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Three-dimensional computed tomography in obstructive sleep apneics treated by maxillomandibular advancement

Authors

  • Cheng-Hui Lin MD,

    Corresponding author
    1. Sleep Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
    2. Craniofacial Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
    • Craniofacial Center, Chang Gung Memorial Hospital and Chang Gung University, 5 Fushing Street, Gueishan, Taoyuan, Taiwan 333
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  • Yu-Fang Liao DDS, PhD,

    1. Sleep Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
    2. Craniofacial Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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  • Ning-Hung Chen MD,

    1. Sleep Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
    2. Department of Pulmonology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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  • Lun-Jou Lo MD,

    1. Craniofacial Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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  • Yu-Ray Chen MD

    1. Sleep Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
    2. Craniofacial Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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  • Part of the paper was presented with the title “Three-Dimensional Computed Tomographic Evaluation of Airway and Craniofacial Changes in Adult Patients With Obstructive Sleep Apnea Who Underwent Segmental Maxillo-Mandibular Rotational Advancement” at the SLEEP 2010 24th Annual Meeting of the Associated Professional Sleep Societies, LLC (APSS), San Antonio, Texas, U.S.A., June 5–9, 2010.

  • This study was supported by the National Science Council, Taiwan (NSC 95-2314-B-182-020-Yu-Ray Chen MD-PI). The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

The goal of this study was to understand the changes to the head and neck musculoskeleton and the pharyngeal airway after surgery. We tested the correlation between the changes in the skeleton and pharyngeal airway and the apnea-hypopnea index (AHI).

Study Design:

Prospective, noncontrolled study.

Methods:

In a pilot study, 12 consecutive subjects (3 women, body mass index: 22.4 Kg/m2 ± 2.7, AHI: 35.9/sec ± 18.0) with Class II dentoskeletal malocclusion and high mandibular plane underwent segmental maxillomandibular rotational advancement (SMMRA). Subjects underwent overnight polysomnography and three-dimensional computed tomography scanning of the head and neck before and 3 months after surgery. Linear, angular, and area measurements were obtained from skeletal images placed in the Frankfort horizontal position and from horizontal cross-sectional tomograms derived from the upright pharyngeal airway. Skeletal movements, dimensional changes of the airway, and correlations between measurements and AHI were calculated. A linear regression model was generated using significant bivariate correlations.

Results:

The AHI was significantly reduced to 4.6/sec ± 4.1 with improvement in the nadir oxygen saturation from 83.0% ± 7.2 to 90.6% ± 3.6 after SMMRA. Following skeletal advancement, the hyoid bone was advanced and elevated by 7.5 mm ± 2.9 and 6.7 mm ± 5.5, respectively; the cervical spine was rotated forward by 4.6° ± 2.8; and the airway length was shortened by 6.8 mm ± 4.0 (all P < .01). Variable improvement of airway dimensions was noted at each horizontal level. A quadratic regression model was derived using the measurements of the Sella-Nasion-B point angle and AHI (Rsq = 0.557, sig = 0.000).

Conclusions:

Dimensions of pharyngeal airway were correlated with dimensions of craniofacial skeleton. Sella-Nasion-B point angle could be used as a guidance in achieving normalized AHI after surgery.

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