Cephalometric evaluation of pharyngeal obstructive factors in patients with sleep apnea syndrome
University Hospital, Strasbourg, France. The Angle Orthodontist
(Impact Factor: 1.23).
02/1990; 60(2):115-22. DOI: 10.1043/0003-3219(1990)060<0115:CEOPOF>2.0.CO;2
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.
Available from: journals.viamedica.pl
- "Compared to the norm according to McNamara, 97.6% of our patients with OSA had reduced sagittal dimensions at the soft palate level, whereas 75.6% – at the tongue base level. The reduced values of the sagittal dimensions of the upper airways were reported by many authors[3,22,23,24,25,30]. Only Allhaija et al. did not find a correlation between the changes in the ANB angle dimensions and anterior-posterior dimensions of the upper airway "
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Obstructive sleep apnoea (OSA) is characterised by at least five 10-second episodes of apnoea or markedly shallow breathing per hour of sleep, which can lead to severe, sometimes life-threatening complications. It is essential to determine the specific features of the affected patients' craniofacial structure, thus enabling their allocation to risk groups. The aim of the study was to assess the craniofacial structure in OSA patients, comparing the findings with Hasund's and Segner's cephalometric norm values. In addition, the sagittal dimensions of the upper airways, measured at two levels, were compared to McNamara's norm values.
Materials and methods:
The study covered 41 patients diagnosed polysomnographically with OSA. Lateral cephalograms with cephalometric analysis and the measurements of the upper and lower sagittal dimensions of the upper airways were taken for each patient.
The only feature of the patents' facial skeleton that significantly diverged from the norm was the SNB angle (p=0.004). Other angles, i.e. SNA, ANB, NL/NSL, NL/ML and NSL/ML, were not significantly different from the norm. The average upper cross-sectional area of the upper airways was 10.4 mm; in 97.6% patients, this measurement was below McNamara's norm values. In the majority of patients (75.6%), the average lower sagittal dimension of the upper airways (10.4 mm) was also below the norm.
Mandibular retrognathia, manifested by the reduced SNB angle, and the narrowed upper and lower sagittal dimensions of the upper airways can be considered one of OSA prognostic factors.
Available from: PubMed Central
- "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 "
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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.
Available from: Kirsti Hurmerinta
- "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). "
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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.
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