Friedman tongue position and cone beam computed tomography in patients with obstructive sleep apnea

Abstract

ObjectiveEvaluate the correlation between Friedman Tongue Position (FTP) and airway cephalometrics in patients with obstructive sleep apnea (OSA).Study DesignRetrospective review of adult patients with OSA undergoing Cone Beam Computed Tomography (CBCT).MethodsCollected data included age, sex, body mass index, apnea hypopnea index, FTP, and airway cephalometric parameters. Data analyses were performed using ANOVA, dichotomous t‐testing, and linear regression.Results203 patients were included in the analysis. (M:F 132:71). The mean posterior airway space (PAS) was inversely correlated (p = 0.001, r =.119) with higher FTP grades with means of 12.3 mm, 7.9 mm, 6.6 mm, and 4.3 mm, I‐IV respectively. Minimal cross‐sectional area for patients with FTP I‐IV was 245.7, 179.8, 137.6, and 74.2 mm, 2 respectively (p = 0.002, r = .095). Mean hyoid‐mandibular plane (H‐MP) for FTP I‐IV was 20.6 mm, 20.4 mm, 24.7 mm, and 28.9 mm respectively. No statistically significant difference between H‐MP values when comparing patients with FTP I or II (p = 0.22). There were statistically significant differences when these two groups were individually compared to FTP III and IV (p = 0.002). Linear regression analysis confirmed an independent association between FTP and PAS (β = −2.06, p < 0.001), minimal cross‐sectional area (β = −45.07, p = 0.02), and H‐MP (β = 3.03, p = 0.01) controlling for BMI, age, AHI, and sex.ConclusionsUse of FTP is supported by objective CBCT cephalometric results, in particular the PAS, minimal cross‐sectional area, and H‐MP. Understanding the correlation between objective measurements of retroglossal collapse should allow Otolaryngologists to more confidently select patients who may require surgery to address the retroglossal area, particularly when the ability to perform cephalometric analysis is not possibleLevel of Evidence4.

<p>High Tongue Position is a Risk Factor for Upper Airway Concentric Collapse in Obstructive Sleep Apnea: Observation Through Sleep Endoscopy</p>

“…In previous research, a high FTP grade was usually accompanied by a low hyoid position and incurred a higher prevalence of CCC, as proven by sleep magnetic resonance imaging in severe OSA patients. 19 , 30 Moreover, the lateral muscles of the tongue and soft palate were thought to be coupled. 31 The circumference pattern may be explained by the increase in magnitude of the tongue drop, incurring pharyngeal occupation and central AP compression and posterior movement of the lateral margins of the soft palate, constituting a circumferential constriction.…”

“…Harvey et al showed that individuals with high FTP scores presented with overall UA volume reduction, and not only a narrowing of the retroglossal area by computed tomography. 19 A relatively high tongue position was found to be associated with increases in soft palate length and UA obstruction. 20 In addition, some studies revealed no relationship between increasing FTP and UA obstruction.…”

Velopharyngeal and Glossopharyngeal Volume Changes after Implant Anchored Maxillary Expansion

“…On the other hand Ono et al 2000 (34) with the use of magnetic resonance image studied the effects of head positions on the volume of the pharyngeal airway and found that a significant increase in volume of the pharyngeal retro-glossal region when the patient rotated his head. Harvey et al 2017 (35) assessed the relationship of the palate to the tongue using the Friedman Tongue Position grading system and concluded that this grading system was objectively supported by CBCT results, So to eliminate the effect of changes in tongue position a part of the pharyngeal airway related to the base of the tongue was sectioned and subtracted from the total volume.…”

Selecting Different Surgical Approaches for Hypopharyngeal Obstruction

“…21 Evidence and relevance: Friedman tongue position provides an indication of the degree of tongue base obstruction as well as the size of the tongue. Friedman tongue position grading has been shown to be inversely correlated with posterior airway space as measured on cone beam CT (CBCT) scan, in a study done by Harvey et al 22 The study showed that the higher the Friedman tongue position grading (III, IV), the narrower the posterior airway space. 22 Used in conjunction with findings from other evaluation methods, FTP can be used to guide surgical management of tongue base obstruction.…”

“…Friedman tongue position grading has been shown to be inversely correlated with posterior airway space as measured on cone beam CT (CBCT) scan, in a study done by Harvey et al 22 The study showed that the higher the Friedman tongue position grading (III, IV), the narrower the posterior airway space. 22 Used in conjunction with findings from other evaluation methods, FTP can be used to guide surgical management of tongue base obstruction. The presence of scalloping is a sign of macroglossia or relative macroglossia where the tongue is big relative to the small mandible.…”