid dynamic (CFD) analysis was used to model the effect of collapsing airway geometry on internal pressure and velocity in the pharyngeal airway of sedated obese children with and without obstructive sleep apnea syndrome (OSAS). Geometry was reconstructed from volume-gated magnetic resonance images during normal tidal breathing of the respiratory cycle and solved using flow data averaged over 12 consecutive breathing cycles. In the OSAS subject, collapse initiated in the proximal nasopharynx and continued downstream into the oropharynx, while the control experienced negligible collapse. Tube laws (pressure vs. cross-section area) derived for the nasopharynx and oropharynx, indicated the oropharynx in the OSAS subject more compliant than the nasopharynx (1.028 mm2/Pa vs. 0.449 mm2/Pa) and had a lower theoretical limiting flow rate, confirming the oropharynx as the flow-limiting segment of the airway in this subject. This new method may help to differentiate anatomical and functional factors in airway collapse.

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Improvement in Snoring and Sleep Apnea after Adenotonsillectomy in Children of 3 To 10 Years of Age

Journal of Sheikh Zayed Medical College ◽

10.47883/jszmc.v11i04.42 ◽

2020 ◽

Vol 11 (4) ◽

pp. 17-21

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Sleep Apnea Syndrome ◽

Upper Airway ◽

Primary Treatment ◽

P Value ◽

Cross Sectional ◽

Obstructive Sleep ◽

Apnea Syndrome

Background: Variability is found about the severity of upper airway obstruction ranging from primary snoring to obstructive sleep apnea syndrome (OSAS). Adenotonsillectomy (AT) is taken as the primary treatment option. Objective: To evaluate the efficacy of Adenotonsillectomy among children having obstructive sleep apnea syndrome. Methodology: This was a cross-sectional study conducted at Bahawal Victoria Hospital Bahawalpur from January 2017 to January 2018. A total of 52 children of both genders, aged 3 to 10 years, having obstructive sleep apnea syndrome (OSAS) and selected for Adenotonsillectomy (AT) were enrolled. Adenotonsillectomy was performed in all the study participants employing general anesthesia. Preoperative and postoperative characteristics as well as respiratory and sleep parameters were compared adopting chi-square test for qualitative variables while t-test was employed for quantitative variables. Results: Out of a total of 52 children, 32 (61.5%) were male. The majority of the children, 27 (51.9%) were between 3-6 years of age. Statistically significant improvement (p-value < 0.05) was noted at the postoperative interval following AT for obstructive AHI score, respiratory disturbance index, obstructive apnea and hypopnea index, SpO2 nadir, TSpO2<90%, and respiratory arousal index. Obstructive AHI score < 1 episode / hour was seen in 37 (71.2%) children while AHI score < 5 episodes / hour were noted in 47 (90.4%). Conclusion: Adenotonsillectomy for obstructive sleep apnea syndrome improved quality of life and polysomnographic parameters in most of the children.

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Anatomical Balance of the Upper Airway and Obstructive Sleep Apnea

Anesthesiology ◽

10.1097/aln.0b013e318173f103 ◽

2008 ◽

Vol 108 (6) ◽

pp. 1009-1015 ◽

Cited By ~ 78

Author(s):

Satoru Tsuiki ◽

Shiroh Isono ◽

Teruhiko Ishikawa ◽

Yoshihiro Yamashiro ◽

Koichiro Tatsumi ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Adult Male ◽

Upper Airway ◽

Cross Sectional ◽

Pharyngeal Airway ◽

Soft Tissue Volume ◽

Obstructive Sleep ◽

Lateral Cephalograms ◽

Maxilla And Mandible

Background Obesity and craniofacial abnormalities such as small maxilla and mandible are common features of patients with obstructive sleep apnea (OSA). The authors hypothesized that anatomical imbalance between the upper airway soft-tissue volume and the craniofacial size (rather than each alone) may result in pharyngeal airway obstruction during sleep, and therefore development of OSA. Methods Blind measurements of tongue cross-sectional area and craniofacial dimensions were performed through lateral cephalograms in 50 adult male patients with OSA and 55 adult male non-OSA subjects with various craniofacial dimensions. Results Maxillomandibular dimensions were matched between OSA and non-OSA groups. While the tongue was significantly larger in subjects with larger maxillomandible dimensions, OSA patients had a significantly larger tongue for a given maxillomandible size than non-OSA subjects. The hypothesis was also supported in subgroups matched for both body mass index and maxillomandible dimensions. Conclusions Upper airway anatomical imbalance is involved in the pathogenesis of OSA.

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MRI study of regional variations of pharyngeal wall compliance in cats

Journal of Applied Physiology ◽

10.1152/jappl.1998.85.5.1884 ◽

1998 ◽

Vol 85 (5) ◽

pp. 1884-1897 ◽

Cited By ~ 13

Author(s):

Michael J. Brennick ◽

Malcolm D. Ogilvie ◽

Susan S. Margulies ◽

Luke Hiller ◽

Warren B. Gefter ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Three Dimensional ◽

Upper Airway ◽

Cross Sectional ◽

Pharyngeal Wall ◽

Regional Variations ◽

Pharyngeal Airway ◽

Obstructive Sleep ◽

Mri Study

Upper airway compliance indicates the potential of the airway to collapse and is relevant to the pathogenesis of obstructive sleep apnea. We hypothesized that compliance would vary over the rostral-to-caudal extent of the pharyngeal airway. In a paralyzed isolated upper airway preparation in cats, we controlled static upper airway pressure during magnetic resonance imaging (MRI, 0.391-mm resolution). We measured cross-sectional area and anteroposterior and lateral dimensions from three-dimensional reconstructed MRIs in axial slices orthogonal to the airway centerline. High-retropalatal (HRP), midretropalatal (MRP), and hypopharyngeal (HYP) regions were defined. Regional compliance was significantly increased from rostral to caudal regions as follows: HRP < MRP < HYP ( P < 0.0001), and compliance differences among regions were directly related to collapsibility. Thus our findings in the isolated upper airway of the cat support the hypothesis that regional differences in pharyngeal compliance exist and suggest that baseline regional variations in compliance and collapsibility may be an important factor in the pathogenesis and treatment of obstructive sleep apnea.

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Dimensional analysis of the upper airway in obstructive sleep apnea syndrome patients treated with mandibular advancement device: a bi and three‐dimensional evaluation

Journal of Oral Rehabilitation ◽

10.1111/joor.13176 ◽

2021 ◽

Author(s):

Rocío Marco‐Pitarch ◽

Marina Selva‐García ◽

Andrés Plaza‐Espín ◽

Javier Puertas‐Cuesta ◽

Rubén Agustín‐Panadero ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Dimensional Analysis ◽

Sleep Apnea Syndrome ◽

Three Dimensional ◽

Upper Airway ◽

Mandibular Advancement ◽

Obstructive Sleep ◽

Apnea Syndrome

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A Versatile IBM-Based AMR Method for Studying Human Snoring

10.1115/fedsm2021-65790 ◽

2021 ◽

Author(s):

Wei Zhang ◽

Yu Pan ◽

Yuchen Gong ◽

Haibo Dong ◽

Jinxiang Xi

Keyword(s):

Adaptive Mesh Refinement ◽

Stokes Equations ◽

Flow Behavior ◽

Upper Airway ◽

Magnetic Resonance Images ◽

Immersed Boundary ◽

Cross Sectional ◽

Pharyngeal Airway ◽

Aerodynamic Pressure ◽

Head Neck

Abstract In this work, a local adaptive mesh refinement (AMR) embedded incompressible flow solver is developed for biomedical flows. This AMR technique is based on the block-structured mesh and adapted from an in-house numerical solver for the Navier-Stokes equations with immersed-boundary method embedded, which is suitable for flows with complex and moving boundaries in biomedical applications. Flow behavior of the human upper airway under various head-neck postures is evaluated using the developed AMR technique, where the head-neck posture is hypothesized to change the cross-sectional area of the airway, therefore the airflow and aerodynamic behavior. The anatomically accurate three-dimensional human upper airway model is reconstructed from human magnetic resonance images (MRI) with measurements from the literature. Analyses were performed on vortex dynamics and pressure fluctuations in the pharyngeal airway. It was found that the vortex formation and aerodynamic pressure were affected by the airway bending. The sniffing position or the head-neck junction extension posture tend to facilitate the airflow through the upper human airway.

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Upper Airway Collapsibility During REM Sleep in Children with the Obstructive Sleep Apnea Syndrome

SLEEP ◽

10.1093/sleep/32.9.1173 ◽

2009 ◽

Vol 32 (9) ◽

pp. 1173-1181 ◽

Cited By ~ 12

Author(s):

Jingtao Huang ◽

Laurie R. Karamessinis ◽

Michelle E. Pepe ◽

Stephen M. Glinka ◽

John M. Samuel ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Rem Sleep ◽

Sleep Apnea Syndrome ◽

Upper Airway ◽

Obstructive Sleep ◽

Airway Collapsibility ◽

Apnea Syndrome ◽

Upper Airway Collapsibility

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Mass loading of the upper airway extraluminal tissue space in rabbits: effects on tissue pressure and pharyngeal airway lumen geometry

Journal of Applied Physiology ◽

10.1152/japplphysiol.91236.2008 ◽

2009 ◽

Vol 106 (3) ◽

pp. 887-892 ◽

Cited By ~ 27

Author(s):

Kristina Kairaitis ◽

Lauren Howitt ◽

John R. Wheatley ◽

Terence C. Amis

Keyword(s):

Pressure Transducer ◽

Tissue Expander ◽

Upper Airway ◽

Fat Pad ◽

Pharyngeal Wall ◽

Airway Patency ◽

Pharyngeal Airway ◽

Obstructive Sleep ◽

Tracheal Pressure ◽

Tissue Space

Lateral pharyngeal fat pad compression of the upper airway (UA) wall is thought to influence UA size in patients with obstructive sleep apnea. We examined interactions between acute mass/volume loading of the UA extra-luminal tissue space and UA patency. We studied 12 supine, anesthetized, spontaneously breathing, head position-controlled (50°), New Zealand White rabbits. Submucosal extraluminal tissue pressures (ETP) in the anterolateral (ETPlat) and anterior (ETPant) pharyngeal wall were monitored with surgically inserted pressure transducer-tipped catheters (Millar). Tracheal pressure (Ptr) and airflow (V̇) were measured via a pneumotachograph and pressure transducer inserted in series into the intact trachea, with hypopharyngeal cross-sectional area (CSA) measured via computed tomography, while graded saline inflation (0–1.5ml) of a compliant tissue expander balloon in the anterolateral subcutaneous tissue was performed. Inspiratory UA resistance (Rua) at 20 ml/s was calculated from a power function fitted to Ptr vs. V̇ data. Graded expansion of the anterolateral balloon increased ETPlat from 2.3 ± 0.5 cmH2O ( n = 11, mean ± SEM) to 5.0 ± 1.1 cmH2O at 1.5-ml inflation ( P < 0.05; ANOVA). However, ETPant was unchanged from 0.5 ± 0.5 cmH2O ( n = 9; P = 0.17). Concurrently, Rua increased to 119 ± 4.2% of baseline value ( n = 12; P < 0.001) associated with a significant reduction in CSA between 10 and 70% of airway length to a minimum of 82.2 ± 4.4% of baseline CSA at 40% of airway length ( P < 0.05). We conclude that anterolateral loading of the upper airway extraluminal tissue space decreases upper airway patency via an increase in ETPlat, but not ETPant. Lateral pharyngeal fat pad size may influence UA patency via increased tissue volume and pressure causing UA wall compression.

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Obesity, The Single Most Important Risk Factor for OSA: A Case Report

Pulse ◽

10.3329/pulse.v10i1.38624 ◽

2018 ◽

Vol 10 (1) ◽

pp. 38-41

Author(s):

SMAA Mamun

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Clinical Symptoms ◽

Upper Airway ◽

Resonance Imaging ◽

Cross Sectional ◽

Airway Narrowing ◽

Fat Deposits ◽

Obstructive Sleep ◽

Normal Controls

Obstructive sleep apnea (OSA) is characterized by repetitive airflow reduction caused by collapse of the upper airway during sleep in addition to daytime sleepiness, clinical symptoms include fatigue, insomnia, and snoring. The condition is associated with adverse clinical outcomes, including cardiovascular disease, hypertension, cognitive impairment, and metabolic abnormalities.1 Among the risk factors for OSA, obesity is probably the most important. Several studies have consistently found an association between increased body weight and risk of OSA. Tomographic scanned images have shown that obesity causes increased fatty deposits in the pharyngeal area.2 The deposits encroach on the airway and contribute to airway narrowing. Also, among obese patients as compared to normal controls, fat deposits appear to alter the shape of the upper airway without necessarily reducing the cross-sectional area. M. A. Ciscar et al used magnetic resonance imaging to investigate differences between obese and normal controls.2 Ultrafast magnetic resonance imaging was used to study the upper airway and surrounding soft tissue in 17 patients with OSA during wakefulness and sleep, and in eight healthy subjects whilst awake. Coronal sections of awake OSA patients showed elliptical-shaped airways with long axes that were oriented anteroposterior; normal controls had airways that were oriented transversely. Studies using computed tomography have produced similar results.14Pulse Vol.10 January-December 2017 p.38-41

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Measurement of pharyngeal segments in Obstructive Sleep Apnea

Brazilian Dental Science ◽

10.14295/bds.2018.v21i1.1486 ◽

2018 ◽

Vol 21 (1) ◽

pp. 64

Author(s):

Marcos Marques Rodrigues ◽

Lucas Borin Moura ◽

Ariane De Souza Oliveira ◽

Marisa Aparecida Cabrini Gabrielli ◽

Valfrido Antonio Pereira Filho ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cone Beam Ct ◽

Sleep Apnea Syndrome ◽

Upper Airway ◽

Cone Beam ◽

Obstructive Sleep ◽

Intimate Relation ◽

The Mean ◽

Cephalometric Measurements

Objective: Obstructive Sleep Apnea (OSA) occurs by recurrent collapse of the upper airway during sleep. It results in complete (apnea) or partial (hypopnea) reduction of airflow and has intimate relation with the upper airway anatomy. Cephalometric analysis has been used to quantify airway dimensions. The aim of this study is evaluate the correlation between the anteroposterior dimension of the upper airway and the severity of obstructive sleep apnea. Material and Methods: A retrospective analysis was performed reviewing polysomnographic data (AHI) and anteroposterior cephalometric measurements of pharynx subregions: nasopharynx, oropharynx, hypopharynx. Results: The sample consisted of 30 patients. The mean body mass index was 29.60 kg/m2 and the average age was 46.8 years. Nine patients presented severe OSA, seven had moderate OSA , seven had mild OSA, and seven were healthy. The Pearson's correlation index between the anteroposterior dimension of the nasopharynx, oropharynx and hypopharynx and AHI was respectively -0.128 (p=0.517), -0.272 (p=0.162) and -0.129 (p=0.513). Conclusion: The correlation between anteroposterior linear dimension of the airway and OSA severity, assessed by AHI, was not positive. As an isolated parameter it did not correlate to the severity of the obstrucive sleep apnea syndrome and should be evaluated in conjunction with other factors. KeywordsUpper Airway; Obstructive sleep apnea; Cone beam CT.

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