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ABSTRACT: To evaluate the effect of maxillary protraction on upper airway dimensions in skeletal Class III malocclusions and to investigate the relationship between changes in craniofacial morphology and upper airway dimensions.
22 patients who had maxillary retrognathism confirmed by cervical vertebral maturation and treated with face mask protraction. Pre- and post-treatment cephalometric radiographs were analyzed with SAS8.2 software package for paired t test and correlation analysis.
The dimensions of PNS-ad1,PNS-ad2,PSP-SPPW, P-MPW increased significantly (P<0.01), Tb-TPPW decreased significantly (P<0.05). The change of V-LPW was not significant (P>0.05).Correlation was found between changes of PNS-Ba and PNS-ad1, PNS-ad2,V-LPW (P<0.05);changes of Hy-H1 and P-MPW,V-LPW (P<0.05);changes of Hy-H0 and V-LPW (P<0.05). No correlation was found between other pharyngeal measurements and investigated craniofacial variables(P>0.05).
Maxillary protraction can affect the upper airway structures. In addition, variables on craniofacial morphology are relative with upper airway dimensions.
Shanghai kou qiang yi xue = Shanghai journal of stomatology 07/2009; 18(3):229-33.
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ABSTRACT: Obstructive sleep apnea and hypopnea syndrome (OSAHS) is characterized by disturbed sleep, excessive daytime sleepiness and heavy snoring. The possible causes are abnormal upper airway structure and factors of nerves and muscles, etc. Oral appliance is known as an effective treatment on mild and moderate OSAHS. This paper reviews anatomical changes of upper airway structure in OSAHS patients treated with oral appliance. Supported by Shanghai Leading Academic Discipline Project(Grant No.Y0203).
Shanghai kou qiang yi xue = Shanghai journal of stomatology 03/2008; 17(1):100-2.
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ABSTRACT: The purpose of this study is to investigate the mechanics of mandibular advancement devices (MAD) assisted uvulopalatopharyngoplasty (UPPP) for treatment of obstructive sleep apnea and hypopnea syndrome (OSAHS).
10 patients (8 males, 2 females) were diagnosed as OSAHS by PSG and operated by UPPP. Mandibular advancement devices was used after operation. One month later, all the patients were evaluated by PSG and cephalometric analysis. Paired t test and correlative analysis were carried out using SPSS 10.0 software package.
Cephalometric analysis indicated that MCF, angle C3-Rgn-H, Ant In Mx. Ht were significantly different before and after MAD treatment. AHI was correlative with Ant In Mx. Ht and ratio of tongue area and intermaxillary area(P<0.05).
MAD in patients undergoing UPPP results in changes of mandibular position, instead of changes of enlargement of velopharynx. Supported by Shanghai Leading Academic Discipline Project (Grant No.Y0203).
Shanghai kou qiang yi xue = Shanghai journal of stomatology 10/2007; 16(5):461-5.
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ABSTRACT: The fluid flow through curved tubes has characteristics that an increase in the curvature induces pressure losses as well as higher resistance in the same region. The purpose of this study is to analyze the relationship between upper airway curvature and obstructive sleep apnea and hypopnea syndrome(OSAHS).
18 male OSAHS patients were paired by age with 18 males with no snoring. The mean AHI was 58.8. The supine lateral cephalometric films were obtained from CT and analysed using curvature software. Data were presented as mean and paired t test was conducted using SPSS10.0 software package. Correlative analysis was performed to indicate the relationship between BMI and AHI, curvature and BMI, respectively.
The airway curvature was significantly different between the two groups(P<0.01). The curvature radius was significantly correlative with BMI (P<0.01), but not with AHI(P>0.05).
Upper airway curvature was related significantly to the pathogenesis of OSAHS. An increase of curvature on anterior wall of velopharynx in OSAHS patients can change the pressure and resistance distribution in upper airway. Supported by Shanghai Leading Academic Discipline Project (Grant No.Y0203).
Shanghai kou qiang yi xue = Shanghai journal of stomatology 08/2007; 16(4):381-4.
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ABSTRACT: To evaluate the feasibility and the results of the procedure of maxillomandibular advancement combined with uvulopalatopharyngoplasty for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS).
Nine cases of obese patients with severe OSAHS [age (47.8 +/- 9.7); body mass index (BMI) (35.3 +/- 2.5) kg/m(2); apnea and hypopnea index (AHI) (88.7 +/- 6.7) per hour] underwent the procedure of maxillomandibular advancement (MMA) combined with uvulopalatopharyngoplasty (UPPP). The patients were monitored by polysomnography (PSG) before operation and 3, 6, 12 months after operation, and cephalometric analysis and velopharyngeal closure function were evaluated at the same time.
The maxilla was advanced by (8.3 +/- 1.3) mm and the mandible and chin were advanced by (23.0 +/- 2.2) mm. AHI was (2.1 +/- 1.1) per hour post-operation. All patients had no speaking problem and swallowing difficulty and had a good appearance and occlusions. The OSAHS in this group of patients was cured.
Good short-term effects were observed with UPPP and MMA in the treatment of obese patients with severe OSAHS. It did not cause the velopharyngeal closure insufficiency and maxillary necrosis. A long-term follow-up is needed.
Zhonghua kou qiang yi xue za zhi = Zhonghua kouqiang yixue zazhi = Chinese journal of stomatology 05/2007; 42(4):199-202.
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ABSTRACT: To evaluate the efficiency of distraction osteogenensis for treatment of unilateral temporomandibular joint ankylosis and secondary OSAHS in children.
4 children with temporomandibular joint ankylosis and secondary OSAHS were retrospectively reviewed for their treatment. There were 2 males and 2 females, ranging from 5 to 13 years in age with the median of 6.5 years. Based on the history of the disease, the clinical manifestations, CT scan and PSG findings, the diagnosis was confirmed to be unilateral temporomandibular joint ankylosis and secondary OSAHS. All the patients were treated by gap arthroplasty to restore mouth opening, combined with mandibular body distraction osteogenesis for treatment of OSAHS. One-stage operation was performed on 3 patients, and two-stage operation on 1 patient. Unilateral and bilateral mandibular distraction osteogenesis was undergone on 2 patients individually. At the end of consolidation period of 3 months, the PSG examination was performed again and the distractor was removed.
OSAHS was cured, the average AHI was lowered from 42.7 to 4.9, the average lowest saturation of blood oxygen rose from 74.3% to 89.8%, the average incisor distance reached 25.5mm compared to 6.5mm before surgery and facial deformity was corrected satisfactorily. Following up 38.1 months (13-58 months), no relapse appeared.
Mandibular body distraction osteogenesis, combined with gap arthroplasty, could be the potential treatment modality for children with unilateral temporomandibular joint ankylosis, secondary OSAHS and facial asymmetry; it is recommended that both procedures be performed at the same time.
Shanghai kou qiang yi xue = Shanghai journal of stomatology 03/2006; 15(1):19-22.
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ABSTRACT: This study was aimed to set up a new method for reconstruction of maxillary defect with distraction osteogenesis through an animal experiment.
11 adult goats were randomly divided into 2 groups (9 in the experimental group and 2 in the control group) in this study. 3 subgroups were set up in the experimental group based on the consolidation period. Other 2 goats were chosen as the control group. Maxillary defect was made firstly through partial maxillectomy for the experimental group. Length of the defects was from 12 to 14mm with an average of 12.7mm. A transport disc was then made through anterior Le Fort I osteotomy and it would be shifted backward for the closure of the defect. Only maxillary defect was made for the control group. Distraction was activated after a latency of 7 days at a rate of 0.4mm twice a day for 15-18 days.
Bone defects in the maxilla were well repaired when the transport disc was distracted back to its original position. Radiology and histology demonstrated good new bone formation in the distraction gap.
Transport distraction osteogenesis would be a reasonable method for reconstruction of maxillary defect. Supported by Shanghai Leading Academic Discipline Project(Y0203)and Shuguang Project of Shanghai Education Committee(02SG46).
Shanghai kou qiang yi xue = Shanghai journal of stomatology 01/2006; 14(6):601-4.
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ABSTRACT: To investigate the histological and ultrastructural variations after radiofrequency volumetric reduction of the soft palate in an animal model.
Thirteen porcines were used to evaluate the tissue response to radiofrequency for various time periods. They were divided into two groups. Group 1 was exposed to radiofrequency in the midline of the soft palate with a constant energy of 2.4 KJ. Group 2 served as a control group. The animals in group 1 were sacrificed after 1 hour, 24 hours, 48 hours, 72 hours, 1 week, 2 weeks, 3 weeks, 4 weeks, 6 weeks and 9 weeks, respectively, and after 72 hours, 2 weeks and 4 weeks for the animals in group 2. Then the soft palates from both groups were examined for histological and ultrastructural variations.
Interstitial edema, hemorrhage and infiltration with inflammatory cells were observed in the early acute stage after radiofrequency, and then the neovascularization of the forming scar was observed. In the end, the injured tissue was replaced by collagenous fibers. Intact vessels and nerves were observed around the lesions.
After radiofrequency, lesion tissue is replaced by collagenous fibers, and it is focused on the lesion site. These findings may help provide a basis for technological suggestion in regard to clinical treatment.
Shanghai kou qiang yi xue = Shanghai journal of stomatology 01/2005; 13(6):534-8.
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ABSTRACT: This study was undertaken to analyze the anatomical location of hypoglossal nerve at tongue base of male adults to avoid creating a function deficit during radiofrequency of tongue base in OSAHS.
Ten tongues of male adults in frozen were coronally dissected at foramen cecum, 5 mm,10 mm, 15 mm before/after the foramen cecum. Vertical and horizontal distance of hypoglossal nerve to the surface and middle line of the tongue were measured using computer image procession in micrometer. The data were analyzed with such statistical methods as descriptive statistics, paired t-testing, linear correlation analysis.
(1) The anatomical location of the bi-lateral hypoglossal nerve is symmetrical in principle. (2) At the tongue base: The distance of hypoglossal nerve to the surface is 22.21+/-2.22 mm, and has no correlation to the length and the width of the tongue. There are some regularities of the anatomical location of the hypoglossal nerve before/after the foramen cecum. Before the foramen cecum the hypoglossal nerve is located in the mid-medial (21.89+/-1.93)% and after the foramen cecum is in the mid-medial (28.61+/-2.66)%.
We conclude that if the depth of the needle-polar penetrating into the tongue base doesn't exceed (22.21+/-2.22)mm, and keep away from mid-medial (21.89+/-1.93)% ( before the foramen cecum ) or mid-medial (28.61+/-2.66)% after the foramen cecum, it may be helpful to avoid creating a function deficit when radiofrequency tongue base in snoring and OSAHS is performed.
Shanghai kou qiang yi xue = Shanghai journal of stomatology 09/2004; 13(4):301-4.
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ABSTRACT: To apply the treatment of distraction osteogenesis(DO) to obstructive sleep apnea-hypopnea syndrome(OSAHS) patients with croniomaxillofacial deformities.
All 46 OSAHS patients with micrognathia are had polysomnography(PSG) study and cephalometric analysis. Their age from 4 to 18 years old, the mean age is 11.4. The number of temporal mandibular joint (TMJ) ankylosis with micrognathia, micrognathia; 1st & 2nd bronchial arch syndrome and crouzon syndrome patients were 32, 9, 2 and 3 respectively. All were treated with DO. Maxilla or mandible was advanced from 5 to 35 micrometers; the mean advanced distance is 18.34 mm. They were all revaluated by PSG and cephalometric analysis postoperatively.
All patients have good respond to the treatment. They have a better appearance and the narrow upper airway was enlarged remarkably, their AHI drop from 66.31 +/- 14.74 pre-operately to 3.16 +/- 1.70 pro-operately, and minimal posterior airway space(PAS) from (5.48 +/- 2.76) mm to (9.97 +/- 2.05) mm. There is remarkable difference (P < 0.001).
DO is a good method for the patients of OSAHS with micrognathia.
Zhonghua er bi yan hou ke za zhi 06/2003; 38(3):166-71.
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Shanghai kou qiang yi xue = Shanghai journal of stomatology 03/2003; 12(1):65-8.
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Shanghai kou qiang yi xue = Shanghai journal of stomatology 10/2002; 11(3):265-7.
