Palatal Thickness Research Articles

Relationship between craniofacial and dental arch morphology with pharyngeal airway space in adolescents.

The aim of the study was to investigate apossible relationship between pharyngeal airway space, craniofacial variables, and dental arch form in adolescents grouped by sex. This cross-sectional study included 108 adolescents aged between12 and 17years. Lateral cephalometric radiographs were used to analyze sagittal craniofacial variables and the pharyngeal airway space. For evaluation of the dental arch form, we used plaster models. Statistical analysis included Student's t‑test and Pearson's correlation coefficient(r). Maxillary length was directly proportional to upper nasopharyngeal airway dimensions in males (r = 0.312, p = 0.021) and females (r = 0.310, p = 0.022). In the female group, upper oropharyngeal measurements showed an inverse correlation with alabial inclination of the upper incisors (r = -0.415, p = 0.001), protrusion of the upper incisors (r = -0.364, p = 0.006), and soft palate thickness (r = -0.27, p = 0.043). In the male group, upper nasopharynx measurements showed an inverse correlation with soft palate thickness (r = -0.277, p = 0.042). The upper arch form appeared to be related to oropharyngeal measurements in females, while the lower arch form was related to oropharyngeal dimensions in males. The findings suggest that there are sex-dependent correlations of the nasopharyngeal and oropharyngeal airway space with the sagittal craniofacial morphology and the transversal dental arch form.

Effect of Twin-block Appliance on Pharyngeal Airway, Sleep Patterns, and Lung Volume in Children with Class II Malocclusion

In this study, we sought to evaluate the effect of the twin-block appliance on pharyngeal airway dimensions, sleep patterns, and lung volumes in growing children with class II malocclusion with a retrognathic mandible. Twenty children aged 9-12 years with class II malocclusion with a retrognathic mandible participated in the study. A validated sleep questionnaire assessed the sleep patterns and the sleep problems of the children. The pre-treatment cephalometric variables and the pharyngeal airway passage (PAP) dimensions were analyzed. Spirometry tests were performed to evaluate lung volumes. A custom-made twin-block appliance was fabricated, and children were instructed to wear it for a minimum of 10 months. All variables including sleep problems, cephalometric variables, and pharyngeal airway measurements were evaluated post-treatment. Spirometry tests were re-evaluated at the end of the twin-block treatment. All data were statistically analyzed. Post-twin-block appliance treatment, there was a definite decrease in snoring, noisy breathing, and sleeping with mouth open. The sella-nasion to B point angle (SNB), mandibular length, the depths of oropharynx, nasopharynx, and hypopharynx as well as the height of nasopharynx (HNP) were significantly increased post-treatment (p <0.001). The length and thickness of soft palate (SPI) increased significantly (p <0.001), while its inclination decreased significantly (p <0.001). We found improvements in forced vital capacity (FVC) and forced expiratory volume at 1 second (FEV1); however, the changes were statistically not significant (p = 0.88 and p = 0.78). Twin-block appliance significantly increased the pharyngeal airway dimensions and improved the length and thickness of the soft palate in children with class II malocclusion. Post-twin-block treatment showed a considerable reduction in the sleep problems of the children. The lung volume measurements showed improvement; however, it was not statistically significant. Twin block may be used not only to correct the facial disharmony of children with a retrognathic mandible but also to improve the airway dimensions and lung volume as well as to reduce the sleep-disordered symptoms.

RADICULAR GROOVE OF MAXILLARY PREMOLAR: IS A “DANGER ZONE"?

Objectives: To evaluate the presence of radicular groove and dentin thickness on the palatal aspect of the buccal root of maxillary first premolars using cone-beam computed tomography (CBCT). Materials and methods: Images of 312 maxillary first premolars belonging to 187 patients (between 18-69 years, 94 females and 93 males) who were referred to the clinic were retrospectively reviewed. Root canal treatment, periapical lesion, and post-core were excluded. One and three-rooted premolars were also excluded. CBCT images were viewed on the axial plane to detect grooves. The concave area on the palatal aspect of the buccal root was recorded as a groove. Buccal and palatal dentin thicknesses were measured by two observers at the level of 3 mm below furcation. Statistical analyses were performed. Results: Buccal and palatal thicknesses were 1.28(±0.25) and 0.87(±0.13) mm, respectively. According to Student’s t-test, buccal dentin thickness was statistically higher than palatal dentin (p=0.016). The prevalence of groove was 82.05%. While palatal thickness without groove was 0.93(±0.14) mm, palatal thickness corresponding to groove was 0.82(±0.12) mm. One-way ANOVA showed palatal and buccal thickness in group 1 (18-35 years) was statistically lower than group 3 (&amp;gt;65 years) (p=0.012 and p=0.003). No statistical difference in thickness was observed between sex and left or right side (p&amp;gt;0.05). Conclusions: Palatal thickness related to groove can be considered a “danger zone” for post-core and endodontic treatment. Considering the high prevalence (82.05%) and thin dentin of the groove, more conservative canal and post space preparation and CBCT examination are recommended to avoid perforation.

Split staphylectomy to address soft palate thickness in brachycephalic dogs: 75 cases (2016-2018).

Describe the split staphylectomy procedure to address soft palate thickness and assess the complications and long-term outcome of this procedure as a part of multi-level surgery for brachycephalic obstructive airway syndrome. To consider whether same-day discharge following this surgery can be recommended. Medical records of dogs treated for brachycephalic obstructive airway syndrome using the split staphylectomy were reviewed. Owners were contacted to complete a questionnaire assessing initial postoperative concerns, the long-term outcome and the effect of surgery on their dog's quality of life. Seventy-five dogs underwent split staphylectomy during the study period. The overall complication rate was 8.3%, of which 2.7% were considered major. No life-threatening complications occurred, and no complications were related to the staphylectomy. The questionnaire was completed by 66.7% of owners (median follow-up 459 days), of which 88% felt that surgery had improved the quality of life for their dog. The majority (88%) of dogs were discharged from hospital on the day of surgery. Of the surveyed owners, 14% sought veterinary attention between their dog leaving the hospital and the scheduled postoperative reassessment 2 weeks after surgery. Four dogs were presented for veterinary intervention during this time period, but no intervention was related to the staphylectomy or for a life-threatening condition. The split staphylectomy offers a safe, straightforward method of addressing both excess thickness and length of soft palate in dogs with brachycephalic obstructive airway syndrome. Dogs can be discharged on the same day as brachycephalic obstructive airway syndrome surgery including split staphylectomy without an increased risk of complications.

Adaptive Changes in the Posterior Pharyngeal Wall Following Large Retraction of Incisors During Comprehensive Orthodontic Treatment.

To evaluate the effects of large retraction of incisors on the adaptive changes in the posterior pharyngeal wall and soft palate during comprehensive orthodontic treatment. Twenty-seven females with Class I mild crowding or spacing who required non-extraction treatment (group I) and 34 females with Class I bimaxillary dentoalveolar protrusion who required all first premolars extraction for the retraction of their incisors (group II) were included in the study. The effects of non-extraction and incisor retraction following all first premolars extraction orthodontic treatment on the sagittal dimensions of pharyngeal airway passage and posterior pharyngeal wall thickness were evaluated from pre- and post-treatment cephalograms. The dimensions of pharyngeal airway passage were comparable among the groups. The length of the soft palate increased (P < .01) and the thickness of the soft palate decreased (P < .01) following retraction of incisors, and the difference between the groups was significant (P < .05). The posterior pharyngeal wall thickness was reduced significantly at PPWT2 (P < .05), PPWT3 (P < .001), PPWT4 (P < .001), PPWT5 (P < .001), and PPWT6 (P < .01) regions following retraction of the incisors, and the difference between the groups was statistically highly significant. The large retraction of incisors during comprehensive orthodontic treatment in Class I bimaxillary dentoalveolar protrusion malocclusion subjects did not affect the sagittal dimensions of pharyngeal airway passage, but the thickness of the posterior pharyngeal wall reduced significantly as an adaptation to maintain the patency of the upper airway.

Optimized Healing of the Donor Wound Area with Ora-Aid, the Miracle Mix Containing Polymers and Vitamin E: A Case Series

Aim: To assess the donor site (in the palate) wound healing in free gingival graft (FGG) procedures after the placement of Ora-aid wound dressing. Methods: A total of five patients who underwent treatment for isolated gingival recession with free gingival graft procedure were enrolled for the study. The palatal donor site was covered with Ora-aid instead of the traditional acrylic stent.The various parameters assessed were: thickness of palate, pain using the visual analogue scale (VAS), measurement of size of surgical wound, wound healing assessment, direct visual assessment of oedema, suppuration, haemorrhage and necrosis and patient satisfaction through direct interaction/communication. Thus, the purpose of this case series was an objective observation of the donor site after the placement of Oraaid dressing. Results: All of the enrolled subjects showed significant improvement of the wound healing parameters. No untoward post-operative complications were reported. Conclusion: Ora-aid can contribute to a substantial reduction in patient discomfort and thus can be a substitute for the acrylic stent

Palatal mucosa thickness and palatal neurovascular bundle position evaluation by cone-beam computed tomography-retrospective study on relationships with palatal vault anatomy.

BackgroundMeasuring the thickness of the palatal mucosa at the planning of the surgical procedure is an important step in order to obtain the maximum width and thickness of the graft from the appropriate area. The aim of this study is to determine whether there is a relationship between palatal angle (PA) or palatal depth (PD) and palatal mucosa thickness (PMT) or palatal neurovascular bundle distance (PNBD).MethodsPMT, PNBD, PD and PA were measured on cone-beam computed tomography (CBCT) images of maxillary posterior region of 200 male and 200 female patients. The mean of all parameters according to gender was compared and the significance of the difference detected between groups was evaluated. Potential relationship between PMT or PNBD and PA or PD was also evaluated.ResultsIn females, the palatal mucosa was significantly thinner at all tooth regions (p < 0.005), and PNBD was lower only at the level of the second molar (p < 0.001). In addition, it was found that there was a significant inverse correlation between the palatal depth value and the palatal mucosal thickness, and palatal depth was correlated with the palatal neurovascular bundle distance (p ≤ 0.001).DiscussionConsistent with previous studies, it was observed that the thickest mucosa in the palatal region was located in the region of the premolar teeth, and women had thinner palatal mucosa. In addition, in patients with a deeper palate vault, the palatal mucosa was thinner, but the palatal neurovascular bundle was more distant from the cemento-enamel junction.

Oral Physical Findings in Patients with Chronic Nasal Obstruction

Background: Although chronic nasal obstruction causes mouth breathing, it causes changes in orofacial anatomy to compensate reduced airflow and facilitate breathing. As a result there is a mismatch between growth and evolution of orofacial structures.The aim of this study is to find oral physical findings in patients with chronic nasal obstruction. Methods: All patients referred to the clinic and ward in Imam Reza Hospital during 2019-2020, who suffered from chronic nasal obstruction, were examined and the findings of the examination included Tonsil size, tongue size, mallampati, tonsillar pillars size, palate height, palate thickness, ovula length, hypertrophy of nasal turbines,septal deviation, long face, neck circumference were compared among case and control groups.And also STOP-BANG score was calculated and risk of OSAS was shown. Results: In this study, the average age of people with nasal obstruction was 42.89±14.30. In physical examinations of the mouth, the size of the tonsils and the size of the neck did not differ significantly between two groups, but other positive examinations were significantly higher in patients with chronic nasal obstruction and there was no significant difference in blood pressure, diabetes, hypercholesterolemia, IHD, fatty liver in the control group. Only patients with nasal obstruction complained significantly more than the control group of hearing loss. Conclusion: The frequency of tongue enlargement, soft palate, and thick palate and Malapmati score were significantly higher in people with chronic nasal obstruction.

Evaluation of the clinical efficacy of nasal surgery in the treatment of obstructive sleep apnoea

Study objectivesThe aim of the study was to evaluate the clinical efficacy of nasal surgery in the treatment of obstructive sleep apnoea (OSA) by comparing the improvement of subjective symptoms and objective metrics before surgery and after 6 months of surgery. MethodsPatients with the main complaint of nasal congestion combined with habitual snoring who were hospitalized and treated were selected. Patients underwent subjective symptom tests and objective indicator monitoring both before surgery and 6 months after surgery. Comparisons between groups were performed using the independent samples t-test. ResultsSubjective scale evaluations demonstrated that nasal congestion, daytime sleepiness, snoring, nose-related symptoms, and sleep symptoms in patients with simple snoring or with OSA were improved after nasal surgery. Additionally, vitality was improved in all groups except for the patients with simple snoring and emotional consequence was improved in patients with simple snoring and mild OSA. Objective evaluations indicated the apnoea-hypopnoea index (AHI), the thickness of the soft palate, and the maximum cross-sectional area of the sagittal plane of the soft palate decreased after surgery in patients with mild OSA. The lowest blood oxygen concentration (LSaO2) and anteroposterior diameter of the soft palate increased after surgery in patients with mild OSA. The arousal index also significantly decreased in patients with mild and moderate OSA. The nasal cavity volumes (NCVs) and the nasal minimal cross-sectional areas (NMCAs) of all groups showed significant differences after surgery. ConclusionsNasal surgery can effectively improve nose and sleep symptoms in patients with simple snoring or with OSA. It can significantly reduce the nasal resistance and increase the ventilation volume. Statement of significanceObstructive sleep apnoea (OSA) is becoming a global health problem. OSA is associated with several coexisting conditions, reduced health-related quality of life, and impaired work productivity. This study performed nasal surgery on OSA patients with the main complaint of nasal congestion combined with snoring and patients with simple snoring to compare the improvement of subjective symptoms and objective metrics before and after surgery. We found that: (1) symptoms such as nasal congestion, daytime sleepiness or snoring were improved after nasal surgery; (2) the apnoea-hypopnoea index (AHI) and arousal index decreased after surgery in patients with OSA; (3) the nasal and oropharyngeal cavity volumes increased after surgery. These findings suggest that patients with OSA or with simple snoring could benefit from nasal surgery.

Determination of sex dimorphisms of the thickness of the hard palate in adolescence using computed tomography: Pilot study

BackgroundIn addition to traditional craniometric techniques, computer craniometry has been used in recent decades, including stereometric methods, which make it possible to determine the microanatomical spatial relationships and dimensional features of various structures of the skull, in particular the thickness of the inert palate of the maxilla. AimDetermination of the gender-specific variability of the thickness of the bony palate at the age of 18–20 years using CT. Material and methodsThe material of the pilot study were 40 computed tomograms of young males and females aged 18–20 years. The method of computer craniometry was used to measure the thickness of the bony palate in sagittal projection taking into account the gender. A graphic raster map was created to identify the palatal areas, then analyze their thickness and determine the safe zones for the mini dental implants. ResultsIn young males and females (18–20 years) the thickness of the bony palate decreases at different levels from front to back and from the median suture to the alveolar process. The greatest thickness of the bony palate corresponds to its anterior third and reliably predominates in young males at all levels compared to young females. In the middle and posterior third palate, the averages do not show gender differences and their variation is insignificant. ConclusionsThe greatest thickness of the bony palate can be used as the most favorable zone for the fixation of orthodontic mini dental implants. The variability in the thickness of the bony palate should be considered when selecting the most optimal zones and depth of mini-implant placement.

Obstructive Sleep Apnea

Aim: To evaluate diagnostic cephalometric parameters and their influence on skeletal and soft tissue components in obstructive sleep apnea (OSA). Materials and Methods: The study is a prospective case study of 40 diagnosed cases (as diagnosed by Type IV level study) of obstructive sleep apnea who were reported to the Department of Oral Medicine and Radiology with their age ranging from 28 to 75 years. Lateral cephalometric radiographs in upright and supine posture were taken, with teeth in centric relation, and the head aligned with Frankfort horizontal (FH) plane parallel to the floor. The focus-coronal plane distance was 5 feet, the film-coronal plane distance was 15 cm, and the magnification was 10%. Results: OSA patients experience an increase in values of sella nasion point A (SNA) and sella nasion point B (SNB) at the supine position with respect to the upright position and experience a decrease in values of nasion sella turcica odontoid process tangent (NSL-OPT) and nasion sella turcica- cervical vertebra tangent (NSL-CVT) at the supine position with respect to the upright position. The parameters of paramount importance in the pathogenesis of OSA are soft palate thickness, length, and tongue length. Conclusion: SNA, SNB and NSL-OPT, NSL-CVT are inversely related to each other and play a role in the consequence or pathogenesis of OSA. Tongue height is of the least significance in the pathogenesis of OSA. The cephalometric findings are of paramount importance to know the exact site of obstruction in the pathogenesis of OSA.

Maxillary width and hard palate thickness in men and women with different vertical and sagittal skeletal patterns

The objective of this research was to compare maxillary width and hard palate thickness in men and women with different vertical and sagittal skeletal patterns. A total of 241 adults (93 men and 148 women aged from 18 to 25years) were divided into male and female groups. Subjects were then separately divided into 3 sagittal skeletal groups and 3 vertical skeletal groups. A lateral cephalogram and a cone-beam computed tomography were taken for each subject. We measured the parameters to make statistical analyses and compared them between the different groups. Women had smaller craniomaxillofacial bone width and palatal thickness than men. In sagittal groups, maxillary width, maxillary alveolar width, and external temporomandibular joint fossa width in Class II and Class III malocclusion groups were smaller than in the Class I group for both women and men. The internal temporomandibular joint fossa width was the same results in men and women. In vertical groups, palate thickness, maxillary width, and maxillary alveolar width of the high-angle group were smaller than those of the low-angle group, regardless of sex. To an extent, maxillary width is correlated with vertical and sagittal skeletal patterns, and insufficient maxillary width would lead to unfavorable skeletal patterns. Differences exist in the morphology of craniomaxillofacial bone between men and women. Therefore, these findings can provide clinicians with references for differential diagnosis and treatment plans.

Influence of computed tomographic dimensions of the nasopharynx on middle ear effusion and inflammation in pugs and French bulldogs with brachycephalic airway syndrome

To compare the prevalence of middle ear abnormalities in pugs and in French bulldogs and evaluate the influence of nasopharyngeal dimensions on middle ear effusion. Retrospective study. Thirty pugs and 30 French bulldogs with brachycephalic airway syndrome and no known history of ear disease. Computed tomographic (CT) studies were reviewed for middle ear effusion, mucosal contrast enhancement, signs of osteitis, and tympanic wall thickness. Soft palate thickness and cross-sectional areas of the nasopharynx at the opening of the auditory tube were measured and normalized to each individual's skull index before statistical comparison between breeds. Statistical dependence of middle ear abnormalities and nasopharyngeal dimensions was assessed by using Spearman's rank correlation tests. Middle ear effusion was observed in 17 of 30 (56.7%) French bulldogs and five of 30 (16.7%) pugs. Contrast enhancement of the tympanic bulla was noted in 25 of 60 (41.6%) French bulldog ears and three of 60 (5.0%) pug ears. The cross-sectional airway dimensions (difference [Δ] = 0.31 cm2 , P < .0001) and soft palate thickness (Δ = 0.44 cm, P < .0001) were reduced in pugs compared with in French bulldogs. Weak correlations were detected between soft palate thickness and nasopharyngeal dimensions and presence of tympanic bulla effusion (r = 0.324 and r = 0.198, respectively) or contrast enhancement (r = 0.270 and r = 0.199, respectively). Middle ear effusion and inflammation were more common in French bulldogs than in pugs and did not seem related to nasopharyngeal dimensions. French bulldogs with brachycephalic airway syndrome seem predisposed to middle ear effusion and inflammation.

Radiological evaluation of the bone and soft tissue thicknesses of the palate for using a miniscrew-supported maxillary skeletal expander.

The purpose of this study was to determine the palatal bone and soft tissue thicknesses using a miniscrew-supported maxillary skeletal expander (MSE) in Class III malocclusion. The thicknesses of the palatal bone and soft tissue were measured in cone-beam computed tomography images obtained from 58 patients. All 20 points were crossing points between five levels, which were defined at 3mm intervals relative to the line connecting the central fossae of the first molar (Level 0), and 2mm and 4mm lateral to the anteroposterior reference line (AP line). The palatal bone was significantly thicker in males than females in the anterior palate up to Level 0, while there was no significant sex-related difference in the posterior palate. There was a tendency for the thickness to decrease in the posterior direction, except in females at 2mm lateral to the AP line. The palatal soft tissue was significantly thicker in males than females in all positions. At 2mm lateral to the AP line, the palatal soft tissue thickness decreased in the posterior direction. A 4mm lateral to the AP line, it initially decreased in the posterior direction, and then increasing again at Level - 6 (6mm posterior of Level 0). As the lateral distance from the AP line increased, the palatal bone thickness decreased while the palatal soft tissue thickness increased. These findings provide quantitative data on the palatal bone and soft tissue thicknesses for the miniscrew-supported MSE in the posterior palate.

Fluoroscopic evaluation of laryngopharyngeal anatomic variations attributable to head posture in dogs.

To fluoroscopically evaluate the effects of head posture and sedation on the laryngopharyngeal anatomic structures in dogs. 6 clinically normal Beagles (mean age, 6.2 years; mean weight, 10.4 kg). Each dog was sedated and placed in right lateral recumbency, and fluoroscopic examinations were performed with flexed, neutral, and extended head postures (FHP, NHP, and EHP, respectively). During 3 respiratory cycles, the angle between the basisphenoid bone and nasopharyngeal dorsal border (ABN), thickness of the soft palate, diameter of the nasopharyngeal lumen (DNL), overlapping length between the epiglottis and soft palate, and distance between the epiglottis and tympanic bulla (DET) were measured and percentage difference in the DNL (PDNLD) during a respiratory cycle was calculated. For the FHP, NHP, and EHP, median ABN was 91.50° (interquartile range [IQR], 86.75° to 95.00°), 125.00° (IQR, 124.50° to 125.50°), and 160.00° (IQR, 160.00° to 163.50°), respectively, with no significant differences between ABN and posture angle. For the FHP, median DNL and DET significantly decreased, compared with values for the NHP, and median thickness of the soft palette significantly increased. For the EHP, the minimal DNL and DET significantly increased, and the median overlapping length between the epiglottis and soft palate significantly decreased, compared with values for the NHP. The PDNLD significantly increased and decreased with FHP and EHP, respectively, compared with the PDNLD with NHP. Sedation did not affect upper airway structure changes. Results indicated that head posture significantly affected the laryngopharyngeal structures in dogs. Fluoroscopic examination of the upper respiratory tract of a dog should be performed with an NHP to minimize posture-induced changes in measurements.

ASSESSMENT OFPHARYNGEAL WIDTH AND LENGTH, POSITION OF HYOID BONE, IT’S SIZE ANDINCLINATION OF SOFT PALATE IN DIFFERENT SKELETAL MALOCCLUSIONS IN UTTRAKHAND POPULATION

Background: Uvulo-glosso-pharyngeal dimensions and size and position of associated structures are integral part of Orthodontic treatment planning. Since decades various authors have assessed airway dimensions by different methods and implied the results in diagnosis and treatment planning.Aims & Objectives: The aim of this study was to investigate the uvulo-pharyngeal dimensions and position of hyoid bone in subjects with different anteroposterior jaw relationships.Method: Cephalometric radiographs of 30 subjects (age 15-25 years of Uttrakhand ethnic origin) were divided into three Groups accorging to ANB and Wits appraisal. Group 1, Skeletal Class I (ANB 1-4 and Wits Appraisal -1 to 0) Group 2, Skeletal Class II (ANB >4 and Wits Appraisal >1) & Group 3, Skeletal Class III (ANB <1 and Wits Appraisal < -1.5). Statistical analysis was undertaken using one-way ANOVA to evaluate the mean and standard deviation in the three Groups and Post hoc Tukey test was done to compare the variables between the three Groups.Results: On an average, upper airway width was decreased in Group 2 and increased in Group 3 (p=0.028). Lower airway was increased in Group 3 (p=o.005). Velopharyngeal airway was decreased in Group 2 and increased in Group 3(p=0.042).Thickness of soft palate was increased in Group 3(p= 0.0.13). Hyoid bone was positioned poaterioinferiorly in Group 2 and Anterosuperiorly in Group 3(p=0.002). In conclusion, uvulo-pharyngeal airway and position of hyoid bone are affected by anteroposterior skeletal patterns in Uttrakhand population despite of its multiethenicity.

Clinical Radiographic Predictors of Response to Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea.

To determine if clinically acquired cephalometric measurements, specifically soft palate size, can predict hypoglossal nerve stimulation outcomes. Combined prospective cohort study and retrospective review. US sleep otolaryngology training program. Adults with obstructive sleep apnea and apneahypopnea index greater than 15 events/h who underwent hypoglossal nerve stimulation. Eligible subjects had diagnostic preoperative sleep studies and full-night efficacy postoperative studies for analysis. Lateral neck x-rays were obtained as part of routine clinical care and measured for key cephalometric variables by trained head and neck radiologists. Continuous variables were compared using the Student t test, while χ2 testing was used for categorical variables. Fifty-one patients met all study criteria. On average, patients were white, middle aged, and overweight. Following hypoglossal nerve stimulation, the overall cohort achieved a significant apnea-hypopnea index reduction from 36.7 events/h to 20.6 events/h (P < .01) and a response rate of 47% (defined as apnea-hypopnea index reduction >50% and apnea-hypopnea index <20 events/h). On average, therapy responders had significantly thinner soft palates than nonresponders (13.4 ± 3.8 mm vs 16.0 ± 3.4 mm, P = .045). Patient-specific anatomic factors, specifically soft palate thickness, may help identify optimal candidates for hypoglossal nerve stimulation. A larger, prospective study including both anatomic and physiologic variables is required to validate these findings.

USEFULNESS OF VARIOUS DYNAMIC AND STATIC PARAMETERS IN SLEEP MRI STUDIES -DO THEIR INCORPORATION IN ROUTINE REPORTING IN PATIENTS WITH OBSTRUCTIVE SLEEPAPNEA PROVE VALUABLE ?

Background: Sleep MRI is a new emerging non invasive modality in the preoperative evaluation of patients with obstructive sleep apnoea. Rather than subjective, the aim of the study is to evaluate the competency of certain dynamic and static parameters (variables and diemensions), that can be used in day to day reporting. Incorporating such parameters, may prove to be helpful in guiding surgical decision making. Materials and Methods: A retrospective analytical study included 27 subjects with OSA aged between 18 and 70 years using 1.5 T MRI . We measured variables such as the cross-sectional area and diameter of the retropalatal and retroglossal airway during the asleep and awakened states.We also measured comprehensive airway dimensions such as antero-posterior diameter of the tongue, midline saggital diameter of tongue, intermandibular rami distance, mentum spine distance and relative size of the tongue using the spine as the posterior border of the bony confines. Results: 21 patients had significant retropalatal airway compromise, and was evidenced by statistically significant variables in awakened and asleep states. The mean minimum anterior–posterior diameter (mm) of retropalatal airway during respiratory cycle was statistically significant measuring 3.1±1.5 mm in awaken state and 1.1±1.5 mm during asleep state (p- value 0.01). The mean minimum cross sectional area during respiratory cycle was statistically significant measuring 98±11 mm2 in awaken state and 63 ±12 mm2 during asleep state (p- value 0.04). 6 patients had significant retroglossal airway compromise, and was evidenced by statistically significant. The thickness of the soft palate and the relative size of the tongue (0.5± 0.01mm) was statistically significant in these patients (p- value 0.01). Conclusion: Our study shows that retropalatal airway is a significant cause of obstruction in patients with OSA, compared with retroglossal airway. We suggest that, when the compromise of the retroplatine aiway is to be evaluated, variables such as cross sectional area and antero-posterior diameter of the retropalatal airway during the respiratory phase in asleep and awakened states proves valuable and dimensions such as soft palate thickness as tool for objective measurement of OSA. When the compromise of the retroglossal aiway is to be evaluated, the relative size of the tongue , proves offers more advantage than the variables of airway compromise such as area and antero-posterior diameter.To further evaluate if some of our parameters correlate with the outcomes of the surgeries of OSA, a multivariate analysis would have been required.

Risk factors and fraction of exhaled nitric oxide in obstructive sleep apnea in adults.

ObjectiveThis study aimed to evaluate the relationship between obstructive sleep apnea (OSA) and the fraction of exhaled nitric oxide (FENO), and to assess the effect of risk factors of airway inflammation on OSA.MethodsMedical records of patients in the Respiratory Sleep Center at Chao-Yang Hospital in Beijing between January 2015 and June 2017 were analyzed. All patients were diagnosed with OSA. Data of the medical history, clinical examinations, FENO, and upper airway computed tomographic findings were collected. Logistic regression was used to evaluate risk factors of OSA.ResultsA total of 181 patients were admitted to the Respiratory Sleep Center during the study and 170 had a diagnosis of OSA and were included in the study. Single factor analysis showed that male sex, age, body mass index, smoking index, alcohol consumption, FENO, soft palate thickness, soft palate length, the narrowest transverse diameter of the upper airway, tonsil size, and nasal sinusitis were risk factors for sleep-disordered breathing and disease severity.ConclusionsMale sex, age, body mass index, FENO, the narrowest transverse diameter of the upper airway, and normal tonsil size are associated with OSA and disease severity. The severity of OSA is associated with FENO levels.

Can MDCT Measures of Upper Airway Dimensions and Central Obesity Indices Predict the Severity of Obstructive Sleep Apnea (OSA)?

Abstract Background: Comparative evaluation of the CT measures of upper air way, tongue adiposity and central obesity in a group of obstructive sleep apnea (OSA) patients and in a control group, and their potential role in grading of OSA severity. Aim of Study: The objective of the present study was to comparatively evaluate the different the upper air way, tongue adiposity and central obesity measures by CT scan in patients with obstructive sleep apnea syndrome (OSA) and in a control group, and their potential role in grading of OSA severity. Material and Methods: This prospective case control study was carried out on 17 OSA patients diagnosed by PSG and 16 control subjects. Non contrast MDCT scan of the upper airway and mid abdomen was performed on Philips 128 detector scanner, 1mm slice collimation during quite breathing. Axial and Sagittal reformatted images were assessed. Man-dibular plane hyoid distance (MPH), upper airway length (UAL), minimum cross-sectional area (MCA), transverse and antero-posterior diameters of the airway (TDA, APD), length and thickness of uvula and soft palate (LUV,TUV), tongue area and tongue base density (TA, TD) were measured. Image J program was used for quantification of neck and visceral adipose tissue (NAT, VAT). Results: Statistically significant difference was found in most CT measures between the OSA and control groups, the highest significant values were found with MCA, TDA, TUV and TA (p < 0.005). MCA and TA had the best diagnostic performance for OSA diagnosis. Statistically significant difference was found in MPH, UAL, MCA, TDA, TA, TD and NAT between the severe OSA and mild/moderate grades, The highest significant values was found with UAL and MCA (p=0.001, 0.002). For identifying severe OSA MCA, TDA and TA offered high diagnostic performances. Binary logistic regression found that TA and MPH were the significant predictors for severe OSA with overall % predicted=88.2%. Conclusion: Our results indicate that CT offers added value in OSA diagnosis and prediction of severity, multiple CT measures varied significantly between OSA and control group as well as between different OSA grades.