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Objective-To compare the Cone-Beam Computerized Tomography (CBCT) scan measurements between patients with Obstructive Sleep Apnea (OSA) and snorers to develop a prediction model for OSA based on CBCT imaging and the Berlin Questionnaire.Materials and methods-80 subjects (46 OSA patients with Apnea-Hypoapnea Index [AHI]≥ 10 and 34 snorers AHI<10 based on ambulatory somnographic assessment) were recruited through flyers and mail at USC School of Dentistry and at a private practice. Each patient answered the Berlin Questionnaire, and was imaged with CBCT in supine position. Linear and volumetric measurements of the upper airway were performed by one blinded operator and multivariate logistic regression analysis was used to identify risk factors for OSA.Results-OSA patients were predominantly male, older, had a larger neck size and larger Body Mass index than the snorers. The minimum cross-sectional area of the upper airway and its lateral dimension were significantly smaller in the cases. Airway uniformity defined as the minimum crosssectional area divided by the average area was significantly smaller in the OSA patients.Conclusions-Age>57 years, male gender, a "high risk" Berlin Questionnaire and narrow upper airway lateral dimension (<17mm) were identified as significant risk factors for OSA. The results of this study indicate that 3-dimensional CBCT airway analysis could be used as a tool to assess the presence and severity of OSA. The presence and severity (as measured by the RDI) of OSA is

Objective-To examine the influence of aging and body-mass-index (BMI) on the oropharynx configuration in male and female Japanese patients.Study design-This study examined the computed tomography (CT) images of 19 male and 19 females, group matched for age and BMI. The airway and the soft tissue volumes between the posterior nasal spine and top of the epiglottis were compared.Results-The patient's height, total oropharynx length (TOL), and lower oropharynx lengths and volume measurements (soft tissue and airway) demonstrated statistically significant gender differences. Men consistently had larger TOL and volumes than women. In men, TOL changed with age, and age was a significant predictor of lower oropharynx length. In males, the upper oropharynx soft tissue volume decreased significantly with age and lower oropharynx soft tissue volume increased significantly with age. In females no significant relationship was identified.Conclusion-The airway lengthens with aging in males and we speculate that it becomes more collapsible, which in turn could contribute to obstructive sleep apnea.

From our results, it is suggested that we are not able to eliminate the influence of parafunction for the prosthesis only by designing the surface of occlusal splint using the semi-adjustable articulator. Our splint may have the potential to detect specific facets due to parafunctions as nocturnal bruxism.

Background-The narrowest area of the airway between the posterior nasal opening and the epiglottis is usually located in the retro palatal area. Many consider this the most likely site of airway obstruction during an obstructive sleep apnea (OSA) event. The aim of this study was to investigate the differences in soft palate and airway length between OSA and non-OSA patients.

The objective of this study is to evaluate usefulness of mandibular reconstructions using a custom-made titanium mesh (Ti-mesh) tray and particulate cancellous bone and marrow (PCBM). A consecutive nine patients who underwent mandibular reconstruction were enrolled in this study. They were five men and four women (mean age: 53.9 years). Virtual reality simulation was performed using computer software based on the pre-operative computed tomography data. A 3-dimensional (3-D) skull model was constructed using a 3-D printer. A tray was custom-made from a Ti-mesh sheet bent to adapt to the model. After PCBM harvesting from bilateral posterior ilia, the tray was fixed to the host bone. New bone formation and configuration of the reconstructed mandible were assessed radiologically. Complications were recorded in each patient during the follow-up period. Patients, satisfaction with post-operative facial contour was evaluated using a visual analogue scale (VAS score, range = 0-100). In six of nine patients, excellent new bone formation was recognised and expected results were radiologically achieved. Complications occurred in four patients. These complications included Ti-mesh fracture, Ti-mesh exposure in the oral cavity, and delayed infection. Mean VAS score on patient satisfaction was 77.6. Although the data are preliminary, the results suggest that this method is clinically useful.

Most obstructive sleep apnea (OSA) patients are overweight, and OSA is substantially more common in obese individuals. In morbidly obese patients, at least 70% suffer from OSA. However, the exact mechanism by which obesity causes OSA is unclear. The aim of this study is to evaluate the retroglossal airway configuration quantitatively and to make clear the relationship between Body mass index (BMI) and airway configuration. This retrospective study included 15 OSA patients (male = 11; female = 4) and 14 normal controls (male = 8; female = 6). We studied the airway configuration on an axial slice at the level of the anterior-inferior corner of the second cervical vertebra. Maximum anterior-posterior diameter (AP) and lateral width (LW) of the airway were measured, and the square area (SA) was calculated. The airway cross-section area (AWA) was also measured, and then the AWA/SA ratio was calculated. AP, LW, and AWA were not statistically significantly different between controls and OSA patients. On the other hand, the AWA/SA ratio in OSA patients was 8.8% statistically significantly smaller than in controls after adjusting for sex, age, and BMI. In this sample, there was a negative correlation between age and the AWA/SA ratio but only in the OSA group. The AWA/SA ratio was significantly negatively correlated with OSA status (R = -0.5; p = 0.008) after adjusting for BMI and age. In this present study, we could evaluate the retroglossal airway configuration quantitatively. The AWA/SA ratio was correlated with OSA status after adjusting for BMI and age.

Objective To compare the incidental radiographic findings in the maxillofacial structures and the pharyngeal airway between moderate/severe Obstructive Sleep Apnea (OSA) subjects and mild OSA/normal subjects using Cone-Beam Computed Tomography (CBCT) scans. Study Design 53 moderate/severe OSA subjects (with a Respiratory Disturbance Index [RDI]≥15 events/hr) and 33 mild OSA/normal subjects, (RDI<15) based on ambulatory somnographic assessment were recruited. Supine CBCT’s were taken and sent for radiological report. The incidental findings were compared between the two groups. Results Moderate/severe subjects had larger prevalence of conchae bullosa, hypertrophic turbinates, hypertrophic tonsils, elongated or posteriorly placed soft palate, narrower airway, enlarged tongue, and focal calcifications, though no significant differences were found. Conclusions CBCT is useful in identifying maxillofacial and airway anomalies that could interfere with normal breathing. However, no significant difference was found in prevalence of incidental findings between moderate/severe OSA and mild/normal subjects. Further studies are necessary to generalize our results.