Pharyngeal Area Research Articles

Reduced pharyngeal dimensions and obstructive sleep apnea in adults with cleft lip/palate and Class III malocclusion

ABSTRACT Objective: To three-dimensionally evaluate the upper airway of individuals with cleft lip and palate (CLP) and Class III malocclusion and the occurrence of obstructive sleep apnea (OSA). Methods: Twenty-one CLP individuals with Class III malocclusion, 20–29 years of age, who underwent computed tomography for orthognathic surgery planning, were prospectively evaluated. All participants underwent polysomnography, and the apnea-hypopnea index ≥ 5 events/hour was considered indicative of OSA. The total upper airway and its subdivisions volumes, as well as the minimum pharyngeal cross-sectional area (CSA), were assessed using Mimics software. Results: Among the 21 individuals analyzed, 6 (29%) presented with OSA. The total upper airway and the oropharynx mean volumes were significantly decreased in subjects with OSA when compared to individuals without OSA. Mean CSA was not statistically different between groups. Conclusion: CLP individuals with Class III malocclusion and OSA have an upper airway significantly smaller than individuals without OSA.

Pharyngeal Area Changes in Parkinson's Disease and Its Effect on Swallowing Safety, Efficiency, and Kinematics.

Pharyngeal area can increase as a function of normal healthy aging and muscle atrophy. These increases in pharyngeal area can negatively affect swallowing function in healthy older adults (HOA). However, the presence of pharyngeal area changes and their effects on swallowing function in Parkinson's disease (PD) remain unknown. Therefore, we compared the pharyngeal area of people with PD to HOA to determine if pharyngeal area changes were present in PD above and beyond what is seen in HOA. Within PD, we also evaluated if and how an increase in pharyngeal area affects swallowing kinematics, swallowing safety, and swallowing efficiency. A secondary analysis of videofluoroscopic swallow studies was completed comparing 41 HOA and 40 people with PD. Measures of pharyngeal area, swallowing kinematics, swallowing safety (penetration/aspiration), and swallowing efficiency (residue) were analyzed. An analysis of covariance (ANCOVA) was used to determine if pharyngeal area was significantly different between the HOA and PD groups while controlling for age, sex, and height. Regression analyses were used to examine if and how pharyngeal area influenced swallowing kinematics, swallowing safety, and swallowing efficiency in PD. Pharyngeal areas were significantly larger for people with PD when compared to HOA (p = .008). An increase in pharyngeal area was associated with less pharyngeal constriction (p = .022), shorter duration of airway closure (p = .017), worse swallowing safety (p < .0005), and worse swallowing efficiency (p = .037). This study revealed that pharyngeal areas are larger in people with PD when compared to HOA, and that this increase in pharyngeal area is associated with maladaptive changes to swallowing kinematics, residue, and penetration/aspiration. These findings support the notion that pharyngeal muscle atrophy may be exacerbated in PD above and beyond what is seen in normal, healthy aging group. Results from this study highlight the need to consider pharyngeal muscle atrophy as a source for swallowing dysfunction in PD, and as a potential treatment target for swallowing rehabilitation.

A pilot study on the efficacy of transcranial direct current stimulation applied to the pharyngeal motor cortex for dysphagia associated with brainstem involvement in multiple sclerosis

Objective: we investigated the effect of anodal transcranial direct current stimulation (tDCS) applied over the pharyngeal motor area in dysphagia associated with multiple sclerosis (MS). Methods: Eighteen MS patients with dysphagia associated with brainstem involvement were randomized to receive either “real” or “sham” tDCS. Primary outcome: The Penetration/Aspiration Scale (PAS). Secondary outcomes: changes in electromyographic (EMG) parameters and pharyngeal cortical motor evoked potentials (MEPs). Patients were evaluated at baseline (T0), at the end of 5-session cycle of tDCS stimulations (T1), after two (T2), and four (T3) weeks.Results: the PAS values were significantly lower in the active group than in “sham” group at T1, and at T3. Over the post-stimulation periods, PAS significantly improved only in the “real” group. As regards the secondary outcomes, we observed a statistically significant difference between the 2 groups only in the MEPs amplitude at T1. The comparison between baseline and each of the post-stimulation times showed significant differences only of the “real” group across all the secondary parameters.Conclusions: Our findings support a beneficial effect of anodal tDCS applied to the pharyngeal motor cortex in MS-associated dysphagia.Significance: Considering its safety and efficacy, tDCS may represent an important resource in MS-associated dysphagia.

The utility of acoustic pharyngometry and rhinometry in pediatric obstructive sleep apnea syndrome

ObjectiveOur objective was to evaluate the usefulness of acoustic pharyngometry and rhinometry in assessing obstructive sleep apnea (OSA) syndrome in children. Patients/MethodsPatients who were hospitalized for polysomnography underwent acoustic pharyngometry and rhinometry in sitting and supine positions to measure anatomical (pharyngeal and nasopharyngeal) volumes and collapsibility characteristics (reduction of pharyngeal volume, estimated pharyngeal compliance, and reduction of nasopharyngeal volume). ResultsIn this study, we prospectively enrolled 103 children (median age, 10.4 years; 47 girls). Measures obtained from rhinometry correlated with height and were further height-normalized whereas measures obtained from pharyngometry did not correlate with height. Sleep apnea was ruled out in 51 subjects, while 52 children fulfilled OSA criteria (35 with obstructive apnea-hypopnea index ≥ 2 and < 5.h−1 [mild] and 17 with an index ≥ 5). The three groups differed on the z-score of BMI, the reduction of pharyngeal volume when supine, the estimated pharyngeal compliance and the supine normalized nasopharyngeal volume. These four factors linearly correlated with the apnea index even though children without OSA and mild OSA were found to be similar overall. A multivariate analysis with apnea index as the dependent variable and BMI z-score, neck circumference, mean pharyngeal area in supine position, estimated pharyngeal compliance and normalized nasopharyngeal volume as independent variables, showed that only BMI z-score and estimated compliance remained independent predictors of obstructive apnea (r2 value = 0.25, p < 0.0001). ConclusionAn increase in pharyngeal compliance is an independent risk factor of OSA syndrome in children; it can be measured using acoustic pharyngometry while awake.

Pharyngeal distensibility during expiration is an independent predictor of the severity of obstructive sleep apnoea.

Pharyngeal distensibility and collapsibility reflect the passive properties of tissue in the airway, are an indicator of the ease with which an airway can be deformed and are related to the severity of obstructive sleep apnoea (OSA). During normal tidal respiration, the collapsibility of the pharynx during expiration is passive without confounding by neuromuscular activation that occurs during inspiration. We evaluated the distensibility and collapsibility of the upper airway in subjects with OSA during wakefulness using sophisticated dynamic computed tomography (CT) imaging. We hypothesized that the dynamic changes of the upper airway during expiration would be related to the severity of OSA. Twenty-three patients with OSA and eight normal subjects underwent simultaneous measurement of respiratory flow and airway calibre using ultrafast CT. The change in pharyngeal cross-sectional area divided by the change in concomitant flow (as distensibility or collapsibility) was measured and compared across different severities of OSA. The slope of this relationship between delta area and delta flow during expiration was significantly higher in severe OSA when compared with normal controls and mild-moderate OSA. Differences in airway distensibility or collapsibility between severity groups were significant in expiration but not in inspiration. Distensibility or collapsibility contributed most to the apnoea-hypopnoea index in regression modelling. Age, gender, and body mass index (BMI) were not significant independent predictors. Our study demonstrates that airway distensibility during the expiratory phase of awake respiration is correlated with the severity of OSA.

Cephalometric and Pharyngometric Evaluation in Snoring Children with Sleep-Disordered Breathing and Adenotonsillar Hypertrophy Under an Orthodontic or Orthopedic Treatment

AbstractAltered craniofacial growth has been implicated in sleep-disordered breathing (SDB) in children. The authors aimed to evaluate the cephalometric measurements and pharyngeal dimensions related to SDB in snoring children with adenotonsillar hypertrophy (ATH) treated with an orthodontic and orthopedic oral appliance (OOA). Forty habitually snoring children, 6 to 9 years old with evidence of grade 3 to 4 ATH, maxillary constriction, and class II dental malocclusion were enrolled, with 24 children being treated with OOA, and 16 remaining untreated children as controls. All children underwent a cephalometric X-ray and acoustic pharyngometry for airway measurements at the start and 6 months after. Cephalometric measurements related to SDB reduced in the treated group (p &lt; 0.01) as follows: maxillary–mandibular relationship: –2.2 ± 1.70°; maxillary–mandibular planes angle: –2.4 ± 3.80°; and hyoid bone position: –4 ± 3.8 mm (p &lt; 0.001). OOA treatment revealed improvements in pharyngeal minimum cross-section area (MCA) (0.2 ± 0.2 cm2) and volume (V) (3.15 ± 2.5 cm3), while reductions in MCA (–0.2 ± 0.3 cm2) and in V (–1.25 ± 1.3 cm3) occurred in controls (p &lt; 0.001 vs. OOA). Six months of OOA treatment in snoring children with SDB promotes enlargement of the pharyngeal dimensions and beneficial cephalometric changes.

Relationship of the airway size to the mandible distance in Chinese skeletal Class I and Class II adults with normal vertical facial pattern.

This study aims to evaluate the pharyngeal airway dimensions among Chinese adults in relation to Class I and Class II facial skeletal patterns using three-dimensional cone-beam computed tomography (CBCT) images. A total of 156 initial CBCT images were evaluated, which were classified into skeletal Class I and Class II according to ANB angle with mean (SD) age being 22.56 ± 4.0 years and 22.32 ± 3.6 years. The pharyngeal airway volume, airway area, minimum cross-sectional area (MCA) and the distance from uvula (tip of the soft palate) to mental spine (U-MS distance) were assessed with Dolphin imaging software. Compared with Class I group, Class II group displayed significantly smaller pharyngeal airway volume, airway area and MCA (P <.01, P =0.03, and P =0.008, respectively), and shorter U-MS distance (P <.001). Comparing gender subgroups, the female subgroup showed the smallest airway measurement. Spearman correlation test results showed that the airway volume and area had a significant positive correlation with U-MS distance (r = 0.22, P = 0.005, and r = 0.28, P < 0.005, respectively) and negative correlation with ANB angle (r = -0.23, P = 0.002, and r = -0.21, P = 0.007, respectively). Pharyngeal airway volume, airway area, MCA, and the U-MS distance were smaller in skeletal Class II than Class I Chinese adult subjects and lower in female Class II subgroup. Additionally, there was a correlation observed between the mandibular distance (U-MS), ANB angle and airway size.

Ejercicios con tracto vocal semi-ocluido: Efectos en la función glótica, aerodinámica y configuración del tracto vocal

El presente artículo corresponde a una revisión de la literatura en relación los efectos asociados a los ejercicios con tracto vocal semiolcuido en la función glótica, medidas aerodinámicas y configuración del tracto vocal. Los ejercicios con tracto vocal semiocluido (alargamientos artificiales del tracto vocal) han sido ampliamente utilizados en terapia, calentamiento y entrenamiento vocal. Se ha establecido que este tipo de ejercicios aumentan la impedancia del tracto vocal, específicamente la reactancia inertiva (inertancia) que puede influir favorablemente en la vibración de los pliegues vocales. Un aspecto común en los programas de terapia de voz fisiológicos, es que todos ellos se basan en ejercicios con tracto vocal semiocluido. Una gran cantidad de estudios han revelado el efecto que estos ejercicios producen en los diferentes subsistemas que participan en la producción de la voz. La evidencia señala que estos ejercicios afectan en grado de aducción de los pliegues vocales dependiendo del grado de resistencia al flujo. El efecto en las medidas aerodinámicas se centra en cambios en el grado de presión subglótica, oral y transglótica. La configuración del tracto vocal es otro aspecto que se ve modificado durante la vocalización con ejercicios con tracto vocal semiocluido. A grandes rasgos se ha observado una mayor área faríngea, posición vertical de la laringe más descendida, elevación de velo del paladar y una modificación en la salida del tubo epilaríngeo. En general, la mayoría de los cambios sugieren que ejercicios con TVSO son buenas herramientas para los sujetos con trastornos de la voz y usuarios profesionales de la voz. Los cambios reportados parecen conducir a una producción de voz más económica.

Obesity, The Single Most Important Risk Factor for OSA: A Case Report

Obstructive sleep apnea (OSA) is characterized by repetitive airflow reduction caused by collapse of the upper airway during sleep in addition to daytime sleepiness, clinical symptoms include fatigue, insomnia, and snoring. The condition is associated with adverse clinical outcomes, including cardiovascular disease, hypertension, cognitive impairment, and metabolic abnormalities.1 Among the risk factors for OSA, obesity is probably the most important. Several studies have consistently found an association between increased body weight and risk of OSA. Tomographic scanned images have shown that obesity causes increased fatty deposits in the pharyngeal area.2 The deposits encroach on the airway and contribute to airway narrowing. Also, among obese patients as compared to normal controls, fat deposits appear to alter the shape of the upper airway without necessarily reducing the cross-sectional area. M. A. Ciscar et al used magnetic resonance imaging to investigate differences between obese and normal controls.2 Ultrafast magnetic resonance imaging was used to study the upper airway and surrounding soft tissue in 17 patients with OSA during wakefulness and sleep, and in eight healthy subjects whilst awake. Coronal sections of awake OSA patients showed elliptical-shaped airways with long axes that were oriented anteroposterior; normal controls had airways that were oriented transversely. Studies using computed tomography have produced similar results.14Pulse Vol.10 January-December 2017 p.38-41

Dysphagia Onset in Older Adults during Unrelated Hospital Admission: Quantitative Videofluoroscopic Measures.

New-onset swallowing difficulties in older patients during unrelated hospital admissions are well recognized and may result in prolonged hospital stay and increased morbidity. Presbyphagia denotes age-related swallowing changes which do not necessarily result in pathological effects. The trajectory from presbyphagia to dysphagia is not well understood. This retrospective observational study compared quantitative videofluoroscopic measures in hospitalized older adults aged 70–100 years, reporting new dysphagia symptoms during admission (n = 52), to healthy asymptomatic older (n = 56) and younger adults (n = 43). Significant physiological differences seen in hospitalized older adults but not healthy adults, were elevated pharyngeal area (p < 0.001) and pharyngeal constriction ratio (p < 0.001). Significantly increased penetration (p < 0.001), aspiration (p < 0.001) and pharyngeal residue (p < 0.001) were also observed in the hospitalized older cohort. Reasons for onset of new swallow problems during hospitalization are likely multifactorial and complex. Alongside multimorbidity and polypharmacy, a combination of factors during hospitalization, such as fatigue, low levels of alertness, delirium, reduced respiratory support and disuse atrophy, may tip the balance of age-related swallowing adaptations and compensation toward dysfunctional swallowing. To optimize swallowing assessment and management for our aging population, care must be taken not to oversimplify dysphagia complaints as a characteristic of aging.

Analysis of pharyngeal edema post-chemoradiation for head and neck cancer: Impact on swallow function.

ObjectivesEdema is a frequent clinical observation following chemoradiation treatment (CRT) of oral/oropharyngeal cancer and is thought to contribute to post‐CRT swallowing impairment. Our aims were to reliably quantify pharyngeal edema pre‐ and post‐CRT from videofluoroscopic (VF) swallowing studies and to explore the relationship between edema and swallowing impairment. Swallowing impairment was captured using patient‐reported swallowing outcomes (EAT‐10) and with VF confirmation of impairment (DIGEST).Methods40 patients (24 M, age 38–76) with oral/oropharyngeal cancer received radiotherapy (70 Gy, 7 weeks) and 3 weekly doses of cisplatin. VF and EAT‐10 were completed pre‐ and 1‐month post‐CRT. Edema was captured by measuring posterior pharyngeal wall (PPW) thickness, vallecular space, and pharyngeal area (PA) on a single post‐swallow rest frame. Wilcoxon sign rank tests and paired t‐tests evaluated within‐subject changes in impairment and edema respectively. A linear mixed effect regression model explored the influence of time, patient‐reported outcomes, and functional impairment on measures of edema.ResultsSwallowing function (EAT‐10 and DIGEST) was significantly worse post‐CRT. PPW thickness (but not vallecular space and pharyngeal area) was significantly worse post‐CRT. PPW thickness was only significantly influenced by time (pre‐ vs. post‐CRT) but not by measures of swallow function.ConclusionOur findings establish the use of PPW thickness as a reliable measure of acute edema in post‐CRT treatment. In this small, retrospective sample, edema was not significantly correlated with either patient‐reported or measured swallow function. Prospective longitudinal work, examining the relationship between objective measures of edema, patient perception of impairment, and swallow function and biomechanics is warranted.Level of Evidence4.

Incorporating a continuous suction system as a preventive measure against fistula-related complications in head and neck reconstructive surgery.

BackgroundAlthough previous studies have focused on determining prognostic and causative variables associated with fistula-related complications after head and neck reconstructive surgery, only a few studies have addressed preventive measures. Noting that pooled saliva complicates wound healing and precipitates fistula-related complications, we devised a continuous suction system to remove saliva during early postoperative recovery.MethodsA continuous suction system was implemented in 20 patients after head and neck reconstructive surgery between January 2012 and October 2017. This group was compared to a control group of 16 patients at the same institution. The system was placed orally when the lesion was on the anterior side of the retromolar trigone area, and when glossectomy or resection of the mouth floor was performed. When the orohypopharynx and/or larynx were eradicated, the irrigation system was placed in the pharyngeal area.ResultsThe mean follow-up period was 9.2±2.4 months. The Hemovac system was applied for an average of 7.5 days. On average, 6.5 days were needed for the net drain output to fall below 10 mL. Complications were analyzed according to their causes and rates. A fistula occurred in two cases in the suction group. Compared to the control group, a significant difference was noted in the surgical site infection rate (P<0.031).ConclusionsClinical observations showed reduced saliva pooling and a reduction in the infection rate. This resulted in improved wound healing through the application of a continuous suction system.

Reduced pharyngeal constriction is associated with impaired swallowing efficiency in Amyotrophic Lateral Sclerosis (ALS).

Swallowing inefficiency is a prevalent but understudied problem in individuals with Amyotrophic Lateral Sclerosis (ALS). Although reduced pharyngeal constriction has been identified as a mechanism contributing to swallowing inefficiency following stroke, this relationship has not been empirically tested in the ALS population. This study sought to characterize profiles of swallowing efficiency in a sample of ALS patients and investigate relationships between pharyngeal constriction and swallowing efficiency. Twenty-six adults with ALS underwent videofluoroscopic swallowing studies, involving 3mL-thin, 20mL-thin, and 3mL-pudding boluses. Full-length recordings were segmented into bolus clips and randomized for analysis. We recorded the total number of swallows per bolus and obtained normalized pixel-based measures of pharyngeal constriction area and post-swallow residue in the vallecular and pyriform sinuses. Linear mixed models with Spearman's correlations were used to determine relationships between pharyngeal constriction and swallowing efficiency, with added factors of bolus volume and thickness. Individuals with ALS demonstrated reduced pharyngeal constriction and increased vallecular and pyriform sinus residue, compared to norms. Reduced pharyngeal constriction had a significant effect on the presence of vallecular and pyriform sinus residue as well as the number of swallows per bolus. Increased bolus thickness was associated with increased vallecular residue, while increased bolus volume was associated with reduced pharyngeal constriction. Results were significant at P<0.05. Our results suggest that reduced pharyngeal constriction is a significant physiological parameter related to swallow inefficiency in ALS. Future work is needed to corroborate these preliminary results and investigate factors to mitigate such impairments.

A comparison of posterior pharyngeal wall areas between different tongue positions during inhalation

A comparison of posterior pharyngeal wall areas between different tongue positions during inhalation

Zoster Laryngitis with Multiple Cranial Nerve Palsy Progressed as Ascending Involvement

Background Herpes zoster of the head and neck commonly presents with Ramsay Hunt syndrome. However, vesicular eruptions may occur on the pharyngeal or laryngeal area with multiple lower cranial-nerve (CN) palsy. Case Report We report on the case of a 54-year-old man with herpes zoster of the pharynx and larynx with multiple CN palsy and persistent hiccups. He initially developed progressive dysphagia, hoarseness, and persistent hiccups (CN IX and X). After admission, Dizziness, hearing impairment, and peripheral facial palsy (CN VII and VIII) were complicated. The results of a polymerase chain reaction test of saliva and vesicular fluid from the ear and throat were strongly positive for varicella zoster virus. The progression of CN palsy was in an ascending sequence. Conclusion We suggest that the sequence of CN palsy may be either ascending or descending, depending on the initial site of involvement. Key Words: Herpes zoster; Cranial nerve diseases; Laryngitis; Hiccup

Cold thermal oral stimulation produces immediate excitability in human pharyngeal motor cortex.

Current strategies of swallowing therapy include facilitation of swallowing initiation by sensory modulation. Although thermal tactile oral stimulation is a common method to treat dysphagic patients to improve swallowing movement, little is known about the possible mechanisms. This study is aimed to investigate whether thermal oral (tongue) stimulation can modulate the cortico-pharyngeal neural motor pathway in humans. Eighteen healthy volunteers participated and were intubated with an intraluminal catheter for recording pharyngeal electromyography. Each participant underwent baseline transcranial magnetic stimulation (TMS) cortico-pharyngeal motor evoked potential (MEP) measurements bilaterally. MEPs were then measured during thermal stimulation over the dorsal tongue, applied using the Peltier device at three different temperatures; 45°C, 37°C, and 15°C, in a pre-ordered manner. Each of the three temperatures was given twice with a 5-min resting time between each trial. Averaged MEP amplitude changes were analyzed using ANOVA and post-hoc t-tests. Two-way repeated measures ANOVA with factors of Temperature×Trial in amplitude of MEP demonstrated a significant effect of Temperature both in the stronger (F2,34 =5.775, P=.007) and weaker (F2,34 =4.771, P=.017) pharyngeal hemispheres. Subsequent post-hoc tests showed the significant increase in pharyngeal MEPs at 15° compared to 37° in both hemispheres (P<.05). Cold oral stimulation was able to induce significant changes in pharyngeal cortical excitability, demonstrating evidence for a sensorimotor interaction between oral and pharyngeal cortical areas.

Upper Airway 3D Changes of Patients With Cleft Lip and Palate After Orthognathic Surgery.

The purpose of this study was to 3-dimensionally assess the airway characteristics of patients with unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) who underwent orthognathic surgery. This was a retrospective study. The study took place at a national referral center for cleft lip and palate rehabilitation. The sample comprised cone-beam computed tomography (CBCT) scans obtained before and after orthognathic surgery of 15 individuals (30 CBCT scans), divided into 2 groups: UCLP group (n = 9 patients/18 CBCT scans) and BCLP group (n = 6/12 CBCT scans). All patients had a nonsyndromic UCLP or BCLP and a skeletal class III malocclusion at the preoperative period. Airway volume, pharyngeal minimal cross-sectional area (mCSA), location of mCSA, sella-nasion-A point (SNA) and sella-nasion-B point (SNB) angles, and condylion-A point and condyloid-gnathion linear measurements were assessed in open-source software (ITK-SNAP and SlicerCMF). Airway dimensions of patients with UCLP and BCLP increase after orthognathic surgery. After orthognathic surgery, UCLP group showed a significant 20% increase in nasopharynx volume. Although not significant, BCLP group also showed an increase of 18% in the same region. Minimal cross-sectional area remained dimensionally stable after surgery and was all located in the oropharynx region, on both groups. Additionally, a positive correlation was observed between volume and mCSA on both groups. Overall, individuals with UCLP and BCLP showed an increase in the upper airway after orthognathic surgery and this might explain the breathing and sleep improvements reported by the patients after the surgery.

Spontaneous meningioma in a pig-tailed macaque (Macaca nemestrina).

We present a case of spontaneous meningioma in a female pig-tailed macaque (Macaca nemestrina) more than 24 years old. Clinically, the monkey displayed slow, weak, and insecure movements and poor vision. A tumorous mass was present at the floor of the cranial vault extending from the optic chiasm towards the foramen magnum. It compressed adjacent parts of the brain, infiltrated the sphenoidal and occipital bone, and showed transcranial expansion into the pharyngeal area. Histologically, the tumor was consistent with a meningioma displaying mostly meningothelial and some microcystic components. Since only six cases of meningiomas in nonhuman primates have been reported so far and only two of these meningiomas have been described in detail, the findings of each case should be reported to expand the knowledge base of this type of tumor. In addition, this is the first description of a meningioma in pig-tailed macaques.

The effects of sex, skeletal age, and sagittal skeletal pattern on pharyngeal airway dimensions and related structures in growing Thai orthodontic patients

PurposeTo evaluate the effects of sex, skeletal age, sagittal skeletal pattern, and the interaction among these three factors on the pharyngeal airway widths and areas, and the positions and dimensions of surrounding structures. Materials and methodsPretreatment lateral cephalometric radiographs of 418 growing orthodontic patients (183 males, 235 females); 6–20 years old (mean age, 13.95±3.62 years), were collected from 2007–2014, Department of Radiology, Faculty of Dentistry, and divided into 3 skeletal ages according to cervical vertebral maturation stages, pre-pubertal (cervical stages (CS) 1,2), pubertal (CS 3,4), and post-pubertal (CS 5,6). Ten angular, 13 linear, and 3 cephalometric area measurements were analyzed. Three-way ANOVA and Factor analysis were applied to compare sex, skeletal age, and sagittal skeletal pattern differences in the pharyngeal airway dimensions and the surrounding structure dimensions and positions. ResultsSex–skeletal age interactions existed in the nasopharyngeal and oropharyngeal airway dimensions, and dimensions and positions (vertical, horizontal) of surrounding structures. Skeletal age–sagittal skeletal pattern interactions also affected the pharyngeal airway dimensions. In the post-pubertal period, male and skeletal Class III subjects tended to have larger pharyngeal airway, tongue, and soft palate dimensions; more anterior positions of the hyoid and tongue; and less obtuse soft palate angulation. The post-pubertal males also had more inferior positions of the hyoid and tongue. ConclusionInteractions between sex–skeletal age and skeletal age–sagittal skeletal pattern affected the pharyngeal airway dimensions. The surrounding structure positions and dimensions varied according to sex–skeletal age interaction and sagittal skeletal difference.

Effect of semi-rapid maxillary expansion in children with obstructive sleep apnea syndrome: 5-month follow-up study.

The purpose of this study was to investigate the effect of semi-rapid maxillary expansion (SRME) orthodontic treatment on biomarkers and respiratory parameters in children with obstructive sleep apnea syndrome (OSAS) and maxillary transverse deficiency. Thirty children with OSAS were included in this study. Fifteen children were enrolled as control, and 15 children were subjected to SRME orthodontic treatment method for 5months. Beside respiratory parameters, pharyngeal area, dental arch, and postero-anterior widths and the levels of OSAS biomarkers in serum and urine were measured. Pharyngeal airway space, dental arch, and postero-anterior widths were increased after SRME treatment. Sleep tests showed a decrease in the apnea-hypopnea index (AHI) after 5-month control/treatment duration. Serum kallikrein (KLK)1 levels decreased significantly in the treatment group. There was a significant increase in serum orosomucoid (ORM)2 levels and a decrease in urine perlecan levels in the control group after a 5-month follow-up. A significant negative correlation between serum ORM2, perlecan, gelsolin, and KLK1 levels and intercanin width, as well as between serum ORM2 and KLK1 levels and intermolar width, was observed. SRME treatment can be considered as a useful approach in children with OSAS. A further investigation of OSAS-related biomarkers and their relationship with sleep and orthodontic parameters is needed for providing easier and reliable modulatory strategies in the treatment of OSAS.