Diagnostic Challenges in a Family with Dominant Dystrophic Epidermolysis Bullosa and Isolated Hereditary Nail Disorder: Paternal Gonosomal Mosaicism for COL7A1 Mutation and Maternal RSPO4 Variant.

Dystrophic epidermolysis bullosa (DEB) has long been recognized as a well-known genodermatosis, caused by COL7A1 gene pathogenic variants. Isolated anonychia associated with RSPO4 gene mutation is a recently described non-syndromic autosomal recessive condition. In this family, a 13-year-old girl presented with severe epidermolysis bullosa symptoms. Family history revealed milder but similar complaints in the siblings, and anonychia affecting all nails in the mother and maternal relatives. The father did not have any signs of DEB. Genetic testing revealed heterozygous c.6127G>A (p.Gly2043Arg) variant in the COL7A1 (NM_000094.4) gene, in the proband and her affected siblings. The variant was not detected in the mother or father, prompting investigation into parental mosaicism. Detection of the variant in sperm sample suggested paternal mosaicism. Additionally, RSPO4 gene (NM_001029871.4) was sequenced in the mother and two of her affected sisters for suspected non-syndromic isolated anonychia, revealing homozygous c.79+1G>A variant. Isolated nail disease in the mother was initially thought to be the result of DDEB nails-only subtype and the DEB in the children was inherited from the mother. However, further clinical and genetic investigation showed that the condition in the patient and her siblings arose from gonosomal mosaicism in the father and the nail phenotype in the mother is a separate coincidental condition. This report aims to serve as an example for similar cases and highlight the importance of detailed genetic analysis guided by comprehensive medical history in reaching a diagnosis.

THE ANATOMICAL AND MEASUREMENT STUDY OF ROSENMÜLLER FOSSA AND OROPHARYNGEAL STRUCTURES USING CONE BEAM COMPUTED TOMOGRAPHY.

The objective of this study was to assess Rosenmüller fossa (RF) anatomy and neighboring structures using cone beam computed tomography (CBCT). A total of 1000 patients were analyzed using CBCT. The reference points were based on the spina nasalis posterior (Snp) and basion. The length between RF and neighboring structures were measured.The mean distance from Snp to the posterior pharyngeal wall was 17.7 mm. The mean distance from right to left torus levatorius was 25.69 mm. The mean depth of right RF was 5.54 mm while the mean depth of left RF was 5.26 mm. RF, also described as the lateral pharyngeal recess, is a source location of nasopharyngeal carcinoma development. Its location is on the lateral pharyngeal wall posterior to the cartilaginous part of the eustachian tube, the torus tubarius. The knowledge of RF is important to diagnose and perform treatment planning of nasopharyngeal carcinoma.

A DETAILED CBCT STUDY OF 'CORONOID FORAMINA' AND ACCESSORY FORAMINA OF THE MANDIBLE: A UNIQUE ANATOMIC VARIATION.

The aim of the study was to evaluate accessory foramina (AF) located on the medial aspect and to present a unique finding of 'coronoid foramina' (CF) along with AF on the mandible. The cone beam computed tomography images of the mandible in 979 patients were retrospectively evaluated for the presence of CF and AF. AF was found in 39 (3.98%) patients. AF located on the medial surface below and above mandibular foramen was found in 15.38% and 84.62% of patients, respectively. CF was confirmed in 20 (2.04%) patients. Mandibular AF is important for surgical procedures in the posterior region of the mandible and for mandibular nerve anesthesia. This study including CF will be useful for further studies due to the lack of literature on the issue.

Esthesioneuroblastoma With Poor Outcome Despite Extensive Treatment.

Esthesioneuroblastoma is a rare malignant tumor of neuroectodermal origin. It usually presents with nonspecific symptoms, such as nasal obstruction, epistaxis, and pain, but has an aggressive course if the treatment is delayed. The authors report a case of esthesioneuroblastoma in a 47-year-old woman, treated with extensive surgical resection, radiotherapy, and chemotherapy. Despite intensive treatment, the patient developed a local recurrence with systemic metastasis and succumbed 4 months later.

A multi-centre evaluation of multiple supernumerary premolar prevalence.

AIM: The occurrence of multiple supernumerary teeth is rare and often found in association with syndromes such as cleidocranial dysplasia, Gardner's syndrome or cleft lip and palate. Few examples of non-syndromal multiple supernumerary teeth have been reported. The aim of this multi-centre study was to investigate the prevalence of supernumerary premolar teeth in non-syndromic patients and to investigate the association between the presence of supernumerary premolar teeth and malocclusion type in a Turkish population. MATERIALS AND METHODS: The clinical records and panoramic radiographs of 10,700 patients (referred to three different university hospitals) were retrospectively examined for the presence of supernumerary premolars. Age, gender, orthodontic malocclusion type, the number of supernumerary premolars (two or more), the distribution, location, position (vertical, horizontal, inverted, mesio-angular), surgical approach, and related complications (pain, cystic changes, root resorption, or eruption disturbance of adjacent teeth) were recorded. RESULTS: Forty-two cases (13 Class I, 17 Class II, 12 Class III) of multiple mandibular supernumerary premolars in patients without an associated syndrome were detected. A total of 97 (27 Class I, 41 Class II, 29 Class III) supernumerary premolar teeth were found, with a prevalence of 0.39%. No statistical difference was found related to gender, malocclusion type and supernumerary premolars (p > 0.05). The majority of the extra premolars were located in the mandible, which was statistically significant (p < 0.05). CONCLUSION: The present study revealed that the prevalence of multiple supernumerary teeth was 0.39%. The most frequently impacted premolars were found in the mandible and more often associated with Class II malocclusions in the examined Turkish population.

Comparison of intraoral radiography and cone-beam computed tomography for the detection of horizontal root fractures: an in vitro study.

OBJECTIVES: This study aimed to compare the diagnostic accuracy of two different cone-beam computed tomography (CBCT) units with several intraoral radiography techniques for detecting horizontal root fractures. METHODS: The study material comprised 82 extracted human maxillary incisors without root fractures that had not undergone any root canal treatment. Root fractures were created in the horizontal plane in 31 teeth by a mechanical force using a hammer with the tooth placed on a soft foundation as described in a previous study. The teeth were divided into two groups: a control group with no fractures and a test group with fractures. These were randomized to the empty maxillary anterior sockets of a dry human maxilla. Each tooth was imaged at various vertical angles using each of the following modalities: a 3D Accuitomo 170 CBCT, a NewTom 3G CBCT, a VistaScan PSP, a CCD sensor, and conventional film. Specificity and sensitivity for assessing horizontal root fracture by each radiographic technique were calculated. Chi-square statistics were used to evaluate differences between modalities. Kappa statistics assessed the agreement between observers. Results were considered significant at P < 0.05. RESULTS: The kappa values for inter-observer agreement between observers ranged between 0.88 and 0.98 for the 3D Accuitomo 170, 0.82 and 0.91 for the NewTom 3G, and 0.61 and 0.72 for the different types of intraoral images. The diagnostic accuracy for detecting fracture lines in 3D Accuitomo 170 (0.93) was significantly higher than NewTom 3G (0.87), VistaScan (0.71), CCD (0.70), and CF (0.68). CONCLUSIONS: 3D Accuitomo 170 has the highest sensitivity and diagnostic accuracy for detecting horizontal root fracture among the 5 radiographic modalities examined. CBCT should be considered as the most reliable imaging modality of choice for the diagnosis of horizontal root fracture. CLINICAL RELEVANCE: CBCT imaging offers the clear advantage over conventional imaging that traumatized teeth can be visualized in all three dimensions--especially the oro-facial dimension.

EVALUATION OF MANDIBULAR TRABECULAR AND CORTICAL STRUCTURE BY FRACTAL ANALYSIS IN HYPERLIPIDEMIA AND HYPERTENSION PATIENTS.

INTRODUCTION: This study aimed to evaluate the mandibular trabecular and cortical changes in patients with hyperlipidemia (HL) and/or hypertension (HT) using fractal dimension (FD) analysis, mandibular cortical width (MCW), panoramic mandibular index (PMI) and mandibular cortical index (MCI). MATERIALS AND METHODS: Panoramic radiographs of 100 patients were evaluated. FD measurement of three region of interest (ROI) including the angulus, corpus and interdental bone area were made. MCW, PMI and MCI were also measured and noted. RESULTS: Angulus, corpus and interdental FD values were significantly lower in three disease groups than the control group. Angulus, corpus, and interdental FD values were significantly lower in the HL+HT group than in the HL group and HT group. MCW value was significantly lower in the HL group, HT group, and HL+HT group than the control group. The cortical index C1 was more common in the control group while C2 was more common in the HT, HL and HL+HT group. CONCLUSION: The fact that FD was significantly lower in the HL+HT group compared to the HL and HT groups indicates the positive effect of their association on bone loss and quality. FD measurements on images obtained using a direct digital panoramic system can be used for treatment planning and follow-up of patients with HL and/or HT.

A retrospective study of the prevalence and characteristics of dens invaginatus in a sample of the Turkish population.

OBJECTIVE: The purpose of this study was to assess the prevalence of dens invaginatus and to classify the types of dens invaginatus in a sample of the Turkish population. STUDY DESIGN: A retrospective study was performed using periapical and panoramic radiographs of 5355 patients who presented to the Department of Oral Diagnosis and Radiology at the Ondokuz Mayis University Dentistry Faculty between January 2009 and December 2010. Maxillary and mandibular anterior teeth were evaluated for the presence and characteristics of dens invaginatus. Statistical evaluation of the presence of dens invaginatus related to gender was performed by the Pearson chi-squared test. RESULTS: Dens invaginatus was observed in 116 of 4556 subjects, with a frequency of 2.5%. There was only one periapical lesion in teeth with type I dens invaginatus, but 8.1% of patients with type II and 87.5% of patients with type III dens invaginatus had apical periodontitis at the time of referral. There were 116 (72%) females and 32 (27%) males with dens invaginatus. CONCLUSION: This data represents the only study carried out in a large population in Turkey, and no dens invaginatus was found in mandibular teeth. The most commonly observed type of dens invaginatus was type I (69.8%).

Evaluation of maxillary palatal process pneumatization by cone-beam computed tomography.

PURPOSE: The aim of this study is to investigate the pneumatization type of the palatal process (PTP) and angular and distance measurements of neighbouring structures on cone beam computed tomography (CBCT) images. MATERIALS AND METHODS: 400 maxillary sinuses (MS) of 200 patients (96 female; 104 male; mean age: 43.2) were retrospectively evaluated. PTP was divided into three as types 1,2 and 3 and evaluated at distances 4, 8, 16, and 24 mm posterior to incisive foramen. The sinus and alveolar ridge height, palatonasal recess angle (PRA) and palatal junction angle (PJA) were also measured and recorded. RESULTS: PTP I (101, 25.3%) was the most frequent type, followed by PTP II (95, 23.8%), and the least was PTP III (4, 1%). In patients with PTP I, the alveolar ridge height in the 4 mm and 8 mm group was significantly higher than in the patients with PTP II and III (p<0.05). In patients with PTP I, PRA in the 4 mm and 16 mm groups was significantly higher than in patients with PTP II and III (p<0.05). Sinus and alveolar ridge height, PRA and PJA did not differ significantly between the right and left sides in the 4 mm, 8 mm, 16 mm, and 24 mm groups (p>0.05). CONCLUSION: Knowing the anatomy of the MS is very important for a successful surgical procedure in this area. Anatomy and pathology of the MS can be understood more clearly in CBCT.

Photodynamic therapy for symptomatic subretinal fluid related to choroidal nevus.

PURPOSE: The purpose of this article is to evaluate the role of photodynamic therapy (PDT) for symptomatic choroidal nevus with subretinal fluid (SRF) extending to the fovea. METHODS: Retrospective review of the medical records of all patients who underwent PDT for a symptomatic choroidal nevus with SRF. RESULTS: Seventeen patients were included in the study. The mean initial visual acuity was 20/80 (range, counting fingers to 20/20). The mean initial tumor thickness was 1.23 mm (range, 0.66-1.93 mm). All tumors presented at least 2 risk factors for growing (including orange pigment, symptoms, peripapillary location, SRF, and thickness >2 mm). The mean number of PDT sessions was 1.41 (range, 1-3). The mean final visual acuity improved to 20/60 (range, counting fingers to 20/20). Subretinal fluid was reduced in all eyes (100%) and had completely disappeared in 9 eyes (53%) after PDT. Of 9 cases with complete resolution of the SRF, 2 patients (22%) presented recurrence. The mean final tumor thickness increased to 1.24 mm (range, 0.66-2.01 mm) at a mean follow-up of 22.47 months (range, 6-60 months). Tumor thickness increased in 3 eyes (18%) and remained unchanged in 13 eyes (76%), and 1 lesion (6%) shrank down to a flat chorioretinal scar. CONCLUSION: Photodynamic therapy is a good treatment option to reduce SRF in symptomatic choroidal nevus with serous macular detachment. Further growth into melanoma was observed in 18% of cases. Thus, PDT may not allow a good local tumor control. Longer follow-up is required to determine its value in these patients.

Corneal melanoma: report of three cases.

OBJECTIVES: We report three cases of corneal melanoma: two without conjunctival primary acquired melanosis or melanoma and one with a history of conjunctival melanoma. METHODS: Report of 3 cases with corneal melanoma and literature review. RESULTS: Medical records of three patients with the diagnosis of corneal melanoma were reviewed. Total excisional biopsy with corneal epitheliectomy using 20% ethanol was performed. Postoperative topical chemotherapy with 0.04% mitomycin-C was used for 4 weeks as adjunctive therapy. The follow-up ranged from 13 months to 7 years. Each of the two patients experienced two recurrences. One was treated in a fashion similar to that of the initial tumor, and the other was treated by enucleation. None of the patients developed regional or distant metastasis. CONCLUSIONS: Malignant melanoma can rarely occur on the cornea with no contiguous conjunctival component. Eye-conserving treatment should be attempted first. Recurrences may occur, and a close follow-up is necessary.

Prevalence and distribution of odontogenic and nonodontogenic cysts in a Turkish population.

OBJECTIVE: To determine the relative frequency and distribution of odontogenic and nonodontogenic cysts in a large Turkish population. STUDY DESIGN: A retrospective survey of jaw cysts was undertaken at the Oral Diagnosis and Radiology and Oral and Maxillofacial Surgery Department, Ondokuz Mayis University Dental School, Samsun, Turkey. Data were retrieved from clinical files, imaging, and histopathology reports from 2000 to 2008; a total of 12,350 patients were included. In each case, we analyzed age, gender, type and number of cysts, and cyst location. Imaging patterns and pathologies associated with cystic lesions were also determined. RESULTS: The prevalence of odontogenic and nonodontogenic cysts was 3.51%; males were affected more frequently than females. There were 452 odontogenic cysts (98.5%) and seven nonodontogenic cysts (1.5%). The most frequent odontogenic cyst was radicular (54.7%), followed by dentigerous (26.6%), residual (13.7%), odontogenic keratocyst (3.3%), and lateral periodontal cyst (0.2%). Nasopalatine duct cyst (1.5%) was the only nonodontogenic cyst. By age, cysts peaked in the third decade (24.2%). Concerning location, no statistically significant difference was found between the maxilla and mandible (p>0.05). The most frequent radiological feature of these lesions was unilocular cyst (93.7%). Pathologies associated with cystic lesions occurred in 14.7%. CONCLUSION: The prevalence of both odontogenic and nonodontogenic cysts were lower than that reported in many other studies. In our study population, cysts were mainly inflammatory in origin.

Evaluation of morphological variations of petrotympanic fissure using computed tomography imaging of the temporal bone.

PURPOSE: Petrotympanic fissure (PF) is important for both dentists and otolaryngologists to know the temporal anatomy well especially for pre-surgical radiological evaluations. Computed tomography (CT) is indispensable method for temporal bone imaging. The purpose of this study was to evaluate PF morphology and position using CT. METHODS: CT scans of 300 patients (600 PFs) were retrospectively evaluated. PF types were recorded by dividing into 3 groups (Type 1,2 and 3). Length of the mandibular fossa (MF) and PF, vertical diameter (VD) of the PF at the MF level, midpoint and tympanic cavity (TC) level were measured. PF position types were subdivided as low, midline and high. RESULTS: Type 1, 2 and 3 was found in 18.7%, 51.5% and 29.8% of the cases, respectively. The mean length of the MF and PF was 18.33 mm and 3.77 mm, respectively. The mean VD of the PF at the MF level, midpoint and TC level was 1.71, 0.98 and 0.97 mm, respectively. The low, midline and high position of PF was observed 14.5%, 54.3% and 31.2% of the cases, respectively. CONCLUSION: Length of the MF and PF in males was significantly higher than females. VD of the PF at the MF level in Type 1 and Type 3 was significantly higher than type 2. In type 1,VD of the PF at the midpoint was significantly higher than type 2 and type 3. VD of the PF at the TC level in Type 1 and Type 3 was significantly higher than type 2.

Morphological Measurement and Anatomical Variations of the Clivus Using Computed Tomography.

Objectives The aim of this study was to evaluate the clivus morphology, including fossa navicularis magna (FNM), canalis basilaris medianus (CBM), and craniopharyngeal canal (CC), on computed tomography (CT) images. Design This is a retrospective study. Setting Faculty of Dentistry, Department of Dentomaxillofacial Radiology. Participants The CT images of 500 patients (253 males; 247 females) were evaluated. Main Outcome Measures The prevalence of FNM, CBM, and CPC; the length, width, and depth of FNM; and CBM types were recorded. Also, a morphological analysis of the clivus (length of the clivus, angle between the clivus and the posterior margin of the foramen magnum, angle between the clivus and the dens axis, and anteroposterior diameter of the foramen magnum) was performed. Results FNM was identified in 5.4%, CBM in 4%, and CC in 0.8% of the study group. Type 5 CBM was not found. Type 6 was the most common CBM type. There was no significant correlation between the age and gender of patients with FNM. There were significant differences between the clivus length, the angle between the clivus and the dens axis, the anteroposterior diameter of the foramen magnum, and gender. Also, there was a significant difference between the angle between the clivus and the foramen magnum and age. Conclusions The anatomical variations of the clivus are rare and important for the oral and maxillofacial radiologist to make the differential diagnosis. These anatomical variations should not be confused with pathologic formations. The morphological measurements and anatomical variations of the clivus can be evaluated in detail on CT images.

The Relationship between an Accessory Maxillary Ostium and Variations in Structures Adjacent to the Maxillary Sinus without Polyps.

Introduction The maxillary sinus and its variations are very important to dentistry and rhinology. Objective To investigate the effect of the accessory maxillary ostium (AMO) on the variations of adjacent structures of the maxillary sinus. Methods The computed tomography (CT) images of 400 patients were retrospectively evaluated. The prevalence of AMO was calculated. The relationship between morphological variations of adjacent structures of maxillary sinus such as agger nasi cell (ANC), Haller cell (HC), nasal septum deviation (NSD), hypertrophy of inferior concha (HIC), pneumatization of middle concha (PMC), mucus retention cyst (MRC), mucosal thickening (MT), and maxillary sinusitis (MS), as well as the presence of AMO, were investigated. Results Presence of AMO was diagnosed in 42 patients (10.5%), having been found in 4.5% of the patients only on the right side, in 1.25% of the patients only on the left side, and in 4.75% of the patients on both sides. There is an increasing incidence of ANC, HC, NSD, HIC, and PMC in the presence of AMO and MS. There is a decreasing incidence of MRC in the presence of AMO. Furthermore, AMO does not affect the incidence of MT. Conclusion This study showed that most parameters, except for MRC and MT, had increasing incidence in the presence of AMO. It is important for radiologists and rhinologists to have knowledge about the location of AMO and the presence of variations of MS adjacent structures to avoid surgical complications.

Orbital schwannoma with fluid-fluid levels on MRI.

A 40-year-old man presented with a progressively growing left orbital mass producing proptosis. Orbital MRI revealed a large bilobed mass that was isointense with respect to the extraocular muscles on T1-weighted images and demonstrated heterogenous contrast enhancement. T2-weighted images revealed a markedly heterogenous internal appearance with fluid-fluid levels. The mass was completely excised in one piece. Histopathologically, the encapsulated tumor consisted mostly of spindle-shaped tumor cells with elongated nuclei forming bundles without obvious mitosis. Richly cellular areas were consistent with the Antoni A pattern, and more hypocellular edematous areas were consistent with the Antoni B pattern. Hemorrhagic and cystic areas were seen within the tumor. The tumor cells stained diffusely positive with S-100 protein. Findings were consistent with the diagnosis of orbital schwannoma. Fluid-fluid levels are usually seen in some vascular and bone tumors and soft tissue lesions. Fluid-fluid levels have previously been reported to occur in intracranial but not in orbital schwannomas. This case demonstrates that orbital schwannoma can also display fluid-fluid levels on MRI, which were thought to be due to intralesional hemorrhage in this case.

Cross-sectional evaluation of the periapical status as related to quality of root canal fillings and coronal restorations in a rural adult male population of Turkey.

BACKGROUND: To determine the prevalence of periapical lesions in root canal-treated teeth in a rural, male adult, Turkish population and to investigate the influence of the quality of root canal fillings on prevalence of periapical lesions. METHODS: The sample for this cross-sectional study consisted of 552 adult male patients, 18-32 years of age, presenting consecutively as new patients seeking routine dental care at the Dental Sciences of Gulhane Military Medicine, Ankara. The radiographs of the 1014 root canal-treated teeth were evaluated. The teeth were grouped according to the radiographic quality of the root canal filling and the coronal restoration. The criteria used for the examination were slightly modified from those described by De Moor. Periapical status was assessed by the Periapical Index scores (PAI) proposed by Orstavik. RESULTS: The overall success rate of root canal treatment was 32.1%. The success rates of adequately root canal treatment were significantly higher than inadequately root canal treatment, regardless of the quality or presence of the coronal restoration (P < .001). In addition, the success rate of inadequate root canal treatment was also significantly affected by the quality of coronal restorations. CONCLUSIONS: Our results revealed a high prevalence of periapical lesions in root canal treatment, which is comparable to that reported in other methodologically compatible studies from diverse geographical locations. In addition, the results from the present study confirm the findings of other studies that found the quality of the root canal treatment to be a key factor for prognosis with or without adequate coronal restoration.

The Radiological Evaluation of Posterior Superior Alveolar Artery by Using CBCT.

BACKGROUND: Evaluation of the maxillary sinus anatomy prior to sinus lift procedures is important to avoid surgical complications due to the close anatomical relationship between the posterior maxillary region and the maxillary sinüs. INTRODUCTION: In order to avoid traumatizing the posterior superior alveolar artery and to prevent perioperative bleeding, locating the exact position of the artery is imperative before the surgical procedures. METHODS: 150 CBCT scans were evaluated. The distance from the inferior border of the PSAA to the alveolar crest (the vertical line from the artery to the crest) and floor of the maxillary sinus, the distance from PSAA to medial sinus wall, nasal septum, zygomatic arch, position, the distance from the floor of maxillary sinüs to the alveolar crest and diameter of the PSAA were assessed. Locations of the artery were classified. RESULTS: The artery diameters were mostly ≥ 1 mm. The artery was mostly intraosseous (59.7%), 21.7% was superficial and only 18.7% was intra-sinuscular. CONCLUSION: The location of PSAA is intraosseous in most patients. The artery diameters were mostly ≥ 1 mm and we can say that increasing the size also increases the risk of complications.

Diagnostic accuracy of endoscopy for the detection of isthmuses of mandibular molar teeth using micro-CT as reference.

PURPOSE: The aim of this study was to evaluate the efficacy of endoscopic visualisation to detect the presence and type of isthmuses within the mesial root canals of mandibular first molar teeth compared with micro-computed tomography (micro- CT) images as reference. MATERIALS AND METHODS: Thirty-two mesial roots of mandibular first molars presenting isthmuses were selected based on micro-CT scans. In all, 12 type I and 20 band-shaped isthmuses were collected. The specimens were mounted in the posterior socket of dental phantom manikin for endoscopic visualisation. The ability of endoscopes to visualize the presence of isthmuses and distinguish the type of isthmuses was compared. Micro-CT images of the specimens were used as references. Data were analyzed using Fisher's exact tests. RESULTS: Sensitivity of endoscope to detect isthmuses were also calculated for each isthmus type. In 37.5% of the samples, isthmus presence was correctly diagnosed via orthograde endoscopic visualization. Type I istmuses were significantly more detected than band-shaped isthmuses (P<0.05). Endoscope showed higher sensitivity to detect type I isthmus than band-shaped isthmus. CONCLUSION: The endodontic endoscope could detect type I isthmuses more accurately than band- shaped isthmuses.

Efficacy of a modified mandibular advancement device for a totally edentulous patient with severe obstructive sleep apnea.

BACKGROUND: It has been asserted that the success rate of oral appliances was more satisfactory for mild to moderate obstructive sleep apnea (OSA) than severe ones; besides, there is a lack of literature about mandibular advancement device (MAD) application for edentulous patients with OSA. REPORT: This clinical case shows fabrication method and treatment efficacy of a modified MAD, which is aiming to displace bulky masseter muscles laterally, to provide more space for tongue on totally edentulous patient with severe OSA.