Obstructive site localization in patients with Obstructive Sleep Apnea Syndrome: a comparison between otolaryngologic data and cephalometric values.

PURPOSE: Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory disorder characterized by repeated obstructive episodes affecting upper airways.This study aims at examining the anatomical craniofacial and pharyngeal characteristics of the patient as to identify the obstructive site which triggers the pathologic process.Correlations between otolaryngologic data observed in the patient and the cephalometric ones for the identification of the obstructive site were also highlighted. MATERIALS AND METHODS: We worked on a sample of 16 patients, 12 males and 4 females, attended to at the Otolaryngology Operative Unit of Bari University Hospital.The patients underwent an otolaryngologic (ORL) diagnostic procedure which provided for ApneaGraph (AG) recording, and a dental diagnostic procedure with cephalometric assessment. RESULTS: The statistical analysis highlighted a strict correlation between the otolaryngologic value of AHI and the cephalometric values of the ANB angle, with the distance between the hyoid bone and the mandibular plane and with the distance between the hyoid bone and the plane passing between C3 and Me. CONCLUSIONS: We observed a concurrence between the ORL diagnosis of the obstruction level assessed with AG and the cephalometric values regarding respiratory tracts (IPAS and SAS). More precisely, we observed the correlation between the otolaryngologic value of AHI with cephalometric values of the ANB angle, with the distance between hyoid bone and mandibular plan, and with the distance between the hyoid bone and the plane passing between C3 and Me. Furthermore, the identification of the caudal position of the hyoid bone can be considered an alarm bell in the diagnosis of severe OSAS.

Clinical and cephalometric analysis of three cases with pycnodysostosis: case reports.

The aim of this article is to present intra- and extra-oral and cephalometric findings of three patients with a rare disease: the pycnodysostosis. Two cases had skeletal Class III malocclusion due to maxillary retrognathia and one had bimaxillary retrusion with Class I relationship. Total circular crossbite, increased gonial angle and vertical facial proportions, deep-narrow palates and retruded upper lip were found in all cases. Maxillary expansion, face mask treatment or/and orthognathic surgery are treatment alternatives, considering the growth and development. Bone fragility and the risk of osteomyelitis after extractions should be considered in such cases before orthodontic treatment and orthognatic surgery.

Cephalometric evaluation of tongue position and airway remodelling in children treated with swallowing occlusal contact intercept appliance (S.O.C.I.A.).

INTRODUCTION: Facial growth changes the position of the jaws (in particular vertical position of the maxilla and antero-posterior position of the mandible) and may, in turn, modify the position of the tongue and the hyoid bone, thus, generating modifications of the upper airway space. In the present paper, effects on upper airway space and tongue position of a new functional appliance, the swallowing occlusal contact intercept appliance (SOCIA) have been investigated. MATERIALS AND METHODS: Retrospective cephaolmetric study of twenty-four children (mean age 9.46±1.60) with hyperdivergent Class II malocclusion with mandibular retrusion and atypical deglutition, was performed on radiographs taken before and after 24 months treatment with "SOCIA" appliance. The variables considered in this study, and analysed by means of a Paired t-test with a 5% level of significance, included the distance between the base of epiglottis (EB) and the tip of the tongue (TT), the distance from the tongue dorsum to EB-TT (TGH), the distance between the posterior nasal spine PNS and EB (VAL), SPAS, MAS and IAS (i.e. superior, medium and inferior pharyngeal airspace width). RESULTS: Our findings showed a significant increase in tongue length (TT-EB) and tongue height (TGH); thus, confirming the reposition of the tongue from a lower posture to its physiological position onto the palatal spot. These modifications of the tongue posture had effects on the upper airway space. The most important modifications were observed in SPAS, with a significant 5.9 mm increase. Some increase was found also for MAS (0.83 mm) and IAS (1.1 mm) but without statistical significance. A significant increase (7.75 mm) was also found for VAL, probably as a result of the augmentation of posterior facial height. CONCLUSIONS: SOCIA appliance is capable to improve tongue position and the superior posterior airway space, and, consequently, to improve deglutition, phonation and respiratory function.

Cephalometric evaluation of the hyoid triangle before and after maxillary rapid expansion in patients with skeletal class II, mixed dentition, and infantile swallowing.

BACKGROUND: Rocabado's hyoid triangle is the only cephalometric parameter that can assess the effects of orthodontic treatment on tongue posture. AIM: To evaluate the restoration of tongue posture and function by conducting a cephalometric assessment of the hyoid triangle before and after rapid maxillary expansion. METHODS: Sixty-four healthy patients aged 6-11 years with skeletal class II malocclusion, mixed dentition, and infantile swallowing took part in this study. They submitted to lateral cephalometric radiography before and after orthodontic maxillary rapid expansion, in order to assess the resulting changes in the proportions of the hyoid triangle (following Rocabado's parameters). The cephalometric findings were compared according to sex, age, and divergence using the chi-square McNemar test at the 5% significance level (p<0.05). RESULTS: The orthodontic treatment resulted an improvement from skeletal class II malocclusion to class I, with elimination of infantile swallowing in 81.8% of male patients [95% confidence interval (CI)=61.5-92.7%], in 87.1% of patients aged 6-7 years (95% CI=71.1-94.9%). CONCLUSIONS: This cephalometric analysis revealed that the hyoid triangle was modified by the orthodontic maxillary expansion, reconditioning of tongue posture and function particularly among male, aged 6-7 years old with skeletal class II malocclusion, mixed dentition, and infantile swallowing.