Computational fluid dynamics for the assessment of upper airway changes in skeletal Class III patients treated with mandibular setback surgery

Shah, Darshit H; Kim, Ki Beom; McQuilling, Mark; Movahed, Reza; Shah, Ankit; Kim, Yong I.

doi:10.2319/122715-892.1

Cited by 26 publications

(26 citation statements)

References 19 publications

(36 reference statements)

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“…The mean Reynolds numbers without MAD-with MAD at the inlet are (1588-1358) and, in the minimum cross-sectional area in the velopharynx are (2625-1844). These values corresponded to that observed in the literature 23,25,26 . Moreover, the values of mean maximum velocity magnitudes at the minimum cross-sectional area without and with MAD are (7.08-4.21) m/s, aligned well with those reported in other computational studies 23,26 .…”

Section: Flow Characteristics Flow Characteristics Are Summarized Insupporting

confidence: 91%

Physiological and geometrical effects in the upper airways with and without mandibular advance device for sleep apnea treatment

Martínez

Muñiz

Soudah

et al. 2020

Sci Rep

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Sleep apnea is a sleep disorder that occurs when the breathing of a person is interrupted during the sleep. This interruption occurs because of the patient has narrowed airways and the upper airways muscles relax, closes in and blocks the airway. Therefore, any forces or reaction originated by the air flow dynamics over the relaxed upper airways muscles could make to close the upper airways, and consequently the air could not flow into your lungs, provoking sleep apnea. Fully describing the dynamic behavior of the airflow in this area is a severe challenge for the physicians. In this paper we explore the dynamic behavior of airflow in the upper airways of 6 patients suffering obstructive sleep apnea with/ without a mandibular advancement device using computational fluid dynamics. The development of flow unsteadiness from a laminar state at entry to the pharynx through to the turbulent character in the soft palate area is resolved using an accurate numerical model. Combining the airflow solution with a geometrical analysis of the upper airways reveals the positive effects of mandibular advance device in the air flow behavior (pressure drop). Improved modeling of airflow and positioning of mandibular advance device could be applied to improve diagnosis and treatment of obstructive sleep apnea.

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Section: Flow Characteristics Flow Characteristics Are Summarized Insupporting

confidence: 91%

Physiological and geometrical effects in the upper airways with and without mandibular advance device for sleep apnea treatment

Martínez

Muñiz

Soudah

et al. 2020

Sci Rep

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“…To apply CFD simulation to such a "flabby" organ, it was reconstructed into a simple shape. CFD simulation applied to the reconstructed airway was helpful in effectively analyzing the airflow pattern according to the individual patient's airway type [10,11,25,27,28].…”

Section: Discussionmentioning

confidence: 99%

“…CFD simulation applied to the reconstructed airway was helpful in effectively analyzing the airflow pattern according to the individual patient's airway type. [10,11,25,27,28] Analysis revealed that the velopharynx at T1 was narrowed, but the oropharynx was rather widened. This is assumed to be a result of the upward movement of the maxillomandibular complex because the position of the hyoid bone did not change immediately after the operation, and the distance from the mandible was increased.…”

Section: Discussionmentioning

confidence: 99%

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Application of Computational Fluid Dynamics Analysis after Bimaxillary Orthognathic Surgery

et al. 2020

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Bimaxillary orthognathic surgery is widely used to treat skeletal class III malocclusion. Changes in jaw position affect the shape of surrounding soft tissues. We used computational fluid dynamics (CFD) simulation to observe changes in airways observed in a patient who underwent bimaxillary orthognathic surgery. For CFD simulation, we performed cone beam computed tomography (CBCT) preoperatively (T0), 3 days postoperatively (T1), and 7 months postoperatively (T2). The values of velocity, pressure drop (ΔP), and wall shear stress all increased 7 months after surgery (Vmax 7.038 m/s to 12.054 m/s, ΔP −7.723 Pa to −53.739 Pa, WSSmax 4.214 Pa to 14.323 Pa). Locations where the velocity and pressure gradients are large included the velopharynx, oropharynx, and epiglottis, with narrow cross-sectional areas. Wall shear stress was also observed at these locations. The velopharynx, oropharynx, and epiglottis are structures most vulnerable to morphological changes, that is, they can easily become obstructed.

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“…Computational fluid dynamics studies have been applied to model the flow field and pressure drop in the UA in SAHS using patient specific geometrical models obtained from medical imaging. These studies have allowed the understanding of the flow characteristics in the UA after a pharyngeal surgery [9] [16] [10] [14] and to determinate treatment response using MAD [15] [12] [13]. In [15] [13] studies combining CFD and medical imaging found a strong correlation between change in airway resistance with and without MAD.…”

Section: Introductionmentioning

confidence: 99%

Computational Fluid Dynamics and Functional Imaging in the Evaluation of Mandibular Advancement Device Positioning

Martínez¹,

Muñiz²,

Soudah³

et al. 2018

World Congress on Electrical Engineering and Computer Systems and Science

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Mandibular Advancement Devices (MAD) have emerged as an accepted substitute of continuous positive airway pressure for the treatment of mild to moderate sleep apnea-hypopnea syndrome (SAHS). These devices bring the mandible forward and back enlarging the upper airway(s) area avoiding its collapsibility. However, to determine the mechanism of MAD positioning is relatively complex and remains a clinical challenge. If the MAD is not adjusted/titrated correctly, it may not have the desired results, and consequently, a reduced treatment response. Therefore, it is of great interest and importance to provide further data/evidence to the clinician by assessing the characteristics of the clinical response of the MAD titration. In this research, we combine computed tomography images and computational fluid dynamics to understand that the effects that the use of MAD has on the upper airway (UA). To achieve this, 10 patients suffering mild-to-moderate apnea were analyzed using MAD in two different scenarios (mandibular antepulsion and open mouth). The purpose of this study is to determine differences in effectiveness between two positioning of the same mandibular advancement device. For both scenarios the total volume, cross-sectional areas, velocities and pressure of the upper airways were studied and compared with the rest position (without MAD). The methodology used in this study may prove valuable in predicting which SAHS patients will benefit from treatment with oral appliances like MAD and may be also used as a potential clinical procedure to understand its titration and use.

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Computational fluid dynamics for the assessment of upper airway changes in skeletal Class III patients treated with mandibular setback surgery

Cited by 26 publications

References 19 publications

Physiological and geometrical effects in the upper airways with and without mandibular advance device for sleep apnea treatment

Physiological and geometrical effects in the upper airways with and without mandibular advance device for sleep apnea treatment

Application of Computational Fluid Dynamics Analysis after Bimaxillary Orthognathic Surgery

Computational Fluid Dynamics and Functional Imaging in the Evaluation of Mandibular Advancement Device Positioning

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