Severity of Mandibular Dysmorphology in Treacher Collins Syndrome for Stratification of Perioperative Airway Risk.

BACKGROUND: Patients with Treacher Collins syndrome (TCS) and attendant airway dysmorphology may be predisposed to airway complications in the perioperative period. However, limited data correlates severity of mandibular hypoplasia and airway status. This study aims to improve risk stratification for perioperative airway insufficiency in TCS by using a previously proposed mandibular severity index. METHODS: Patient demographics, perioperative airway status, difficulty of intubation, and Cormack Lehane grade were collected and compared using a TCS mandibular hypoplasia severity grading scale in patients with TCS treated between 2000 and 2022. RESULTS: Twenty-six patients underwent 222 procedures with institutional mandibular severity gradings as follows: 23% Grade I, 31% Grade II, 39% Grade III, 8% Grade IV. Our severity index was associated with intubation difficulty ( P <0.001) and difficult airway status ( P <0.001), with 72% of difficult airways found in grade III and grade IV patients. Mandibular retrusion and ramal hypoplasia subscores were positively correlated with measures of airway severity ( P <0.001), whereas the gonial angle was negatively correlated ( P <0.001). Age was negatively correlated with difficult visualization for endotracheal intubation ( P =0.02) but had no association with difficult airway status ( P =0.2). CONCLUSIONS: This study found a positive correlation between severity of maxillomandibular dysmorphology and perioperative airway difficulty in TCS patients. Our findings suggest that severely affected patients require heightened vigilance throughout life, as difficult airways may not completely resolve with aging. Given the risk of morbidity and mortality associated with airway complications, proper identification and preparation for challenging airways is critical for TCS patients.

Surgical correction of neonatal obstructive sleep apnea due to a temporomandibular joint ankylosis.

In growing children, temporomandibular joint (TMJ) ankylosis and septic arthritis are uncommon. Retrognathia and micrognathia affect airway patency and can cause obstructive sleep apnea (OSA). No unified diagnostic criteria have been established for the management of this pathology. We describe the first case of treatment for pediatric TMJ ankylosis and severe OSA due to neonatal group B streptococcal septic TMJ arthritis. Untreated pathological changes in the TMJ will eventually lead to ankylosis. Among children, this will include facial growth disturbances leading to mandibular retrognathia, reduction in the oropharyngeal spaces, and OSA. Our patient had severe OSA with an apnea-hypopnea index of 24.9 events/h and oxygen saturation nadir of 73% as measured by polysomnography. She was treated successfully according to Andrade protocol. This is the first report of pediatric OSA due to TMJ ankylosis following neonatal group B streptococcal septic arthritis. CITATION: Pesis M, Goldbart A, Givol N. Surgical correction of neonatal obstructive sleep apnea due to a temporomandibular joint ankylosis. J Clin Sleep Med. 2024;20(1):173-179.

Screening for Obstructive Sleep Apnea and Associated Risk Factors in Adolescents and Adults With Isolated Robin Sequence.

OBJECTIVE: To investigate the subjective risk for obstructive sleep apnea (OSA) in adolescents and young adults with isolated Robin sequence (IRS). Additionally, to investigate the association of OSA risk with respiratory signs/symptoms, and retrognathia. DESIGN: Prospective, observational, and cross-sectional study. SETTING: Tertiary reference hospital for the rehabilitation of craniofacial anomalies. PARTICIPANTS: Adolescents and adults (n = 30) with IRS were clinically evaluated and screened through the Berlin Questionnaire (BQ) and Respiratory Symptoms Questionnaire. The maxillomandibular relationship was assessed on lateral cephalograms of those that reached skeletal maturity (n = 13). Polysomnography (PSG) was performed in a subgroup of 4 individuals. RESULTS: The mean age of the sample was 18.2 (±3.4) years, 17 (56.7%) were adolescents (14-19 years), and 16 were (53.3%) female, all presented a repaired cleft palate. CLINICAL PARAMETERS: Systemic arterial pressure (118.0 ± 4.1/76.3 ± 4.9 mmHg), body mass index (BMI) (20.9 ± 2.8 kg/m2), neck (33.2 ± 2.3 cm), and waist circumferences (72.0 ± 5.8 cm) were within normal ranges. A skeletal class I pattern was observed in 61.5% of the participants while a class II was seen in 15.4% of them. A high risk for OSA was detected in 16.7%, and it was associated with nasal obstruction, snoring and drowsiness, and a skeletal class II pattern (P ≤ .05). One patient presented with mild OSA (apnea-hypopnea index [AHI] = 10.1 events/hour) at the PSG exam. CONCLUSIONS: A high risk for OSA can be observed with a moderate frequency among adolescents and young adults with IRS, especially among those who are concurrently suffering from nasal obstruction, snoring and retrognathia.

Tri-lobed Tongue: Rare Manifestation Accompany With Pierre Robin Sequence.

BACKGROUND: The tongue is an essential organ accounted for proper deglutition and articulation. Surgical repair should be planned soon after diagnosis of any structural abnormality to prevent later speech and swallowing disorders. The lobulated tongue could be isolated (sporadic) or in association with other disorders. Pierre Robin Sequence (PRS) consists of the clinical trial of congenital micrognathia, glossoptosis, and airway obstruction with variable inclusion of a cleft palate. We present the case of a rare congenital tri-lobed tongue with Pierre Robin sequence and its surgical management in our hospital setting. CASE PRESENTATION: Six-month-old boy presented with severe retrognathia, high arch, complete isolated cleft palate, and a bizarre mass in the oral cavity instead of his tongue that led to disruption of his swallowing. The mass (deformed tongue) check clearly, and the normal shape of the tongue was restored through multiple local randomized flaps. Dramatic improvement in swallowing was noticed 6 months after surgery during postoperative follow-up. DISCUSSION: We present the case of a patient with a tri-lobed tongue with Pierre Robin sequence characterized by severe retrognathia, high arch, and complete isolated cleft palate. This seems to be the first reported case of this particular craniofacial anomaly. CONCLUSION: The management of infants with the Pierre Robin sequence is complex, and much still needs to be learned and practiced. Congenital tri-lobed tongue with a cleft as part of the Pierre Robin sequence is a very rare malformation. Early repair of the tongue is important to assist the baby in adapting to speech and swallowing as they grow.

Efficacy of orthodontic treatment versus adenotonsillectomy in children with moderate obstructive sleep apnoea and mandibular retrognathia: study design and protocol for a non-inferiority randomised controlled trial.

INTRODUCTION: Orthodontic treatment and adenotonsillectomy (AT) are both conventional treatments for paediatric obstructive sleep apnoea (OSA). Each approach has distinct treatment advantages; however, there is currently a lack of solid evidence to support their efficacy comparison. We hypothesise that the objective effect of orthodontic treatment is not inferior to AT in children with moderate OSA and mandibular retrognathia, but orthodontic treatment has the advantage of promoting dentofacial growth. METHODS AND ANALYSIS: This is a randomised, open-label, parallel-group, active controlled trial that will study the efficacy of orthodontic treatment versus AT in children with moderate OSA accompanied by tonsillar adenoid hypertrophy and mandibular retrognathia. A total of 98 patients will be enrolled and randomised in a 2:1 ratio to either orthodontic treatment or AT group. Participants will be recruited at Shanghai Stomatological Hospital, Shanghai Children's Hospital of Shanghai Jiaotong University and Children's Hospital of Fudan University, which are all located in Shanghai, China. The primary endpoint is the per cent change in the obstructive apnoea-hypopnoea index from baseline (month 0) to the primary endpoint (month 7), and the mean reduction in A point, nasion and B point angle on cephalometric measurements by lateral X-ray films. Important secondary efficacy endpoints include sleep duration with oxygen saturation below 90% according to polysomnography and subjective symptoms (assessed by the OSA-20 questionnaire), etc. Safety endpoints will also be evaluated. ETHICS AND DISSEMINATION: The study was approved by the ethics committees of Shanghai Stomatological Hospital (approval no. (2021)002), Shanghai Children's Hospital of Shanghai Jiaotong University (approval no. 2021R046-F01) and Children's Hospital of Fudan University (approval no. (2021)136). Before enrolment, a qualified clinical research assistant will obtain written informed consent from both the participants and their guardians after full explanation of this study. The results will be presented at national or international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ChiCTR2000037288.

Restricted upper airway dimensions in patients with dentofacial deformity from juvenile idiopathic arthritis.

BACKGROUND: This retrospective, cross-sectional study aimed to assess the pharyngeal airway dimensions of patients with juvenile idiopathic arthritis (JIA) and moderate/severe JIA-related dentofacial deformity (mandibular retrognathia/micrognathia), and compare the results with JIA patients with a normal mandibular appearance and a group of non-JIA patients. METHODS: Seventy-eight patients were retrospectively included in a 1:1:1 manner as specified below. All patients had previously been treated at the Section of Orthodontics, Aarhus University, Denmark. All had a pretreatment cone beam computed tomography (CBCT). Group 1 (JIA+); 26 JIA patients with severe arthritis-related dentofacial deformity and mandibular retrognathia/micrognathia. Group 2 (JIA-); 26 JIA patients with normal mandibular morphology/position. Group 3 (Controls); 26 non-JIA subjects. Dentofacial morphology and upper airway dimensions, excluding the nasal cavity, were assessed in a validated three-dimensional (3D) fashion. Assessment of dentofacial deformity comprised six morphometric measures. Assessment of airway dimensions comprised nine measures. RESULTS: Five morphometric measures of dentofacial deformity were significantly deviating in the JIA+ group compared with the JIA- and control groups: Posterior mandibular height, anterior facial height, mandibular inclination, mandibular occlusal inclination, and mandibular sagittal position. Five of the airway measurements showed significant inter-group differences: JIA+ had a significantly smaller nasopharyngeal airway dimension (ad2-PNS), a smaller velopharyngeal volume, a smaller minimal cross-sectional area and a smaller minimal hydraulic diameter than JIA- and controls. No significant differences in upper airway dimensions were seen between JIA- and controls. CONCLUSION: JIA patients with severe arthritis-related dentofacial deformity and mandibular micrognathia had significantly restricted upper airway dimensions compared with JIA patients without dentofacial deformity and controls. The restrictions of upper airway dimension seen in the JIA+ group herein were previously associated with sleep-disordered breathing in the non-JIA background population. Further studies are needed to elucidate the role of dentofacial deformity and restricted airways in the development of sleep-disordered breathing in JIA.

The efficacy of different treatment approaches for pediatric OSAHS patients with mandibular retrognathia: study protocol for a multicenter randomized controlled trial.

BACKGROUND: Pediatric obstructive sleep apnea/hypopnea syndrome (OSAHS) is a multifactorial syndrome caused by many risk factors, such as craniofacial anomalies, adenotonsillar hypertrophy, obesity, and airway inflammation. Although new treatment patterns have recently been proposed, treatment methods for children remain particularly challenging and controversial. This randomized controlled trial was designed to investigate the efficacy of adenotonsillectomy and/or orthodontic treatment for children who have mild OSAHS with mandibular retrognathia. METHODS: A sample of 352 children with mild OSAHS and mandibular retrognathia, who are aged between 7 and 10 years, will be enrolled in the study. They will be randomized into four groups: the drug treatment group, the surgical treatment group, the orthodontic treatment group, or the surgery and postoperative orthodontic group. After randomization the children will receive treatments within 4 weeks. Outcome assessment will take place at the following points: (1) baseline, (2) 7 months after the treatment starting point, (3) 12 months after the treatment starting point, and (4) 24 months after the treatment starting point. The primary endpoint of the trial is the mean change in obstructive apnea/hypopnea index. Other endpoints will consist of the lowest oxygen saturation, apnea index, and hypopnea index assessed by polysomnography, subjective symptoms (assessed by the OSA-20 questionnaire), cephalometric measurements, and morphologic analysis of the upper airway. DISCUSSION: The results of this study will provide valuable evidence for the merits and long-term efficacy of different treatment approaches and contribute to facilitating the multidisciplinary treatment of pediatric OSAHS. TRIAL REGISTRATION: ClinicalTrials.gov : NCT03451318. Registered on 2 March 2018 (last update posted 19 April 2018).

Nonoperative Orthodontic Therapy for Retrognathia and Finding of Sella Turcica Bridging in a 16-Year-Old Girl With Freeman-Burian Syndrome.

In the context of a case presentation of a 16-year-old girl treated for retrognathia associated with Freeman-Burian syndrome (FBS), importance of early orthodontic evaluation and unique problems posed by FBS are discussed. Freeman-Burian syndrome universally presents limited oral access and risk of pulmonary complications, making immaculate oral health-care arduous but mandatory. With early identification and conscientious planning, satisfactory orthodontic and overall health outcomes can be achieved. Sella turcica bridging, when presenting in FBS in the absence of endocrine pathology, may be related to the underlying myopathy of FBS.

Computational analysis of airflow dynamics for predicting collapsible sites in the upper airways: a preliminary study.

The present study aimed to detail the relationship between the flow and structure characteristics of the upper airways and airway collapsibility in obstructive sleep apnea. Using a computational approach, we performed simulations of the flow and structure of the upper airways in two patients having different facial morphologies: retruding and protruding jaws, respectively. First, transient flow simulation was performed using a prescribed volume flow rate to observe flow characteristics within upper airways with an unsteady effect. In the retruding jaw, the maximum magnitude of velocity and pressure drop with velocity shear and vortical motion was observed at the oropharyngeal level. In contrast, in the protruding jaw, the overall magnitude of velocity and pressure was relatively small. To identify the cause of the pressure drop in the retruding jaw, pressure gradient components induced by flow were examined. Of note, vortical motion was highly associated with pressure drop. Structure simulation was performed to observe the deformation and collapsibility of soft tissue around the upper airways using the surface pressure obtained from the flow simulation. At peak flow rate, the soft tissue of the retruding jaw was highly expanded, and a collapse was observed at the oropharyngeal and epiglottis levels. NEW & NOTEWORTHY Aerodynamic characteristics have been reported to correlate with airway occlusion. However, a detailed mechanism of the phenomenon within the upper airways and its impact on airway collapsibility remain poorly understood. This study provides in silico results for aerodynamic characteristics, such as vortical structure, pressure drop, and exact location of the obstruction using a computational approach. Large deformation of soft tissue was observed in the retruding jaw, suggesting that it is responsible for obstructive sleep apnea.

Effects of maxillary protraction appliances on airway dimensions in growing class III maxillary retrognathic patients: A systematic review and meta-analysis.

OBJECTIVES: The purpose of this study was to assess, through a systematic review and meta-analysis, the efficacy of maxillary protraction appliances (MPAs) on improving pharyngeal airway dimensions in growing class III patients with maxillary retrognathism. METHODS: An electronic search in PubMed, Cochrane Library, Web of Science, and EMBASE was until September 2nd, 2017. The assessments of methodological quality of the selected articles were performed using the Newcastle-Ottawa Scale. Review Manager 5.3 (provided by the Cochrane Collaboration) was used to synthesize the effects of MPAs on pharyngeal airway dimensions. RESULTS: Following full-text articles evaluation for eligibility, 6 studies (168 treated subjects and 140 untreated controls) were included in final quantitative synthesis and they were all high-quality. Compared to untreated control groups, the treatment groups had increased significantly nasopharyngeal airway dimensions with the following measurements: PNS-AD1 (fixed: mean difference, 1.33 mm, 95% CI, 0.48mm-2.19 mm, P = .002), PNS-AD2 (random: mean difference, 1.91 mm, 95% CI, 0.02mm-3.81 mm, P = .05), aerial nasopharyngeal area (fixed: mean difference, 121.91 mm2, 95% CI, 88.70 mm2-155.11 mm2, P < .00001) and total nasopharyngeal area (fixed: mean difference, 142.73 mm2, 95% CI, 107.90 mm2-177.56 mm2, P < .00001). Meanwhile, McNamara's upper pharynx dimension (fixed: mean difference, 0.96 mm, 95% CI, 0.29mm-1.63 mm, P = .005), which was highly related to post-palatal airway dimension, was also improved significantly. However, no statistically significant differences in adenoidal nasopharyngeal area (P > .05) and McNamara's lower pharynx dimension (P > .05) existed. CONCLUSIONS: MPAs can increase post-palatal and nasopharyngeal airway dimensions in growing skeletal class III subjects with maxillary retrusion. It may be suggested that MPAs have the potential to reduce the risk of obstructive sleep apnea syndrome in children with maxillary retrusion by enlarging airway space.

Predictors of sleep disordered breathing in children: the PANIC study.

Objective: We studied longitudinally the associations of craniofacial morphology, mouth breathing, orthodontic treatment, and body fat content with the risk of having and developing sleep disordered breathing (SDB) in childhood. We hypothesized that deviant craniofacial morphology, mouth breathing, and adiposity predict SDB among children. Materials and methods: The participants were 412 children 6-8 years of age examined at baseline and 329 children aged 9-11 years re-examined at an average 2.2-year follow-up. An experienced orthodontist evaluated facial proportions, dental occlusion, soft tissue structures, and mode of breathing and registered malocclusions in orthodontic treatment. Body fat percentage was assessed by dual-energy X-ray absorptiometry and SDB symptoms by a questionnaire. Results: Children with SDB more likely had convex facial profile, increased lower facial height, mandibular retrusion, tonsillar hypertrophy, and mouth breathing at baseline and convex facial profile, mandibular retrusion, and mouth breathing at follow-up than children without SDB at these examinations. Male gender and body adiposity, mouth breathing, and distal molar occlusion at baseline were associated with SDB later in childhood. Adipose tissue under the chin, mandibular retrusion, vertically large or normal throat and malocclusion in orthodontic treatment at baseline predicted developing SDB during follow-up of among children without SDB at baseline. Limitations: We could not conduct polysomnographic examinations to define sleep disturbances. Instead, we used a questionnaire filled out by the parents to assess symptoms of SDB. Conclusions: The results indicate that among children, deviant craniofacial morphology, mouth breathing, body adiposity, and male gender seem to have implications in the pathophysiology of SDB.

Bilateral pediatric mandibular distraction for micrognathia with temporomandibular joint ankylosis and sleep apnea.

Mandibular retrognathism is one of the important contributing anatomical factors to the obstructive sleep apnea (OSA). Such patients suffer from number of apneic or hypopneic events during sleep such as snoring, daytime sleepiness, fatigue, inability to concentrate, and irritability. Distraction osteogenesis is a less invasive surgical technique in the management of OSA by correcting the reduced airway space. Apart from correcting functional disturbances due to OSA, it also corrects the facial profile resulting in the substantial improvement in cosmetic appearance. We report a case of a 3-year-old boy who was struggling with severe retrognathic chin and OSA causing hypopneic episodes and snoring. He was successfully treated by bilateral mandibular distraction which resulted in significant improvement of respiratory distress and feeding as well as evidential advancement of the mandible was achieved.

Early, Computer-Aided Design/Computer-Aided Modeling Planned, Le Fort I Advancement With Internal Distractors to Treat Severe Maxillary Hypoplasia in Cleft Lip and Palate.

Traditionally, maxillary hypoplasia in the setting of cleft lip and palate is treated via orthognathic surgery at skeletal maturity, which condemns these patients to abnormal facial proportions during adolescence. The authors sought to determine the safety profile of computer-aided design/computer-aided modeling (CAD/CAM) planned, Le Fort I distraction osteogenesis with internal distractors in select patients presenting at a young age with severe maxillary retrusion. The authors retrospectively reviewed our "early" Le Fort I distraction osteogenesis experience-patients performed for severe maxillary retrusion (≥12 mm underjet), after canine eruption but prior to skeletal maturity-at a single institution. Patient demographics, cleft characteristics, CAD/CAM operative plans, surgical complications, postoperative imaging, and outcomes were analyzed. Four patients were reviewed, with a median age of 12.8 years at surgery (range 8.6-16.1 years). Overall mean advancement was 17.95 + 2.9 mm (range 13.7-19.9 mm) with mean SNA improved 18.4° to 87.4 ±â€Š5.7°. Similarly, ANB improved 17.7° to a postoperative mean of 2.4 ±â€Š3.1°. Mean follow-up was 100.7 weeks, with 3 of 4 patients in a Class I occlusion with moderate-term follow-up; 1 of 4 will need an additional maxillary advancement due to pseudo-relapse. In conclusion, Le Fort I distraction osteogenesis with internal distractors is a safe procedure to treat severe maxillary hypoplasia after canine eruption but before skeletal maturity. Short-term follow-up demonstrates safety of the procedure and relative stability of the advancement. Pseudo-relapse is a risk of the procedure that must be discussed at length with patients and families.

Treatment with Twin-block appliance followed by fixed appliance therapy in a growing Class II patient.

A girl, aged 11 years 4 months, with a skeletal Class II pattern and a severe overjet (10 mm) was treated with a Twin-block appliance. After 9 months of appliance therapy, the skeletal Class II was overcorrected. After 26 months of retention, when the occlusion was stable and the growth rate was diminishing, fixed orthodontic appliances using temporary skeletal anchorage devices were initiated. The total active treatment time with fixed orthodontic appliances was 30 months. Posttreatment records after 18 months demonstrated excellent stability: a functional occlusion and a pleasing facial balance. Cone-beam computed tomography was used to visualize temporomandibular joint adaptations after the functional and fixed orthodontic therapies.

Pharyngeal airway effects of Herbst and skeletal anchored Forsus FRD EZ appliances.

BACKGROUND AND OBJECTIVE: To evaluate the skeletal and pharyngeal airway effects of skeletal anchored Forsus FRD EZ appliance using bilateral miniplates inserted on mandibular symphyses and to compare the findings with a well matched control group treated using a Herbst appliance. METHODS: Thirty patients with skeletal Class II malocclusion due to mandibular retrusion were divided into two groups. Group 1 consisted of 15 patients (8 females and 7 males; mean age: 13.11 ± 1.29 years) treated using the Herbst appliance and Group 2 consisted of 15 patients (9 females and 7 males; 12.84 ± 1.27 years) treated using the skeletal anchored Forsus FRD EZ appliance. Treatment changes were assessed by means of linear, angular, and area measurements. RESULTS: The groups were well matched regarding to the chronological ages, gender distribution and initial cephalometric values (P > 0.05). In both groups, skeletal Class II malocclusion was corrected by decrease in SNA and increase in SNB, Co-Gn, VRL-B and VRL-Pog measurements. Those changes caused a significant correction in the maxillo-mandibular relationship. Upper and lower pharyngeal airway dimensions were increased in both group, while the increase in the lower pharyngeal dimension was found to be statistically significant in the skeletal anchored Forsus FRD EZ group (P < 0.05). Oropharyngeal area measurements significantly increased in both groups (P < 0.001 and P < 0.01, respectively). Comparison of the groups showed that both groups had similar changes with no statistically significant differences (P > 0.05). CONCLUSION: Skeletal changes produced by both appliances caused significant pharyngeal airway changes.

Thin-plate spline analysis of mandibular shape changes induced by functional appliances in Class II malocclusion : A long-term evaluation.

AIMS: The purpose of this work was to evaluate the long-term morphological mandibular changes induced by functional treatment of Class II malocclusion with mandibular retrusion. METHODS: Forty patients (20 females, 20 males) with Class II malocclusion consecutively treated with either a Bionator or an Activator followed by fixed appliances were compared with a control group of 40 subjects (19 females, 21 males) with untreated Class II malocclusion. Lateral cephalograms were available at the start of treatment (T1, mean age 9.9 years), at the end of treatment with functional appliances (T2, mean age 12.2 years), and for long-term follow-up (T3, mean age 18.3 years). Mandibular shape changes were analyzed on lateral cephalograms of the subjects in both groups via thin-plate spline (TPS) analysis. Shape differences were statistically analyzed by conducting permutation tests on Goodall F statistics. RESULTS: In the long term, both the treated and control groups exhibited significant longitudinal mandibular shape changes characterized by upward and forward dislocation of point Co associated with a vertical extension in the gonial region and backward dislocation of point B. CONCLUSION: Functional appliances induced mandible's significant posterior morphogenetic rotation over the short term. The treated and control groups demonstrated similar mandibular shape over the long term.

Anesthetic management of an ex utero intrapartum treatment procedure: a novel balanced approach.

Ex utero intrapartum treatment (EXIT) procedures are therapeutic interventions for fetuses with life-threatening airway abnormalities and/or other prenatally diagnosed congenital malformations requiring immediate neonatal extracorporeal membrane oxygenation support. Although certain anesthetic goals are common among EXIT procedures, many different approaches to their management have been described in the literature. Herein, we present a novel anesthetic approach to an EXIT procedure for fetal micrognathia and retrognathia. We also review the indications and anesthetic considerations for these procedures and highlight the need for multidisciplinary collaboration to optimize clinical outcomes.

Influence of craniofacial and upper spine morphology on mandibular advancement device treatment outcome in patients with obstructive sleep apnoea: a pilot study.

BACKGROUND/OBJECTIVES: The aim of the study was to assess cephalometric predictive markers in terms of craniofacial morphology including posterior cranial fossa and upper spine morphology for mandibular advancement device (MAD) treatment outcome in patients with obstructive sleep apnoea (OSA). MATERIAL/METHODS: Twenty-seven OSA patients were treated with MAD for 4 weeks. Apnoea-hypopnoea index (AHI) was recorded before and after MAD treatment. The criteria of treatment success were 75 per cent reduction of AHI. Accordingly, two groups occurred: the success treatment group of 8 patients and the no success treatment group of 19 patients. Before MAD treatment lateral cephalograms were taken and analyses of the craniofacial morphology including the posterior cranial fossa and upper spine morphology were performed. Differences between the groups were analysed by Fisher's exact test, t-test, and multiple regression analysis. RESULTS: Upper spine morphological deviations occurred non-significantly in 25 per cent in the success treatment group and in 42.1 per cent in the no success treatment group. Body mass index (BMI; P < 0.05), maxillary prognathism (S-N-Ss; P < 0.01), mandibular prognathism (S-N-Pg; P < 0.05 and S-N-Sm; P < 0.01), and the distance between sella turcica and the deepest point in posterior cranial fossa (S-D; P < 0.05) was significantly smaller in the success treatment group. The maxillary prognathism (P < 0.05) was the most important factor for the MAD treatment outcome (R (2) = 0.47). LIMITATIONS: Relatively small sample size. CONCLUSIONS: The results indicate that BMI, posterior cranial fossa morphology, and retrognathia of the jaws are factors related to MAD treatment outcome. Furthermore, OSA patients with upper spine morphological deviations may respond poorer to MAD treatment.

The effects of TMJ symptoms on skeletal morphology in orthodontic patients with TMJ disc displacement.

OBJECTIVE: The aim of this study was to investigate the effects of temporomandibular joint (TMJ) symptoms on skeletal morphologies of orthodontic patients with TMJ disc displacement (DD). MATERIALS AND METHODS: The sample consisted of 197 women seeking orthodontic treatment. The subjects were divided into two groups according to the presence of TMJ symptoms: the presence and absence of TMJ symptoms. Each group was sub-divided into three groups based on magnetic resonance images of bilateral TMJs: bilateral normal disc position (BN), bilateral disc displacement with reduction (DDR) and bilateral disc displacement without reduction (DDNR). Seventeen variables from lateral cephalograms were analyzed by two-way analysis of variance to identify differences in skeletal morphologies with respect to TMJ symptoms and TMJ DD status. RESULTS: Patients with TMJ DD were more likely to have short ramus height, short mandibular body length and backward positioning of the ramus and mandible. These skeletal morphologies became more severe as TMJ DD progressed to DDNR. However, the skeletal morphologies associated with TMJ DD were not significantly different between symptomatic and asymptomatic patients. As a result, patients with TMJ DD had backward positioning and clockwise rotation compared to those with bilateral normal TMJs, irrespective of the presence of TMJ symptom. CONCLUSIONS: This study suggests that TMJ DD is associated with altered skeletal morphology, but TMJ symptoms do not significantly influence the relationships between TMJ DD and skeletal morphology.