Pharyngeal Airspace Alterations after Using the Mandibular Advancement Device in the Treatment of Obstructive Sleep Apnea Syndrome

Abstract

Background: Mandibular Advancement Devices (MADs), inserted in non-surgical treatments for obstructive sleep apnea and hypopnea syndrome (OSAHS), are used intra-orally during the sleep period, with the aim of promoting mandibular protrusion. The aim of the study is to analyze the changes in the upper airway after the use of an MAD in the treatment of OSAHS. Methods: 60 patients diagnosed with OSAHS, as established by the Sleep Medicine Service, underwent treatment with the Silensor SL device at the Stomatology Service of the University Hospital Center of Coimbra, from January 2018 to January 2019. All patients completed two polysomnographies and two lateral teleradiographies: one before starting treatment (T0) and one after 1 year of treatment (T1). In the lateral teleradiography performed after one year of treatment, the patient had the MAD placed intra-orally. The linear measurements of the airspace proposed by the Arnett/Gunson FAB Surgery cephalometric analysis were measured at four craniometric points: A, MCI, B, Pog. Results: The results demonstrate an anteroposterior airway enlargement in two of the four points studied with the MAD placed intra-orally (B and Pog point). The greatest average increase is observed at point Pog (3 mm), followed by B (1 mm), and finally, point A (0.6 mm). Conclusions: This study proved that there is an improvement in anteroposterior measurements at various points in the upper airways after treatment with MAD.

Respiratory Repercussions Due to Mandibular Advancement in Children and Adolescents with Mandibular Class II Malocclusion: A Retrospective Longitudinal Study

“…In the present study, more changes were observed in the volume of the NA, followed by the laryngopharynx than in the oropharynx, presenting a notable increase in air permeability at points A, MCI and very prominent at Pg, unlike point B. which reflected minor changes. This does not agree with the other studies analyzed such as that of Ferraz et al 2022 and Bariana et al 2022 [12,21], in which many of these changes were noted especially in the upper pharynx, and were of small to moderate magnitude, meaning that changes in the nasopharynx could have little clinical relevance. In contrast, greater effects were observed in the lower pharynx, indicating that any clinically relevant benefits in airway dimensions or breathing could be attributed to this compartment, consistent with the results of the present study.…”

“…According to Do Vale et al 2019, an explanation for the improvement of the airway at point Pg and less at point B, is due to the rotation of the occlusal plane counter clockwise, described as a movement that optimizes the gain of space in the airways. Respiratory [12,22].…”

“…To check for changes in craniofacial and dentofacial structures, teleradiography is performed before and after mandibular advancement, and a cephalometric analysis is traced to check for increased airway parameters. The increase in airway dimensions seems to have an important effect on the success of mandibular advancement and, therefore, the comparative analysis of the craniofacial structures is one of the possible ways to evaluate the effect of this therapy [12][13][14].…”