Obstructive sleep apnea (OSA) is characterized by episodes of pharyngeal collapse during sleep. Craniofacial alterations such as retrognathia are often found in OSA patients. Maxillomandibular advancement (MMA) surgeries increase the pharyngeal space and are a treatment option for OSA. The aim of this study was to present a successful case of MMA surgery in the treatment of OSA. A patient with moderate OSA (apnea-hypopnea index (AHI)=25.2) and mandibular retrognathism and Maxillomandibular asymmetry underwent MMA surgery. The apnea-hypopnea index (AHI) were considerably improved after six months (IAH =6.7) and one year of treatment (IAH=0.2).
The cone beam computed tomography (CBCT) image provides clear differentiation of soft tissues from empty spaces. This paper presents a literature review to evaluate the effects of orthopedic and surgical treatment on the pharyngeal dimension by CBCT. It was concluded that treatments involving dentofacial orthopedics and orthognathic surgery have been related with an increase in the upper airway volume. Standardized capturing of tomographic images and more controlled and randomized studies are necessary.
Objective: This study aimed to evaluate the efficacy of mandibular exercises for the prevention of temporomandibular disorder (TMD) during Obstructive Sleep Apnea (OSA) treatment with mandibular advancement device (MAD) in patients without TMD symptoms. Material and methods: Nineteen subjects with mild to moderate OSA were included. Patients were randomized into two groups: a control group and a support therapy group. Both groups received the MAD at 75% of their maximum protrusion. The support therapy group was instructed to perform mandibular exercises two times per day. Pain was assessed by an analogical pain scale during progressive protrusion at the 4 th , 12 th and 16 th week. The Research Diagnostic Criteria for Temporomandibular disorders (RDC-TMD) were applied at the initial evaluation and at 16 th week. Student's t-test, paired t-test, ANOVA, Friedman's ANOVA and chi-square were performed for statistics analyses. Results: A total of 19 subjects, 10 in the support therapy group and 9 in the control group completed the protocol. According to the analogical pain scale and the RDC-TMD, none of the patients from either group experienced temporomandibular pain.
Background:The efficacy of mandibular advancement devices (MAD) in the treatment of obstructive sleep apnea (OSA) varies widely among patients, and at present it is difficult to predict success. Previous studies have shown a relationship between a gain in pharyngeal volume with MAD in situ and the success of the treatment. The aim of this study was to evaluate this change in volume of the upper airway using cone beam computed tomography (CBCT), measured at a baseline of maximum intercuspation (T0) and at maximum protrusion (T1) using a George Gauge to simulate a MAD produced protusion, and investigate whether this change in volume can be used to predict success with MAD.
Objectives: The purpose of this study was to use standardized digital facial photography to investigate craniofacial and cervical characteristics of individuals with obstructive sleep apnea (OSA) and the possible associations between these characteristics and polysomnographic data.
Material and methods:The final sample included 50 individuals with OSA (Apnea Hypopnea Index -AHI > 5) and 10 controls (AHI < 5). All subjects underwent a history and physical examination with measurements of anthropometric parameters and overnight polysomnographic records. Anthropometric assessment and standardized frontal-profile facial photographs were performed prior to polysomnography.
Results:Higher AHI was associated with alterations in the cervical area, where the neck circumferences were significantly increased. We observed an interaction between the craniofacial and anthropometric variables with the polysomnographic variable. Specifically, when there was increased superior facial third (P=0.032), inferior facial third (P=0.039) and cervical circumference (P=0.050), there was a greater chance of having AHI over 5.
Conclusions:Using craniofacial measurements in standardized photographs and anthropometric measurements, the vertical facial pattern and the neck circumference are the strongest predictors of OSA.
IntroductionObjective evaluation of sleep bruxism (SB) using whole-night polysomnography (PSG) is relevant for diagnostic confirmation. Nevertheless, the PSG electromyogram (EMG) scoring may give rise to controversy, particularly when audiovisual monitoring is not performed. Therefore, the present study assessed the concordance between two independent scorers to visual SB on a PSG performed without audiovisual monitoring.MethodsFifty-six PSG tests were scored from individuals with clinical history and polysomnography criteria of SB. In addition to the protocol of conventional whole-night PSG, electrodes were also placed bilaterally on the masseter and temporal muscles. Visual EMG scoring without audio video monitoring was scored by two independent scorers (Dentist 1 and Dentist 2) according the recommendations formulated in the AASM manual (2007). Kendall Tau correlation was used to assess interobserver concordance relative to variables “total duration of events (seconds), “shortest events”, “longest events” and index in each phasic, tonic or mixed event.ResultsThe correlation was positive and significant relative to all the investigated variables, being T>0.54.ConclusionIt was found a good inter-examiner concordance rate in SB scoring in absence of audio video monitoring.
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