Abstract
Upper airway assessment is particularly important in the daily work of orthodontists, because of its close connection with the development of craniofacial structures and with other pathologies such as Obstructive Sleep Apnea Syndrome (OSAS). Three-dimensional cone-beam computed tomography images provide a more reliable and comprehensive tool for airway assessment and volumetric measurements. However, the association between upper airway dimensions and skeletal malocclusion is unclear. Therefore, the current systematic review evaluates the effects of different surgical movements on the upper airway. Materials and Methods: Medline (PubMed, OVID Medline, and EBSCO), Cochrane Library (Cochrane Review and Trails), Web of Knowledge (social science, and conference abstracts), Embase (European studies, pharmacological literature, and conference abstracts), CINAHL (nursing and allied health), PsycInfo (psychology and psychiatry), SCOPUS (conference abstracts, and scientific web pages), and ERIC (education) databases were searched. Two authors independently performed the literature search, selection, quality assessment, and data extraction. Inclusion criteria encompassed computed tomography evaluations of the upper airway spaces with retrospective, prospective, and randomised clinical trial study designs. To grade the methodological quality of the included studies a GRADE risk of bias tool was used. Results and conclusion: In total, 29 studies were included. Among these, 17 studies had a low risk of bias, whereas 10 studies had a moderate risk of bias. A meta-analysis was performed with the mean differences using a fixed-effects model. Heterogeneity was assessed with the Q-test and the I2 index. The meta-analysis revealed significant (p ≤ 0.001, 95% confidence interval) increases in upper airway volume after rapid maxillary expansion and surgical advancement for the correction of Class II.
Highlights
The human upper airway could be defined as the airway space extending from the nose’s nares and the mouth’s stoma down to the cricoid cartilage in the larynx
Lateral cephalograms could be used as an initial screening method for airway evaluation, but three-dimensional conebeam computed tomography (CBCT) images provide a more reliable and comprehensive tool for airway assessment and volumetric measurements
Through a meta-analysis, this study aims to assemble scientific evidence related to the effects of orthodontic treatment modalities on airway space
Summary
The human upper airway could be defined as the airway space extending from the nose’s nares and the mouth’s stoma down to the cricoid cartilage in the larynx. The close anatomical relationship between the upper airway and the craniofacial and dental structures dictates their influence on each other. The normal growth and development of craniofacial structures depend on a patent airway and nasal breathing. Orthodontists have long been interested in airway analysis because of the airway’s potential importance to the normal development of the craniofacial region as well as its involvement in the diagnosis and treatment of mouth breathing and sleep disorders. Clinicians need to evaluate the upper airway objectively and identify the normal and abnormal anatomical boundaries and dimensions. Two-dimensional lateral cephalograms have been used for decades to evaluate the airway’s shape, size, position, and relationship with other anatomical structures, they lack the information to illustrate the anatomically complex airway structure in three dimensions. The findings of snoring and interrupted sleep together with diagnostic images obtained during the dental examination can provide indications of possible airway disorders and support the need for referral to a medical specialist referral
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