To determine accurately the morphological characteristics specific to patients with sleep apneas syndrome (SAS), a group of 43 adult males with SAS was compared in a cephalometric evaluation with a homologous control group. In SAS patients, the soft palate was elongated; the sagittal dimensions of upper face and anterior cranial base were reduced and correlated with reduced bony pharynx opening; and the increased lower face height was associated with a retruded position of the chin and tongue, thus contributing to lower pharynx crowding. With the four variables entering the discriminant function analysis, 93 percent of the whole population was correctly classified. If anatomical rehabilitation of the pharynx is to be envisaged, the leading factors to consider should be: soft palate length, maxillary position, chin and tongue position, in that order.
"Lateral cephalometric characteristics of the soft tissue structures include a long soft palate, a long large tongue, and a long pharynx.9 Some of the studies reported that soft palate length was increased in patients with airway problems.10,16,19,20,22,28,30,31,40 In addition, soft palate length increases with age,41 and so that studies must match control subjects for age.28 "
[Show abstract][Hide abstract] ABSTRACT: The volume of air passing through the nose and nasopharinx is limited by its shape and diameter. Continuous airflow through the nasal passage during breathing induces a constant stimulus for the lateral growth of maxilla and for lowering of the palatal vault. Maxillary morphological differences exist between patients with airway problems and control groups, identifying a potential etiological role in these patients. The purpose of this article was to review the literature on the interaction between airway problems and expressed maxillary morphology including specific dental and skeletal malocclusions. Statistically significant differences were found between patients with airway problems and control groups, in maxillary skeletal morphology including shorter maxillary length, more proclined maxillary incisors, thicker and longer soft palate, narrower maxillary arch and higher palatal vault.
European journal of dentistry 07/2009; 3(3):250-4.
"The hyoid bone between the fourth and sixth cerebra vertebrae is located more inferiorly in OSA male patients than in healthy males. Retrognathia of both maxilla and mandible and increased lower face height have a strong relationship with OSA (Bacon et al., 1989; Tangugsorn et al., 1995; Kollias and Krogstad, 1999). Soft tissue factors can also predispose to OSA, for example tonsillar hyperthropy and obesity, which can cause fatty infiltration into the pharyngeal tissues (Erkinjuntti et al., 1990; Strollo and Rogers, 1996). "
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to cephalometrically compare pharyngeal changes between upright and supine positions in patients with upper airway resistance syndrome (UARS) or obstructive sleep apnoea (OSA). Eighty-two OSA patients, 70 men (mean age 49 +/- 11.8 years) and 12 women (45.9 +/- 8.3 years), underwent cephalometric sleep apnoea analysis. One upright and one supine radiograph were taken of each patient (a total of 164 cephalometric radiographs). The results showed no significant changes either in naso- or hypopharyngeal soft tissues between the two positions. In contrast, the shortest distance from the soft palate (ve1-ve2) and the tip of the soft palate (u1-u2) to the posterior oropharyngeal wall was significantly narrower (P < 0.001) in the supine position. Furthermore, in the supine position a slight thickening in the soft palate (sp1-sp2, P < 0.05) was detected with no change in the length of the soft palate (PNS-u1). The form of the tongue changed significantly: it was shorter (Tt-Tgo, P < 0.001; Tt-va, P < 0.001) and thicker (Ts/Tt-Tgo, P < 0.05) in the supine position. The present results suggest that OSA patients are prone to significant narrowing of their oropharyngeal, but not of their naso- or hypopharyngeal, airways in the supine position. Thus, treatment of OSA and UARS patients should mainly be aimed at preventing further oropharyngeal airway narrowing as a result of supine-dependent sleep.
The European Journal of Orthodontics 06/2004; 26(3):321-6. DOI:10.1093/ejo/26.3.321 · 1.48 Impact Factor
"Several anatomical and physiological factors have been suggested as causes of sleep apnoea, but the disorder is likely to be due to inter-related factors, which in the presence of sleep and decreased muscle tone, lead to airway occlusion . Many studies have suggested differences in craniofacial structure in sleep apnoea subjects, such as mandibular deficiency, bimaxillary retrusion, reduced cranial base length, increased lower face height, elongated soft palate, large base of tongue, and inferior position of the hyoid bone (Rojewski et al., 1984; Lowe et al., 1986, 1995; Bacon et al., 1989; Battagel and L'Estrange 1996). Soft tissue imaging of airway structures has been used to identify sites of mechanical obstruction, and a reduced pharyngeal airway "
[Show abstract][Hide abstract] ABSTRACT: Orthognathic surgery has been associated with airway narrowing and induction of sleep-related breathing disorders. Therefore, the pharyngeal airway dimensions of 32 orthognathic surgery cases were prospectively investigated, and the relationship between the surgery and sleep quality assessed. Digitized lateral cephalometric radiographs were used to compare oropharyngeal airway morphologies before and after surgery. Patients were assessed in two main surgical groups based on sagittal jaw relationship. A questionnaire was used to assess changes in daytime sleepiness. The mandibular surgery cases were also assessed by overnight domiciliary sleep monitoring. A significant decrease in the retrolingual airway dimension was found in all patients after mandibular setback surgery and a significant increase in this dimension after mandibular advancement. The questionnaire and sleep study revealed no significant changes in snoring incidence or apnoeic events after mandibular setback surgery. For the mandibular advancement group, a change in sleep quality was found, but only in cases with signs of a pre-existing sleep disorder.
Journal of orthodontics 10/2000; 27(3):235-47. DOI:10.1179/ortho.27.3.235
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