Correlation between polysomnographic parameters and volumetric changes generated by maxillomandibular advancement surgery in patients with obstructive sleep apnea: a fluid dynamics study.

STUDY OBJECTIVES: Maxillomandibular advancement surgery (MMA) is a therapeutic option for obstructive sleep apnea (OSA). The main objective of this study was to determine the impact of MMA on the physical and airflow characteristics of the upper airway based on data obtained by computational fluid dynamics (CFD) and to correlate these data with polysomnography parameters. Other objectives included the identification of presurgical variables that could help avoid surgeries likely to have a low success rate. METHODS: This was a retrospective observational study of 18 patients with moderate-severe OSA who underwent MMA. Polysomnography and computed axial tomography imaging were performed before and after the surgery. Three-dimensional models for CFD study were made based on the images obtained. RESULTS: MMA achieved an average increase in airway volume of 43.75%, with a mean decrease in the maximum airway velocity of 40.3%. We found significant correlations between improved apnea-hypopnea index values and both the increase in airway volume and decrease in maximum airway speed. Patients with a maximum velocity of less than 7.2 m/s before the intervention had a high rate of surgical failure (43%). CONCLUSIONS: MMA generates a significant increase in the volume of the upper airway, which was associated with improved flow conditions in the CFD simulation. These findings also correlated with improved polysomnography parameters. Thus, CFD simulation on three-dimensional anatomical models of patients with OSA could contribute to the better selection of candidates for MMA. CITATION: Furundarena-Padrones L, Cabriada-Nuño V, Brunsó-Casellas J, et al. Correlation between polysomnographic parameters and volumetric changes generated by maxillomandibular advancement surgery in patients with obstructive sleep apnea: a fluid dynamics study. J Clin Sleep Med. 2024;20(3):371-379.

Nasal and maxillary sinus volume change in patients with obstructive sleep apnea after bimaxillary advancement surgery.

The airway complex is modified by bimaxillary advancement surgery performed in patients suffering from obstructive sleep apnea (OSA). The aim of the present study is to analyse the volume of nasal and maxillary sinus after bimaxillary advancement surgery in patients suffering from OSA. The maxillary sinus and nasal complex of eighteen patients with OSA was measured through cone-beam computed tomography (CBCT) before and after they were treated with bimaxillary advancement surgery. Digital planning software was used to effectively measure the upper volume changes, as well as, statistical analysis of the results was performed.Methods Eighteen patients were diagnosed with OSA the severity of which was measured by the apnea hypopnea index and were selected and submitted to preoperative and postoperative CBCT scans. Afterwards, datasets were uploaded into therapeutic digital planning software (Dolphin Imaging) to measure the volume of the right and left maxillary sinus and nasal and maxillary sinus complex. Statistically analysis between preoperative and postoperative measures was performed by Student t-test statistical analysis.Results The paired t-test showed statistically significant volumetric reductions in the left maxillary sinus (p = 0.0004), right maxillary sinus (p < 0.0001) and nasal and maxillary sinus complex (p = 0.0009) after bimaxillary advancement surgery performed in patients suffering from OSA.Conclusion The results showed that bimaxillary advancement surgery reduces the maxillary sinus volume as well as, the fossa nasal and sinus complex volume.

The Use of Human Sterilized Crushed Tooth Particles Compared with BTCP Biomaterial and Empty Defects in Bone Formation inside Critical Rabbit Calvaria Sites.

This study aimed to assess the bone regeneration of critical-size defects in rabbit calvaria filled with freshly crushed extracted teeth, comparing them with BTCP biomaterial and empty sites. Materials and methods: Twenty-one female New Zealand rabbits were used in this study. Two critical-size defects 6 mm in size were created in the skull bone, each with a 3 mm separation between them. Three experimental groups were evaluated: Group A (human sterilized crushed teeth granules alone), Group B (Bioner Bone, Bioner Sitemas Implantológicos), and Group C (unfilled defects). The animals were sacrificed at 4 and 8 weeks. Evaluation of the samples involved histological and histomorphometric analyses with radiographic evaluation. The histological evaluation showed a higher volume reduction in Group A compared with Group B (p < 0.05) and Control. Group A showed the highest values for cortical closure and bone formation around the particles, followed by Group B and Group C (p < 0.05). Within the limitations of this animal study, we can conclude that the use of human tooth particles leads to increased bone formation and reduced connective tissue in critical-size defects in rabbit calvaria when compared to BTCP biomaterial. The calvarial model is a robust base for the evaluation of different biomaterials.

How Confinement and Back to Normal Affected the Well-Being and Thus Sleep, Headaches and Temporomandibular Disorders.

The COVID-19 pandemic is having negative consequences not only for people's general health but also for the masticatory system. This article aimed to assess confinement and its new normal impact on well-being, sleep, headaches, and temporomandibular disorders (TMD). An anonymous survey was distributed to a Spanish university community. Participants completed a well-being index (WHO-5), a questionnaire related to sleep quality (the BEARS test), a headache diagnostic test (the tension type headache (TTH) and migraine diagnosis test), and the DC-TMD questionnaire. Questions were addressed in three scenarios: before confinement, during confinement, and the new normal. A total of 436 responses were collected (70% women, 30% men). A reduction in well-being and sleep quality was recorded. Respondents reported more TTH and migraines during and after confinement. Overall, confinement and return to normal did not increase TMD symptoms, and only minor effects were observed, such as more intense joint pain and a higher incidence of muscle pain in women during confinement. Reduced well-being is correlated with sleep quality loss, headaches, and TMD symptoms. This study provides evidence that pandemics and confinement might have had a negative impact on population health. Well-being was strongly affected, as were sleep quality, depression risk, TTH, and migraine frequency. In contrast, the temporomandibular joint and muscles showed more resilience and were only slightly affected.

International Consensus Document on Obstructive Sleep Apnea. / Documento internacional de consenso sobre apnea obstructiva del sueño.

The main aim of this international consensus document on obstructive sleep apnea is to provide guidelines based on a critical analysis of the latest literature to help health professionals make the best decisions in the care of adult patients with this disease. The expert working group was formed primarily of 17 scientific societies and 56 specialists from a wide geographical area (including the participation of 4 international societies), an expert in methodology, and a documentalist from the Iberoamerican Cochrane Center. The document consists of a main section containing the most significant innovations and a series of online manuscripts that report the systematic literature searches performed for each section of the international consensus document. This document does not discuss pediatric patients or the management of patients receiving chronic non-invasive mechanical ventilation (these topics will be addressed in separate consensus documents).

[Sleep-disordered breathing and dentofacial development]. / Trastornos respiratorios del sueño y desarrollo dentofacial en los niños.

Humans breathe an average of 20 times per minute, totalling about 30,000 times a day, and swallow nearly 2,000 times a day. These functions are vital for life. Growing children must adapt their developing structures to various destabilizing processes. When these factors outweigh the compensatory mechanisms, growth may become unbalanced by favoring the development of pathological processes such as sleep breathing disorders.

[Maxillary orthopedics and sleep-related respiratory disorders in children]. / Ortopedia maxilar y trastornos respiratorios del sueño en niños.

Early maxillary orthopedics can improve jaw relations and the jaw-skull base relationship. The objectives are clear: to correct the shape and improve function. A better proportioned skeletal framework is achieved, in which the underlying soft tissues become more resistant to collapse.

Detección de placas de ateroma mediante radiografías dentales / Detection of atheroma plaques by dental radiographs

Introducción: el accidente cerebrovascular o «stroke» es la tercera causa de muerte en Estados Unidos y representa casi la mitad de las muertes ocurridas cada año en España. Una de las posibles causas del stroke es la formación de placas de ateroma en la bifurcación carotídea. En ocasiones, estas placas se calcifican y pueden ser detectadas de manera casual en la consulta dental mediante una radiografía panorámica o telerradiografía. Material y método: se han revisado las ortopantomografías de 1300 pacientes pertenecientes a la Escuela de Estomatología de la Universidad de Oviedo. Para el estudio, sólo se tuvieron en cuenta los pacientes mayores de 40 años, resultando una población definitiva de 459 pacientes (194 hombres y 265 mujeres). En caso de sospecha de lesión, se estudió la historia clínica de dichos pacientes para determinar la presencia de otros factores de riesgo relacionados con la aterosclerosis, y se hizo una valoración aproximada de la densidad ósea de las mismas. Resultados: 13 individuos (2,83% de la población de estudio), (53,84% hombres y 46,15% mujeres) presentaron radiopacidades en las ortopantomografías y telerradiografías que fueron clasificadas como placas de ateroma. Dichas lesiones, medidas en una escala de grises, registraron unos valores muy similares al obtenido a nivel del hueso alveolar retromolar. De los 13 casos positivos, 30,76% presentaron las lesiones bilateralmente, y 69,23% unilateralmente. Conclusión: el odontólogo deberá prestar especial atención a la posible detección de placas de ateroma mediante radiografías panorámicas y telerradiografías, especialmente en aquellos pacientes con mayor riesgo de stroke (AU)

Introduction: Stroke is the third leading cause of death in the United States and almost the half of deaths in Spain. One of the possible causes of stroke is the formation of atheroma plaques in the carotid bifurcation. Eventually, these plaques calcify and can be detected by chance on panoramic and lateral cephalometric radiographs. Material and Methods: The panoramic radiographs of 1,300 patients of the Dental School of the University of Oviedo, Spain, were evaluated. For our study, only patients over the age of 40 were analized, resulting in a final population of 459 patients (194 men and 265 women). In the cases in which a lesion was suspected, the dental history of the patients was studied in order to determine the presence of risk factors related with atherosclerosis: tobacco, alcohol, prior stroke or ischemic attacks, hypertension. Results: 13 individuals (2,83% of the final study population), (53,84% men and 46,15% women) had radiopacities in the panoramic radiographs which were classified as atheroma plaques. Those lesions were measured in a greyscale and the results were very similar to those obtained in the retromolar alveolar bone. 30,76% of the positive cases, showed bilateral radiopacities, and 69,23% unilateral ones (AU)

Conclusion: dentists must pay special attention to the possible detection of atheroma plaques on panoramic and lateral cephalometric radiographs, specially in those patiens with high risk of stroke (AU)