Supine Radiographs Research Articles

Changes of Deformity due to the Position and Anesthesia in Adolescent Idiopathic Scoliosis

Restrospective case series. To determine changes in the end vertebra and neutral vertebra, and in the magnitudes of coronal and rotational deformities according to position and anesthesia in patients with adolescent idiopathic scoliosis. Although it is known that coronal deformity of scoliosis has a tendency to decrease by position and anesthesia, there have been few reports on the effects of position and anesthesia on the rotational deformity of scoliosis. End vertebra and neutral vertebra can change after positioning and anesthesia, but little is known about it. Sixty-two structural curves in 31 patients were evaluated using standing, supine, side bending, postanesthesia, and postoperative anteroposterior plain radiographs. Cobb angles and rotation angles by Perdriolle torsionmeter were measured, and the end vertebra and neutral vertebra were identified in each radiograph. Coronal Cobb angles decreased significantly with the correction rates of 25.0%, 31.7%, 59.5%, and 74.0%, and rotational deformities decreased with the correction rates of 6.1%, 24.5%, 6.2%, and 25.7% by supine position, anesthesia, side bending, and surgery, respectively. The end vertebrae changed in 18 patients (58.1%) in both supine and postanesthesia radiographs, and the neutral vertebrae changed in 10 patients (32.3%) in supine radiographs and in 20 patients (64.5%) in postanesthesia radiographs. Coronal deformities are significantly corrected by supine position and anesthesia. Anesthesia significantly corrects axial rotation, but further correction cannot be achieved by rod derotation. The end vertebra and neutral vertebra have a tendency to vary by position and anesthesia, which gives rise to confusion in the determination of fusion levels.

Are Supine Chest and Abdominal Radiographs the Best Way to Confirm PICC Placement in Neonates?

Peripherally inserted central catheters (PICCs) are commonly used in NICUs. Although they have many benefits, they also have many potential complications. Confirming catheter tip position is essential to decreasing complications, but the best method to achieve confirmation is unclear. Literature review for studies that address line position confirmation to assist health care providers in evaluating the available research and to identify gaps in the literature. A literature search of four major databases followed by an ancestry approach was performed. Articles reviewed specifically discuss PICC lines and PICC line placement confirmation. Data on confirming PICC placement were lacking. Fluoroscopic placement is ideal, but cannot be done at the bedside and is costly. Supine chest radiograph is the most widely used method and is convenient, but when line tip position is unclear, contrast or ultrasound confirmation can be used. When PICC lines are placed in the saphenous vein, infants may benefit from supine and lateral abdominal radiographs to ensure placement in the inferior vena cava. More studies are needed to generalize findings. PICC line tips should be located in the superior vena cava or inferior vena cava close to the junction with the right atrium (0.5-1 cm outside of the cardiac chambers in premature infants and 1-2 cm outside of the cardiac chambers in larger infants). Arm position is very important when performing radiographs for placement because movement of the arm can cause migration of the catheter. There is also significant inter-observer variability when identifying line tip position.

Acute ovarian torsion in an infant: diagnostic clues on supine and decubitus abdominal radiographs confirmed by ultrasound

Acute ovarian torsion is an uncommon yet important diagnostic consideration in any female pediatric patient presenting with acute abdominal pain. A 2-month-old infant presented to the emergency department with a several-day history of constipation. Evaluation with plain radiographs demonstrated a subtle yet persistent soft tissue mass in the right pelvis. Follow-up ultrasound revealed characteristic findings for ovarian torsion and subsequent salpingo-oophorectomy was performed confirming the diagnosis. Acute ovarian torsion is an uncommon and frequently overlooked diagnosis in female infants presenting with gastrointestinal or urinary tract symptoms. Careful assessment of plain radiographic findings may aid in the further management of this difficult diagnosis in female infants. Ultrasound is recommended to confirm the diagnosis.

Cholecystostomy does not prevent gallstone ileus: a case report

IntroductionGallstone ileus following cholecystostomy has been reported once, in a patient with acute cholecystitis, where symptoms of small intestinal obstruction had developed one day after surgery. We report a case of gallstone ileus eight months following a cholecystostomy, which might deter the diagnosis. This is the only such reported case in medical literature according to our knowledge.Case presentationA 54-year-old Sri Lankan female with a past history of a cholecystostomy presented with symptoms suggestive of small intestinal obstruction. Evidence of ileal obstruction with pneumobilia in the supine radiograph of the abdomen and cholecyto-duodenal fistula in the water soluble contrast study was suggestive of the diagnosis of gallstone ileus. An enterolithotomy was performed with no attempt of closure of the cholecysto-duodenal fistula.ConclusionThis case demonstrates the value of the supine radiograph of the abdomen and the barium follow-through in diagnosis. A cholecystogram, preferably preoperative, is the mainstay of prevention and identification of this clinical scenario.

Quantification of the Radiographic Joint Space Width of the Ankle

Quantification of joint space width of the ankle could provide information essential to evaluate the effects of potential disease-modifying agents and adverse effects of devices intended to ameliorate osteoarthritis elsewhere in the lower extremity. Current methods require proprietary software or have not been well validated; our purpose was to develop and assess the reliability of a digital joint space width quantification method using public access software. We studied 95 patients, asymptomatic in the ankles and without history of ankle trauma, but with symptomatic medial knee osteoarthritis, participating in an ongoing longitudinal trial. Weightbearing anteroposterior radiographs of the ankle and supine radiographs of the pelvis were assessed, and the narrowest medial and lateral tibiotalar joint space widths and hip joint space widths were measured using Image J software (US NIH, Bethesda, MD). Medial joint space widths were 2.56 +/- 0.50 and 2.55 +/- 0.48 mm, and lateral joint space widths were 2.45 +/- 0.55 and 2.44 +/- 0.52 mm, for right and left ankle, respectively. Coefficients of variation for repeat measurements by the same observer were 1.13% and 4.5%, and by different observers 7.30% and 7.27%, for medial and lateral joint space widths, respectively. Men had wider joint space widths than women when accounting for height. Joint space width of the ankle correlated with the joint space width of the hip and with height and weight, but not with age.

Reappraisal of radiographic signs of pneumoperitoneum at emergency department

Purpose This study aimed to evaluate the sensitivities of the reported free air signs on supine chest and abdominal radiographs of hollow organ perforation. We also verified the value of supine radiographic images as compared with erect chest and decubitus abdominal radiographs in detection of pneumoperitoneum. Methods Two hundred fifty cases with surgically proven hollow organ perforation were included. Five hundred twenty-seven radiographs were retrospectively reviewed on the picture archiving and communication system. Medical charts were reviewed for operative findings of upper gastrointestinal tract, small bowel, or colon perforations. The variable free air signs on both supine abdominal radiographs (KUB) and supine chest radiographs (CXR) were evaluated and determined by consensus without knowledge of initial radiographic reports or final diagnosis. Erect CXR and left decubitus abdominal radiographs were evaluated for subphrenic free air or air over nondependent part of the right abdomen. Result Upper gastrointestinal tract perforation was proven in 91.2%; small bowel perforation, in 6.8%; and colon perforation, in 2.0%. The positive rate of free air was 80.4% on supine KUB, 78.7% on supine CXR, 85.1% on erect CXR, and 98.0% on left decubitus abdominal radiograph. Anterior superior oval sign was the most common radiographic sign on supine KUB (44.0%) and supine CXR (34.0%). Other free air signs ranged from 0% to 30.4%. Conclusions Most free air signs on supine radiographs are located over the right upper abdomen. Familiarity with free air signs on supine radiographs is very important to emergency physicians and radiologists for detection of hollow organ perforation.

Gastric Migration of Intestinal Ascariasis

Journal of Ultrasound in MedicineVolume 27, Issue 12 p. 1799-1801 Just Images Gastric Migration of Intestinal Ascariasis B-Mode Sonographic Depiction Nitin P. Ghonge MD, DNB, Nitin P. Ghonge MD, DNB [email protected] Diwan Chand Imaging Research Center, New Delhi, India.Search for more papers by this author Nitin P. Ghonge MD, DNB, Nitin P. Ghonge MD, DNB [email protected] Diwan Chand Imaging Research Center, New Delhi, India.Search for more papers by this author First published: 01 December 2008 https://doi.org/10.7863/jum.2008.27.12.1799Citations: 3 Address correspondence to Nitin P. Ghonge, MD, DNB, Diwan Chand Imaging Research Center, 10B, K. G. Marg, New Delhi-110 001, India., Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume27, Issue12December 2008Pages 1799-1801 RelatedInformation

Weightbearing Anteroposterior Pelvic Radiographs are Recommended in DDH Assessment

Neutral pelvic positioning during recording of anteroposterior pelvic radiographs has been recommended for precise interpretation of acetabular deformities. Because the effect of pelvic positioning is controversial in the literature, we asked whether the weightbearing position would alter radiographic interpretations. We obtained sets of supine and weightbearing anteroposterior pelvic radiographs of 31 patients with developmental dysplasia of the hip and measured pelvic tilt, acetabular version, center edge angle, acetabular index, joint space width and femoral head translation. For both genders the pelvis extended when patients were repositioned from supine to weightbearing but extension was more pronounced in women compared with men. The number of patients with apparent acetabular retroversion was reduced from 11 supine to four when weightbearing. The center edge angle, acetabular index, joint space width and femoral head translation were similar in both views. We recommend weightbearing anteroposterior pelvic radiographs be obtained to assess DDH given the differences in pelvic flexion-extension and interpretations of acetabular version. Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Change of Deformity due to Position and Anesthesia in Adolescent Idiopathic Scoliosis

Purpose: To determine changes in the end vertebra and neutral vertebra as well as in the magnitudes of coronal and rotational deformities according to position and anesthesia in patients with adolescent idiopathic scoliosis. Materials and Methods: Sixty-two structural curves in 31 patients were evaluated using standing, supine, side bending, post-anesthesia, and postoperative anteroposterior plain radiographs. Cobb angles and rotation angles by perdriolle torsionmeter were measured, and the end vertebra and neutral vertebra were identified in each radiograph. Results: Coronal cobb angles decreased significantly with correction rates of 25.0%, 31.7%, 59.5%, and 74.0%, and rotational deformities decreased with correction ratesof 6.1%, 24.5%, 6.2%, and 25.7% by supine position, anesthesia, side bending and surgery, respectively.The end vertebrae changed in 18 patients (58.1%) in both supine and post-anesthesia radiographs, and the neutral vertebrae changed in 10 patients (32.3%) in supine radiographs and in 20 patients (64.5%) in post-anesthesia radiographs. Conclusion: Coronal deformities are significantly corrected by supine position and anesthesia. Anesthesia significantly corrects axial rotation, but more correction cannot be achieved by rod derotation. The end vertebra and neutral vertebra have a tendency to vary by position and anesthesia, which gives rise to confusion in the determination of fusion level.

Test Characteristics of the 3-View Abdominal Radiograph Series in the Diagnosis of Intussusception

To determine the test characteristics of the 3-view abdominal radiograph series to exclude intussusception in children presenting to the pediatric emergency department. We performed a single-center retrospective review of children for whom supine, prone, and lateral decubitus abdominal radiographs were performed as part of our standard diagnostic evaluation for intussusception. A pediatric radiologist masked to the patient's clinical data and outcome reviewed all radiographs. The criterion evaluated was whether air was visualized in the ascending colon on each of the 3 radiograph views. We determined the presence or absence of intussusception hierarchically by definitive radiological study report, surgical operative note, or clinical outcome. We analyzed 179 patients, of whom 27 (15.1%) were diagnosed with intussusception. The test characteristics of the 3-view radiograph series in the diagnosis of intussusception when all 3 views had air in the ascending colon were sensitivity of 100% (95% confidence interval [CI] 87-100), specificity of 18.4% (95% CI, 12.3-24.6), likelihood ratio for a negative test of 0 (95% CI, 0.01-1.53), and negative predictive value (NPV) of 100% (lower bound 95% CI, 98%). When at least 2 views had air in the ascending colon, the test characteristics were sensitivity of 96.3% (95% CI, 89.2-100), specificity of 41.4% (95% CI, 33.6-49.3), likelihood ratio for a negative test of 0.09 (0.01-0.62), and NPV of 98.4 (95% CI, 95.2-100). Using specific criteria, the presence of air in the ascending colon on 2 or 3 abdominal radiograph views has the potential to substantially decrease the likelihood of or exclude intussusception.

The Reliability of Preoperative Supine Radiographs to Predict the Amount of Curve Flexibility in Adolescent Idiopathic Scoliosis

Retrospective review. To determine the reliability of supine long-cassette radiographs as compared with side-bending films in predicting curve flexibility in operative cases of adolescent idiopathic scoliosis (AIS). The value of side-bending films is important in the classification of AIS, as well as predicting curve flexibility. A total of 675 patients with a diagnosis of operative AIS were evaluated. All curves were classified by the Lenke classification. Coronal parameters included: proximal thoracic (PT), main thoracic (MT), and thoracolumbar/lumbar (TL/L) Cobb measurements; sagittal data including: T2-T5, T5-T12, and TL/L measurements. Curves were divided into Lenke Types 1 (N = 263), 2 (N = 118), 3 (N = 52), 4 (N = 31), 5 (N = 57), and 6 (N = 54). Lenke Types 1 to 4 (Group I-MT Major) were compared with Types 5 and 6 (Group II-TL/L Major). For Group I, MT supine films were highly predictive of MT side-bending while TL/L supine films were highly predictive of TL/L side-bending and standing films. An equation was derived to predict the value of the side-bending radiographs for each part of the curve. For Group II, MT supine films were highly predictive of MT side-bending and standing films. TL/L supine films were highly predictive of TL/L side-bending and standing films. Contingency table analysis for Group I resulted in the supine film providing a strong statistical ability to predict a nonstructural PT curve (sensitivity = 0.952, PPV = 0.864, NPV = 0.865) and also a nonstructural TL/L curve (sensitivity = 0.958, PPV = 0.916). Similarly, in Group II, we found a strong statistical ability to predict a nonstructural PT (sensitivity 1.00, PPV = 0.982, NPV = 1.00) and a nonstructural MT curve (sensitivity 0.789, specificity = 0.842, PPV = 0.833, NPV = 0.80). A single preoperative supine radiograph is highly predictive of side-bending radiographs and can be used as an adjunct to predicting curve type, flexibility, and structurality. Thus, this singular, reproducible, and non-effort-related radiograph can potentially replace the need for dual side-bending films.

Early predictive value of supine and upright X-ray films of odontoid fractures treated with halo-vest immobilization

Background Although halo-vest immobilization remains a common form of treatment for type II odontoid fractures, nonunion and C1–2 instability may be the result in up to 20% to 40% of patients. Purpose Supine and upright lateral X-ray films may allow early identification of patients likely to fail halo-vest treatment and earlier surgical treatment with decreased morbidity from prolonged unsuccessful halo-vest immobilization. Study design/setting A prospective cohort study was performed. Patient sample Twenty patients with type II odontoid fractures. Outcome measures Posttreatment nonunion and C1–2 instability as determined by plain X-ray films and computed tomography scan. Methods Both supine and upright lateral X-ray films were obtained immediately after halo-vest application and at the 2-week, 6-week, and 3-month follow-up. Flexion-extension lateral X-ray films were obtained after halo-vest removal. Patients with nonunion or instability underwent computed tomography scan. Upright X-ray films were compared serially to identify loss of reduction. Pairs of supine and upright X-ray films were compared to measure any change in displacement or angulation upon transition from supine to upright position. Nonunion patients were compared with healed patients to determine any difference in fracture behavior based on serial supine and upright X-ray films. Results Twenty patients with type II odontoid fractures were identified during the study period. Three patients with multiple trauma underwent immediate surgical stabilization. Three elderly patients with nondisplaced fractures were treated in a cervical orthosis. Fourteen patients initiated and completed 3 months of halo-vest immobilization. After halo-vest removal, 4 of 14 patients (29%) showed radiographic nonunion or instability. In all 4 nonunion patients, supine and upright radiographs at 2 weeks revealed change in fracture angulation ≥5° between the supine and upright positions. In three of these patients standard serial upright lateral X-ray films failed to identify any loss of reduction. In the remaining patient, progressive angulation of 15° was observed. No measurable change in angulation between supine and upright X-ray films was observed in any patient who healed successfully with halo-vest treatment. Conclusions Obtaining both supine and upright lateral X-ray films during the follow-up period may identify patients at risk for failure of halo-vest treatment as early as 2 weeks after initiation of treatment. A change in fracture angulation ≥5° suggests an increased risk of treatment failure and the potential benefit of early surgical stabilization.

The Position of the Bipolar Cup Reflects the Direction of the Hip Contact Force Acting on It

We radiographically measured the bipolar cup position to analyze the direction of joint force acting on the bipolar cup. The abduction angle of the bipolar cup was measured in each radiograph taken immediately and at six 12 weeks and yearly after the operation. Radiographs in patients with weight bearing were also investigated. The results indicated that the abduction angle of the bipolar cup was 24.1° ± 11.2° immediate postoperatively and was 16.2° ± 5.1° at 6 weeks, 16.1° ± 5.1° at 3 months, and 16.2° ± 5.1° at 1 year. The cup abduction angles with weight bearing were not different from those without weight bearing and were 15.9° ± 4.9°, 16.2° ± 4.4°, and 16.1° ± 4.7° on the supine, double-legged stance, and single-legged stance radiographs, respectively. Because the position of the bipolar cup reflects the direction of loads pivoting on it, the direction of the joint force in the frontal plane acting on the bipolar prosthesis is about 16° to vertical.

Radiographic Measures of Knee Alignment in Patients with varus Gonarthrosis

Background Radiographic measures of lower limb malalignment are used to indicate abnormal loading of the knee and to plan corrective procedures. Hypotheses Weightbearing status during hip-to-ankle radiographs will significantly affect malalignment measures; malalignment in single-limb standing will be most highly correlated to the external knee adduction moment during gait, a proposed dynamic measure of functional knee joint load. Study Design Controlled laboratory study. Methods Mechanical axis angle was measured in 40 patients with varus gonarthrosis from hip-to-ankle radiographs taken with patients in single-limb standing, double-limb standing, and supine positions. Kinematic and kinetic data were collected during walking and used to calculate the peak adduction moment about the knee. Results Repeated-measures analysis of variance and Scheffé post hoc tests indicated that mechanical axis angle measured on single-limb standing radiographs (-8.7°± 4.0°) was significantly greater than on double-limb standing radiographs (-7.1°± 3.8°), which was significantly greater than on supine radiographs (-5.5°± 2.8°). The peak knee adduction moment (2.8 ± 0.8 percentage body weight × height) was only moderately correlated with mechanical axis angle on single-limb standing (r = -0.46), double-limb standing (r = -0.45), and supine (r = -0.43) radiographs. Conclusion Patient position significantly affects frontal plane knee alignment. However, the peak knee adduction moment is only moderately correlated to mechanical axis angle, regardless of weightbearing status. Clinical Relevance These findings are inconsistent with the hypothesis that mechanical axis angle measured in single-limb standing is more representative of dynamic joint load and further highlight the differences between static and dynamic measures. Results also underscore the importance of reporting patient position during radiographs and keeping positions consistent when evaluating patients over time.

Changes in Vertebral Wedging Rate Between Supine and Standing Position and its Association With Back Pain: A Prospective Study in Patients With Osteoporotic Vertebral Compression Fractures

Prospective consecutive series. To analyze supine and standing radiographs and the association of back pain using subjective pain criteria. It has been considered that there is little correlation between the degree of collapse of the vertebral body and the level of pain. In previous studies, however, measurements have only been based on supine radiographs. Although there were 2 authors who reported the results of supine lateral and standing lateral radiographs in patients with thoracolumbar vertebral fractures, as far as we know, there has not been any detailed report concerning the correlation between radiologic findings using supine and standing lateral radiographs and back pain. We examined 100 consecutively treated patients, prospectively. Back pain and the supine and standing radiographs were assessed 1 month after injury. Changes in vertebral wedging rate (WR) from supine to standing position (Delta WR) was reported by the following equation: Delta WR = WR(standing)-WR(supine). The median age of the cohort was 75 years (range, 60-89 years). The median VAS of back pain at supine position, at standing position, and when standing erect was 13, 33, and 41, respectively. The median wedging rate on the supine and standing radiographs were 28% and 37%, respectively (P < 0.001). There was a significant correlation between Delta WR and back pain when standing erect (r = 0.79, P < 0.001). Changes in vertebral wedging rate between supine and standing position and its association with back pain may give a clue to the pathogenesis of pain from osteoporotic thoracolumbar vertebral compression fractures.

P120. The Reliability of Preoperative Supine Radiographs to Predict the Amount of Curve Flexibility in Adolescent Idiopathic Scoliosis

BACKGROUND CONTEXT: The value of side bending films is important in the classification of AIS, as well as predicting curve flexibility. However, the reproducibility of side-bending films is highly variable depending on the experience of the technologist and the willingness of the patient to perform a maximal bend.

4:51134. Use of a Supine Radiograph to Accurately Predict Structural Curve in Operative Adolescent Idiopathic Scoliosis

BACKGROUND CONTEXT: Side bending (SB) radiographs have been the gold standard technique by which spinal flexibility is assessed. In the Lenke classification system for AIS, a residual side bending curve equal to or more than 25° indicates that a minor curve is structural, but inherent variability exists in the subjective nature of the procedure. Because a supine X-ray is not effort or technician dependent, it will be more reliable and reproducible.

An Extremely Low-Birthweight Infant Who Has Scrotal Discoloration

### Prenatal History: ### Birth History: ### Hospital Course: The infant had respiratory distress syndrome that required mechanical ventilation and three doses of exogenous surfactant; he was extubated to nasal continuous positive airway pressure on the eighth postnatal day. Additionally, he received three doses of prophylactic indomethacin during the first 72 hours after birth. His ductus arteriosus was closed upon completion of indomethacin treatment. He was treated with cefotaxime and ampicillin for the first eight postnatal days for culture-negative presumed sepsis. Within the first 24 hours of birth, he received dopamine, an insulin infusion to treat hyperkalemia, and nitric oxide for 36 hours due to refractory hypoxemia. His nutritional requirements were delivered with total parenteral nutrition; enteral feedings had not been started. He did not receive postnatal steroids. Nine days after birth, he developed inguinal and scrotal discoloration (Fig. 1). These findings were associated with hypotension (mean arterial pressure, 20 mm Hg), decreased urine output (0.13 mL/kg per hour), hypothermia (core body temperature of 96.4°F [35.8°C]), and five episodes of …

Standing versus Supine Radiographs in RSA Evaluation of Femoral Head Penetration

Evaluation of polyethylene acetabular component wear in total hip arthroplasties commonly is performed using serial radiographs of the hip by measuring the change in the location of the center of the femoral head in relation to the acetabular component. Of the different methods currently used for this purpose, radiostereometric analysis (RSA) is considered the most accurate and precise. In all such radiographic studies, it is assumed the femoral head is seated into the deepest portion of the acetabular component during all radiographic examinations. Although most radiographs used for wear measurements are taken with the patient supine, we questioned whether standing radiographs, with substantial joint load, are better suited for these measurements. We evaluated two groups of patients having total hip arthroplasty who had radiostereometric radiographs taken in supine and standing positions. The average femoral head penetration that occurred between the 6-month and 2-year time interval was measured with radiographs taken in the standing or supine position. We found no difference between the average total femoral head penetration when using supine or standing radiographs.

A thermoplastic mandibular advancement device for the management of non-apnoeic snoring: a randomized controlled trial

This randomized, controlled, crossover trial assessed the effectiveness of an adjustable, thermoplastic, mandibular advancement device (MAD), the TheraSnore, in the management of non-apnoeic snoring. Twenty-three adults who had been referred for a MAD wore the appliance in both a non-advanced and advanced position for 4-6 weeks: the starting position of the MAD was randomized. The outcomes were assessed at baseline and after each phase of MAD wear using questionnaires [(Epworth Sleepiness Scale, snoring history, sleep disturbance, side-effects of the appliance) and a visual analogue scale (daytime sleepiness)]. Eleven subjects had overnight sleep studies at baseline and with the appliance in each position to assess snoring frequency (snores/hour), oxygen saturation, and apnoea hypopnoea index. Supine radiographs were used to examine the oropharyngeal airway at baseline and in response to both appliance positions. In comparison with the non-advanced appliance, the advanced MAD reduced the snores per hour from a median of 398 to 17 (P = 0.002). Sleeping partners reported a marked improvement in their own daytime tiredness (P = 0.002) and sleep disturbance (P = 0.001) when the subject wore the active appliance. The most common side-effect was a dry mouth and 64 per cent of subjects considered the appliance bulky. Radiographic analysis revealed significant vertical opening associated with the appliance and small but significant post-lingual changes with protrusion. The results suggest that the advanced TheraSnore MAD is effective in the treatment of snoring in two out of three non-apnoeic snorers, their sleeping partners derive benefits from this form of treatment, and that complaints of bulkiness and dry mouth may to be related to the inherent vertical opening of the TheraSnore.