Airway Volume Simulation in Virtual Mandibular Distraction: A Cohort Study

Humphries, Laura S.; Yates, Essie K.; Mhlaba, Julie M.; Collins, John M.; Baroody, Fuad M.; Reid, Russell R.

doi:10.1097/prs.0000000000004249

Cited by 8 publications

(7 citation statements)

References 18 publications

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“…25 3D reconstructions are obtained and volumetric analysis of the upper airway is performed and frequently used in preoperative planning. 14,16,26 Previous studies have demonstrated that mandibular distraction is effective in expanding the upper airway. 10,[27][28][29] However, predicting how much expansion is necessary to affect a physiologic response is challenging, 16 and an arbitrary percentage of volume increase is often used to determine the approximate length of mandibular advancement.…”

Section: Discussionmentioning

confidence: 99%

Creating Normative Growth Curves for Pediatric Upper Airway Volume

Prescher

Jiang

Siddiqui

et al. 2023

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Background: The objective of this study was to create normative growth curves for pediatric upper airway volume using 3D computed tomography with emphasis on the neonatal age group. Methods: We completed a single-institution, retrospective review of all patients with available CT scans between the ages of 0 and 60 months. Patients were excluded if they exhibited any maxillofacial dysmorphism or upper airway pathology or if scans showed the presence of airway appliances or tubes. 3D volumetric upper airway analysis was performed and 2D cephalometric measurements and growth parameters including height, weight and age were recorded for all patients. Linear regression analysis was used to develop a prediction model for airway volume in terms of age adjusting for cephalometric and growth parameters stratified by sex and the resulting model was used to create separate percentile curves for each sex group. Results: The growth curves were created based on CT scans from 217 healthy patients. Mean airway volume was significantly larger in males than females (3.23 ± 1.98 mm3 vs 2.61 ± 1.64 mm3, p = 0.017). Conclusions: Normative growth curves for neonatal and pediatric upper airway volume are a useful tool for tracking changes in airway volume in the growing infant.

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Section: Discussionmentioning

confidence: 99%

Creating Normative Growth Curves for Pediatric Upper Airway Volume

Prescher

Jiang

Siddiqui

et al. 2023

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“…VSP has emerged in an attempt to increase the precision of MDO by establishing a target endpoint to distraction based on anticipated airway volume changes. 17-19 Previous studies have demonstrated a high correlation between VSP-predicted and actual airway volume changes post-distraction. 17 However, these static predictions do not provide a physiologic measurement of the frequency and severity of OSA and do not correlate with physiologic improvements on post-distraction PSG.…”

Section: Discussionmentioning

confidence: 99%

“…The use of virtual surgical planning (VSP) based on patient-specific 3D reconstructed CT scans can help establish a target endpoint for distraction. 16-18 However, this endpoint does not always correlate precisely with resolution of OSA and the patient’s clinical symptoms are likewise an imprecise measure of OSA severity. Post-distraction PSG therefore plays a critical role, as the only quantitative physiologic assessment of OSA severity, in evaluating persistent OSA and the subsequent need for further distraction once the initial predicted target endpoint has been reached.…”

Section: Introductionmentioning

confidence: 99%

Polysomnography in the Early Consolidation Phase of Mandibular Distraction as a Tool to Identify Residual Tongue-Based Airway Obstruction and Need for Further Distraction: A Follow-Up Study

Prescher

Mokhlesi

Mhlaba

et al. 2021

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Background: The objective of this study was to analyze and report our experience with using polysomnography (PSG) during the early consolidation phase of mandibular distraction osteogenesis (MDO) in patients with Pierre Robin Sequence and associated tongue-based airway obstruction with management decisions informed by the results. The secondary objective was to determine whether pre-operative PSG can predict which patients will have persistent obstructive sleep apnea (OSA) and require additional distraction. Methods: A single-surgeon, retrospective review was performed of all patients who underwent MDO for treatment of tongue-based airway obstruction over an 11-year period. Pre-operative and post-distraction 16-channel overnight bedside PSG was performed on all patients and scored according to the AASM Scoring Manual. Patients who demonstrated persistent OSA underwent further distraction and were reevaluated by PSG after final distraction length was achieved. Results: Pre-operative and post-distraction PSG was obtained and available for analysis in 37 patients. Apnea-Hypopnea Index (AHI) improved from 45.85 ± 34.41 to 9.73 ± 10.85 ( P < .001). There was evidence for persistent, severe OSA in 14 patients (38%) and persistent, moderate OSA in 6 patients (16%) in the early consolidation phase of MDO. Nine of these patients underwent additional distraction and demonstrated symptomatic resolution and quantitative improvement in all PSG measures. The group of patients that underwent additional distraction had significantly more severe baseline OSA as defined by preoperative AHI, oxygen desaturation index (ODI), and percentage of time spent below 90% SpO2. There was no significant difference in patient characteristics or pre-operative symptoms between the 2 groups. Conclusions: PSG can be performed at the bedside at the end of the distraction phase of MDO to assess for residual airway obstruction and inform the need for further distraction. Pre-operative PSG measures can help predict the need for further distraction and aid in operative planning and distractor placement.

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“…Second, an understated feature of VSP is the ability to simulate soft tissue changes that occur from virtual surgery, including external soft-tissue elements such as facial contours and airway simulation. 51 52 Though some limitations in VSP software exist in terms of soft-tissue modeling, the ability to compare simulated and postoperative airway volumes and external soft tissue drape can be used as a modicum of quality control.…”

Section: Anatomic and Technical Considerationsmentioning

confidence: 99%

Virtual Planning and 3D Printing in Contemporary Orthognathic Surgery

Roy

Steinbacher

2022

Semin Plast Surg

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Orthognathic surgery is a powerful tool to improve facial balance, form, and function. Virtual planning and three-dimensional printing has improved our ability to visualize complex anatomy, consider various iterations and execute complex movements, and create accurate splints, plates, and cutting guides. This article will outline the distinct advantages of the use of virtual surgical planning over traditional planning, and it will explore the utility of computer-aided design and technology within contemporary orthognathic surgery, including its expanded applications and limitations.

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Airway Volume Simulation in Virtual Mandibular Distraction: A Cohort Study

Abstract: Predictive airway volume calculation may be an effective adjunct to determine anatomic endpoint of mandibular distraction but small sample size, operator and software variability, and patient airway morphology may confound firm conclusions. Further studies are warranted.

Cited by 8 publications

References 18 publications

Creating Normative Growth Curves for Pediatric Upper Airway Volume

Creating Normative Growth Curves for Pediatric Upper Airway Volume

Polysomnography in the Early Consolidation Phase of Mandibular Distraction as a Tool to Identify Residual Tongue-Based Airway Obstruction and Need for Further Distraction: A Follow-Up Study

Virtual Planning and 3D Printing in Contemporary Orthognathic Surgery

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