Craniofacial features of adult obese obstructive sleep apnoea patients in relation to the obesity onset - A pilot study.

INTRODUCTION: Obesity and craniofacial structures are aetiologies of obstructive sleep apnoea (OSA). The effect of obesity onset on the craniofacial development and growth of obese OSA subjects has been suggested, but supporting data were lacking. This study aimed to assess the craniofacial features of adult obese OSA patients in relation to their obesity onset. MATERIALS AND METHODS: A total of 62 adult OSA patients were included in the study, consisting of 12 early-onset (i.e. before puberty), 21 late-onset (i.e. after puberty) and 29 non-obese. All participants underwent a sleep study and cephalometric radiograph. Cephalometric analysis was conducted to measure the craniofacial features among the groups. RESULTS: The early obesity onset group (n = 12) showed a more prognathic mandible, longer lower facial height, protrusive incisors, a more caudal position of the hyoid bone and a wider lower airway. The late-onset group (n = 21) had more proclined and protrusive upper incisors, a shallower overbite, a more inferiorly positioned hyoid bone and an obtuse craniocervical angle. The overall obese group showed a combination of the findings above, plus a shorter soft palate and shorter airway length. There was no significant difference between early and late obesity onset groups. However, the early group showed a tendency for a shallower or decreased mandibular plane angle and deeper overbite. CONCLUSIONS: The current pilot study had many limitations but holds important information as a hypothesis generator. Craniofacial features of OSA patients with different obesity onset showed discrepancies and were distinguished from non-obese controls. Adult OSA patients with an early obesity onset showed a tendency for a more hypodivergent growth pattern than those with a late obesity onset.

Cervicofacial subcutaneous emphysema and pneumomediastinum secondary to dental treatment in a young man.

The occurrence of cervicofacial subcutaneous emphysema and pneumomediastinum is very rare but can be potentially life-threatening. These complications can happen during or after bronchoscopic or dental procedures, esophageal rupture or perforation, infections involving the head and neck and alveolar rupture in the setting of an inciting event such as asthma. The symptoms can appear promptly after the inciting event, but can also be delayed or do not reach maximal intensity for hours. Cervicofacial subcutaneous emphysema usually occurs during or within minutes to hours after dental treatment and can be easily misdiagnosed as post-procedure swelling or an allergic reaction. We report a 36-year-old male who underwent dental treatment for a fractured left lower molar tooth and subsequently developed extensive subcutaneous emphysema and pneumomediastinum. The purpose of this report is to bring attention to the fact that obtaining an accurate diagnosis for this condition is very important and management in a timely manner can prevent serious complications.