Efficacy of Maxillomandibular Advancement Examined with Drug‐Induced Sleep Endoscopy and Computational Fluid Dynamics Airflow Modeling

Liu, Stanley Yung‐Chuan; Huon, Leh-Kiong; Iwasaki, Tomonori; Yoon, Audrey; Riley, Robert; Powell, Nelson B.; Torre, C. de la; Capasso, Robson

doi:10.1177/0194599815611603

Cited by 67 publications

(54 citation statements)

References 32 publications

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“…1,2 The new anatomy of this region establishes a breathing pattern characteristically seen in patients with obstructive sleep apnea (OSA). 3 Although the etiology of OSA is a multifactorial conundrum, obstruction of the upper airway due to collapse of the surrounding soft tissues, especially from the retropalatal and retroglossal regions, is a pivotal factor. 4 Many studies have been performed to help understand the effect of mandibular setback surgery on airway volume.…”

Section: Introductionmentioning

confidence: 99%

“…12 Although evidence is available for the effects of mandibular setback on airway volume, to the best of our knowledge no study has been performed to evaluate the effects of mandibular setback on changes in airway pressure and, subsequently, on airflow characteristics. 3,5,[7][8][9][13][14][15][16][17] Thus, the aim of this study was to use CFD to evaluate the changes in pharyngeal airflow characteristics before and after mandibular setback surgery in skeletal Class III patients.…”

Section: Introductionmentioning

confidence: 99%

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

Shah

Kim

McQuilling

et al. 2016

The Angle Orthodontist

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Following mandibular setback surgery, pharyngeal airway volume was decreased and relative mean negative pressure was increased, implying an increased effort required from a patient for maintaining constant pharyngeal airflow. Thus, high-risk patients undergoing a large amount of mandibular setback surgery should be evaluated for obstructive sleep apnea and the proposed treatment plan be revised based on the risk for potential airway compromise.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Shah

Kim

McQuilling

et al. 2016

The Angle Orthodontist

View full text Add to dashboard Cite

show abstract

“…While the field may go beyond NOHL and VOTE to more quantitative methods for describing results, the DISE will be justified in the planning for other surgical procedures, such as mandibular-maxillary advancement or robotic approaches to the base of the tongue 48 , or intervention with oral appliances 49 , especially when there is CPAP failure 50 .…”

Section: The Vote Classificationmentioning

confidence: 99%

Insights since FDA Approval of Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

Strohl

Yamauchi

Peng

2017

Curr Sleep Medicine Rep

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Purpose The literature on hypoglossal nerve stimulation (HNS) for the treatment of moderate-to-severe obstructive sleep apnea (OSA) was reviewed from 2014, the time of FDA approval for the Inspire Systems device, to 2017 for themes that might be useful conceptually and practically in the consideration of this new non-anatomic surgical therapy. Recent Findings there are now further follow-up articles since the 12-month results for Apnea Reduction (STAR) trial of the Inspire device, and post-approval publications which report similar and/0r improved AHI outcomes. Other emerging themes include drug-induced sedation endoscopy (DISE) as a tool in assessment of eligibility and a more detailed understanding of mechanisms for an HNS effects. Summary The post-STAR literature provides guidelines for an integrated coordination of medicine and surgery to appropriately screen and manage patients.

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“…[20] This is supported by the finding that airway stenosis is observed at the level of the velopharynx and oropharynx in many patients with OSA. [21][22][23][24][25][26] We conducted this study to determine the effect of positional changes in the maxillomandibular complex on the airway. We performed bimaxillary orthognathic surgery in one patient and acquired CBCT images preoperatively (T0), postoperatively (T1), and 7 months postoperatively 7 (T2).…”

Section: Discussionmentioning

confidence: 99%

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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Efficacy of Maxillomandibular Advancement Examined with Drug‐Induced Sleep Endoscopy and Computational Fluid Dynamics Airflow Modeling

Abstract: AHI and ODI improvement after MMA is best correlated with (1) decreased retropalatal airflow velocity modeled by CFD and (2) increased lateral pharyngeal wall stability based on VOTE scoring from DISE.

Cited by 67 publications

References 32 publications

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

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

Insights since FDA Approval of Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

Application of Computational Fluid Dynamics Analysis after Bimaxillary Orthognathic Surgery

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