Upload
razeev-mishra
View
217
Download
0
Embed Size (px)
Citation preview
8/11/2019 Methods of Evaluation of Airway
1/62
Rajeev
kumar Mishra
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
Methods of evaluation of airway and itsrole in orthodontics
8/11/2019 Methods of Evaluation of Airway
2/62
Contents Introduction
Anatomy
Methods of evaluation
Orthodontic consideration
Adenoid facies
Variations in airway
Effect of treatment
Obstructive sleep apnoea
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
3/62
Introduction
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
From the late 1800s until now, the relationship betweenpharyngeal structures and dentofacial pattern has beenintensively researched
Meyer in 1872 reported thinned nose, flattened from sideto side, and the nostrils collapsed and narrow in patientssuffering from obstruction of nasopharyngeal cavity.
According to the functional-matrix hypothesis proposed byMoss, soft-tissue units guide the hard tissues to an extent
8/11/2019 Methods of Evaluation of Airway
4/62
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
Some authors claim that patients with deficient respiratory
functions present with so called adenoid facies (Ricketts,1968)
However, there is still a dispute whether this relationshipbetween craniofacial morphology and respiratory functioncauses dentofacial anomalies ( Leech, 1958,Vig ,1998)
8/11/2019 Methods of Evaluation of Airway
5/62
It is a general belief that the upper airway structures play asignificant role over the development of craniofacial complex(El &Palamo, 2011)
There exists a close relationship between the pharynx and thedentofacial structures, a mutual interaction is expected to occurbetween the pharyngeal structures and the dentofacial pattern, andtherefore justifies orthodontic interest.(Ceylan et al)
2/15/2013Department of Orthodontics and Dentofacial Deformities,
Centre for Dental Education and Research, All India
Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
6/62
ANATOMY
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
7/62
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
8/62
Methods of evaluation of
Airway
Lateral Cephalogram
Dynamic MRI
CT/CBCT
PolysomnographyAcoustic reflection test
Fluoroscopy
Nasopharyngoscopy
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
9/62
Lateral cephalogram
Two dimensional image but useful in evaluation of airway
Recorded at the end of expiration and not at deglutition
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
10/62
Lateral head film studies of the airway have included bothlinear and area measurements based on specificcephalometric landmarks and subjective classification of
airway restriction based on an ordinal scale
Linear measurement are considered unreliable and areameasurement more meaningful in airway evaluation
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and Research,
All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
11/62
A number of reference measurements are attributed to theairway and several studies have attempted to establish
normal values for some of these
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
12/62
McNamara (1984)
Upper pharynx-point on the posterior outline of the softpalate to the closest point on the posterior pharyngealwall.(measurements of less than 5 mm are of concern).
Lower pharynx -intersection of the posterior border of thetongue and the inferior border of the mandible to theclosest point on the posterior pharyngeal wall. (averagevalues, 10-12 mm). Any value over 15-16 mm is of
concern
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
13/62
2/15/2013
Cervical axis(od-C5c)
Odontoid tangent
Pterygoid vertical
1 Anterior cranial base
2 Posterior cranial base
3 Effective cranial base length
4 Length of palate(floor of nasal
cavity)
5 Posterior height of nasal cavity(S-
PNS)
6 Vertical diameter of choanal
opening(ho-PNS)
7 Length of pharyngeal clivus(ba ho
8 Length of floor of nasopharynx(AA
to PNS)9 Depth of nasopharynx(Ba-PNS)
10 Effective length of maxilla(TMJ to
ANS)Some important linear measurements used in radiographic
cephalometric studies of upper airway
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
14/62
2/15/2013
1 Saddle angle(N-S-ba)
2 SNA
3 Angle between palatal plane a
Cranial base
4 The angle of nasopharyngeal
depth and included angle of baS-PNS
5 The angle of nasopharynx and
included angle of PNS-ba-S
6 The angle of roof of
nasopharynx and include angl
ba -ho-PNSDepartment of Orthodontics and DentofacialDeformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
15/62
Basic cephalometric
analysis for OSA patient
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
PAS Distance between posterior
pharyngeal wall and base oftongue measured on line B-
Go
11
mm
PNS-
P
Length of soft palate 35
mm
MPH Distance of hyoid bone
measure don perpendicularfrom MP to anterior superior
point of hyoid bone
15
SAS Distance from pharyngeal wall
to maximum convexity of soft
palate
15-
20
MAS Minimum anteroposteriorairway space in lower pharynx
9-11
G width of soft palate 8
8/11/2019 Methods of Evaluation of Airway
16/62
Limitations
Two dimensional representation of a three dimensionalstructure
Differences in magnifications
Superimposition of the bilateral craniofacial structures
Low reproducibility as a result of difficulties in landmarkidentification
No information about lateral structures
Cannot be performed dynamically
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
17/62
Nasopharyngoscopy
Widely available Easy to perform
No radiation
Can be performed in the sitting
and supine positions Imaging during wakefulness and
sleep
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
18/62
Limitations lnvasive
Evaluates only airway lumen, not surrounding soft tissuestructures
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
19/62
Muller maneuver, performed during the procedure, mayprovide insight into the location of upper airway closure bypotentially simulating obstructive apnoeas
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
20/62
FluoroscopyAdvantages
Provides dynamic airwayimaging during wakefulness
Can also be performed duringsleep
Limitations Significant radiation exposure
Poor sensitivity
Not capable of cross sectionaimaging
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
21/62
Acoustic Reflection Technique based on analyzing reflected sound waves from the
respiratory system, which provides a calculation of the upperairway area as a function of distance from the incisors (mouth)
Advantages
Noninvasive
No associated radiation
Easily repeated
Dynamic imaging ,can determine location of obstruction
Determine effect of mandibular advancement and protrusion onairway
Can be done in an orthodontic clinic
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
22/62
Limitations
Primarily used as a research tool; clinical usefulness has not beenadequately assessed
Technique is performed through the mouth, which alters upper airw
anatomy
Does not provide high resolution anatomical representation of theairway or soft tissue structures
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
23/62
Polysomnography Multi-parametric test
Gold standard for diagnosis of apnoea Electroencephalogram
Electrooculogram
Electromyogram
Electrocardiogram
Respiratory flow
Pulse oxymetry
Provides apnoeahypnoea index
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
24/62
Magnetic Resonance Imaging
Since the shape of upper respiratory tract continuouslychanges with the respiratory movement, conventional MRlacks sufficient temporal resolution to diagnose the severitof obstruction
Dynamic MRI provides excellent temporal resolution todefine dynamic changes of the upper airway, requires noexposure to ionizing radiation and provides a pharyngeal
airway view on the sagittal plane
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
25/62
Accurate assessment of upper airway cross-sectional area andvolume
Excellent airway, soft tissue and fat resolution
Direct sagittal, coronal, and axial images without radiation,therefore studies can be performed and repeated duringwakefulness and sleep
Three dimensional reconstruction of soft tissue structures (tongusoft palate, lateral parapharyngeal fat pads, lateral pharyngealwalls) and airway
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
26/62
Technique not widely available
Expensive
Weight limitation of approximately 300 pounds
Claustrophobia is a problem
Cannot be performed in patients with ferromagnetic clips orpacemakers
2/15/2013Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
27/62
Computed Tomography
Excellent airway and bony resolution
Accurate assessment of upper airway cross-sectional area and
volume
Three dimensional reconstruction of craniofacial structures andairway
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
28/62
Limitations
High radiation exposure
High cost
Poor resolution for upper airway adipose tissue at leastcompared with MR imaging
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
29/62
Cone Beam CT Low radiation exposure
Possible to visualize sites of interest by adjusting the imageorientation and rotation
Different gray-level intensities that allow visualization of soft tissas well as hard tissue with different tissue densities
Low cost
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
30/62
Scans are converted to DICOM image
Image analyzed with special software
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
31/62
Mimics (Materialise, Leuven, Belgium),
ITK-Snap
OsiriX (Pixmeo, Geneva, Switzerland)
Dolphin3D (Dolphin Imaging & Management Solutions,Chatsworth, Calif)
InVivo Dental (Anatomage, San Jose, Calif)
Ondemand3D (CyberMed, Seoul, Korea)
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
32/62
Segmentation
Manual
Semiautomatic
Image thresholding Static
Dynamic
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
33/62
2/15/2013
8/11/2019 Methods of Evaluation of Airway
34/62
2/15/2013
Anterior Posterior Superior Inferior
8/11/2019 Methods of Evaluation of Airway
35/62
boundary boundary boundary boundary
Nasopharynx Line extending from
sella (S) to the
posterior
nasal spine (PNS)
Line extending from
S to
the tip of the
odontoid
process
Line extending
the PNS to tip o
the
odontoid proce
Oropharynx Line extending from
the
posterior nasal
spine (PNS)
to the base of the
epiglottis
Line extending from
the
tip of the odontoid
process
to the posterior-
superior
border of CV 4
Line extending from
the PNS to the tip
of the odontoid
process
Line extending
the
base of the
epiglottis
to the posterior
superior
border of CV 4
Hypopharynx Line extending from
the
base of the
epiglottisto the inferior
border
of the symphysis
Line extending from
the
posterior-superior
cornerof CV 4 to the
posteriorinferior
corner of CV 4
Line extending from
the
base of the
epiglottisto the posterior-
superior
corner of CV 4
Line extendin
from the
posterior-infe
corner ofCV 4 to the
inferior borde
of the symphySmith T, Ghoneima A, Stewart K, Liu S, Eckert G, Halum S, Kula K.Threedimensional computed tomography analysis of airway volume changes after rapid maxillary expansion. Am J Orthod Dentofacia
2/15/2013
http://www.ncbi.nlm.nih.gov/pubmed?term=Smith%20T[Author]&cauthor=true&cauthor_uid=22554756http://www.ncbi.nlm.nih.gov/pubmed?term=Ghoneima%20A[Author]&cauthor=true&cauthor_uid=22554756http://www.ncbi.nlm.nih.gov/pubmed?term=Stewart%20K[Author]&cauthor=true&cauthor_uid=22554756http://www.ncbi.nlm.nih.gov/pubmed?term=Liu%20S[Author]&cauthor=true&cauthor_uid=22554756http://www.ncbi.nlm.nih.gov/pubmed?term=Eckert%20G[Author]&cauthor=true&cauthor_uid=22554756http://www.ncbi.nlm.nih.gov/pubmed?term=Halum%20S[Author]&cauthor=true&cauthor_uid=22554756http://www.ncbi.nlm.nih.gov/pubmed?term=Kula%20K[Author]&cauthor=true&cauthor_uid=22554756http://www.ncbi.nlm.nih.gov/pubmed?term=Kula%20K[Author]&cauthor=true&cauthor_uid=22554756http://www.ncbi.nlm.nih.gov/pubmed?term=Halum%20S[Author]&cauthor=true&cauthor_uid=22554756http://www.ncbi.nlm.nih.gov/pubmed?term=Halum%20S[Author]&cauthor=true&cauthor_uid=22554756http://www.ncbi.nlm.nih.gov/pubmed?term=Halum%20S[Author]&cauthor=true&cauthor_uid=22554756http://www.ncbi.nlm.nih.gov/pubmed?term=Eckert%20G[Author]&cauthor=true&cauthor_uid=22554756http://www.ncbi.nlm.nih.gov/pubmed?term=Liu%20S[Author]&cauthor=true&cauthor_uid=22554756http://www.ncbi.nlm.nih.gov/pubmed?term=Stewart%20K[Author]&cauthor=true&cauthor_uid=22554756http://www.ncbi.nlm.nih.gov/pubmed?term=Ghoneima%20A[Author]&cauthor=true&cauthor_uid=22554756http://www.ncbi.nlm.nih.gov/pubmed?term=Ghoneima%20A[Author]&cauthor=true&cauthor_uid=22554756http://www.ncbi.nlm.nih.gov/pubmed?term=Ghoneima%20A[Author]&cauthor=true&cauthor_uid=22554756http://www.ncbi.nlm.nih.gov/pubmed?term=Smith%20T[Author]&cauthor=true&cauthor_uid=225547568/11/2019 Methods of Evaluation of Airway
36/62
`
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
37/62
Nasopharynx morphology is complex, and its volume measurement hasless reliability than does oropharynx volume measurement
El H, Palomo JM. Measuring the airway in 3 dimensions: a reliability and accuracy study. Am J
Orthod Dentofacial Orthop 2010;137: S50.e1-9
Poor soft tissue resolution
More noise and movement artifact
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
O th d ti id ti
8/11/2019 Methods of Evaluation of Airway
38/62
Orthodontic considerationsAdenoid facies
Term coined by Tomes(1872)
Studies by Linder-Aronsen supported the relationship betwenasal obstruction and craniofcial and dental patterns
Harvold suggested the role of neuromuscular changes
Solow & kreiborgSoft tissue stretch theory
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
39/62
Clinical features
Excessive lower facial anterior facial height
Incompetent lip posture
Gummy smile
Flattened nose, poorly developed nostrils
Steep mandibular plane
Posterior cross bite
Open mouth posture Short upper lip and fuller lower lip
Narrow V shaped upper jaw and high narrow palatal vault
Class II skeletal relationship
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
40/62
Diagnosis
History Clinical examionation
Assesment of mode of respiration
Water holding test
Mirror condensation test Cotton wisp test
Cephalometric analysis
Rhinomanometric examination
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
41/62
Orthodontic implication Effective orthodontic therapy necessitates elimination of
nasal obstruction
Early intervention
Appliances
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
CBCT study of airway in different malocclusion type
8/11/2019 Methods of Evaluation of Airway
42/62
CBCT study of airway in different malocclusion type
Investigators Samplesize Age Measurement
modality
Conclusion
El &
Palamo(201
1)
140(m-70,f-
70)
Class I,Class
II & Class III
14-18 yrs CBCT/IN
vivo
OP volume-Class II
8/11/2019 Methods of Evaluation of Airway
43/62
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
El &
Palamo(20
11)
101(m-57,f-
44)
Class I
Class II
MaxP
Class II Man
R
Class III
max R
Class IIIManP
14-18 CBCT/IN
Vivo Posterior airway space, area of the most
constricted region at the base of the
tongue (minAx), and OP volume were
significantly higher for the CIIIMandP
group, whereas CIIMandR subjects had
the lowest values. The only significant
difference for the NP volume was
between CI and CIIMandR groups where
a smaller volume for the CIIMandRgroup was observed.
Cephalometric studies
8/11/2019 Methods of Evaluation of Airway
44/62
Cephalometric studiesINVESTIGATOR SAMPLE Conclusion
Ceylan and Oktay
(1995)
90(M-45,f-45)
oropharynx areas of patients with ANB 5
degrees
Kirjavainen and
Kirjavainen (2007)
120
Class II div1-40
Class I-80
children with Class II malocclusion had a wider or
similar nasopharynx than the controls but narrower
oropharyngeal (OP) and hypopharyngeal areas
Martin et al(2011) 162
Class I(M-55,F-
36)
Class III(M-33,F-
38)
Upper airway thickness is greater in those with
ideal occlusions than in Class III patients, in
contrast to lower
pharynx dimension, which is greater in Class III
patients
No significantdifferences in lower airway
thicknesswere found. However, the Class III group showed
a statistically significantconstricted airway at this
region because of reduced aerial thickness and
greater adenoidal tissues
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
45/62
However some studies have concluded that malocclusion typedoes not influence pharyngeal airway width (de Freitas et al.,2006; Alves et al., 2008).
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
Investigator Sample Method Conclusion
De Freitas et al 80
Male -32Female -48
Mean age -11.64
McNamara analysis on
lateral cephalogram
No difference ina
airway width of ClassI and Class II subject
Alves et al 60
Male-30
Femle-30Mean age-17.32-
18.21.2
Spiral computed
tomography
No statistical
difference
between skeletalpattern of classes II
and III
8/11/2019 Methods of Evaluation of Airway
46/62
Variations due to growth pattern
Hyperdivergent patients had a narrower antero-posteriorpharyngeal dimension especially in the nasopharynx at thelevel of hard palate and in the oropharynx at the level of thetip of the soft palate and mandible
Patients with long faces tended to have an extremely narrowairway, both antero-posteriorly and coronally, when compareto patients with normal faces(Grauer et al 2009)
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
47/62
Subjects with Class I and Class II malocclusions and verticalgrowth patterns have significantlynarrower upper pharyngealairways than those with Class I and Class II malocclusions andnormal growth patterns however growth pattern doesntinfluence volume of lower pharyngeal airway(de Feritas et
al,2006)
2/15/2013
Department of Orthodontics and Dentofacial Deformities,
Centre for Dental Education and Research
All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
48/62
Trenouth and Timms (1999) who measured the length of
mandible between gonion and menthon and found thatoropharyngeal airway was positively correlated with length ofthe mandible.
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
49/62
Effect of Treatment
Godt et al (2011)evaluated the changes in upper airway widthassociated with Class II treatments (headgear vs activator) anddifferent growth patterns
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
50/62
Dimensional changes in the pharyngeal area within the
overall context of orthodontic treatment were only minor,and even the differences noted between various treatmentmodalities were small.
However they also noted that pharyngeal width reductionscan occur in the phase of isolated headgear treatment whichmay exacerbate any preexisting OSAS or may result indecompensation of compensated OSAS.
2/15/2013
Department of Orthodontics and Dentofacial Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
E i i
8/11/2019 Methods of Evaluation of Airway
51/62
Extraction vs non-extraction treatment
No statistically significant oropharyngeal airway volumechanges were found between cases treated with theextraction of four premolars and nonextraction groups.(Valiathan et al ,2010)
The pharyngeal airway size became narrower after thetreatment in cases treated with extraction of all fourpremolars compared to non extraction case(wang et al,2012
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research
All India Institute of Medical Sciences
Effect of RME /Maxillary protraction
CBCT t di
8/11/2019 Methods of Evaluation of Airway
52/62
CBCT studies
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
Ribeiro etal
15
Males-8,Females-7Mean age-7.5 yrs
Bonded Hyrax RME is able to increase thetransverse width of the nasal cav
but it does not have the same effe
in the nasopharynx
Smith et al
20Males-8,Females-12
Mean Age-12.3 yrs +
1.9 months
Banded hyraxRME causes significant increase in
nasal cavity volume and nasophary
volume
Investigators Sample
size/averag
Intervention
Done
Duration Imagig
Modalitie
conclusion
8/11/2019 Methods of Evaluation of Airway
53/62
Department of Orthodontics and Dentofacial Deformities,
Centre for Dental Education and Research, All India
e age of
sample
Sayinsu et al,2006 19(12M+7F)/
10.51+1.15 yrs
RPE+face mask 6.78+0.93 mth Lateral
Cephalograp
h
Increase in
Nasopharyngeal
airway,no change inoropharymgeal airway
Oktay et al, 2008 20(5M+15F)
11.5+1.54 yrs
Face Mask 8+2.5 mth Lateral
Cephalograp
h
Maxillary protraction
caused the upper airway
dimension to increase
Kilinc et al,2008 18(11F+7M)
10.5+0.93
Protraction
headgear+RPE
6.94+0.56
mth
Lateral
Cephalograms
Improved naso and
oropharyngeal airwaydimension
Kaaygisiz et
al,2009
25(11F+14M)
11.32+1.08 yrs
Reverse Head
Gear
6.94+0.91 mth
with follow up
upto 4 yrs
Lateral
Cephalograp
hs
Improved airway
dimension initially which
was maintained in long
term followup
Tiziano Baccetti etal,2010
22(12F+10M)
8.9+1.5 yrs
Bite block+ facemask
LateralCephalograp
h
No significant change inoropharyngeal &
nasopharyngeal airway
2/15/2013
Orthodontic consideration in Obstructive sleepapnoea
8/11/2019 Methods of Evaluation of Airway
54/62
apnoea
Craniofacial anomalies associated with OSA
Mandibular deficiency-Posterior positioning of tongueleading to airway obstruction
Maxillary deficiency-approximation of soft palate withposterior pharyngeal wall
Combination of both
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
55/62
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
Role of Orthodontist in Multidisciplinary teamAnalysis of craniofacial anatomy and upper airways
Design and fabrication of appliance for mandibularadvancement
Institute orthodontic treatment during orthognathicsurgery/distraction osteogenesis
Treatment of mandibular deficiency by functional
applainces
8/11/2019 Methods of Evaluation of Airway
56/62
Oral appliance therapy Primary snoring
Mild to moderate OSA not responding to CPAP
Unsuitable for behavior modificaton procedures
Most of oral appliance work by placing mandible forwardand thus increases the distance between posteriorpharyngeal wall and tongue
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
57/62
Mandibular advancement device(MAD) Monoblock appliances
Splint
Acivator
BionatorKarwetzky activator
Twin block appliances
Removable herbst appliance
Twin block
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
58/62
Tongue retaining devices
Tongue repositioning manoeuvre with oral shields
Titrable MADS
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
8/11/2019 Methods of Evaluation of Airway
59/62
Limitations of MADs
Treatment outcome cant be predicted
Acclimatization period is required
Uncertainty about selection of maximum dosage
Potential long term complications irt TMJ and
occlusion
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
References
8/11/2019 Methods of Evaluation of Airway
60/62
References
2/15/2013
Department of Orthodontics and Dentofacial
Deformities,
Centre for Dental Education and Research,
All India Institute of Medical Sciences
Kharbanda O P. Orthodontics diagnosis and management of malocclusion anddentofacial deformities .2nd edition.2012
Graber T M,Vanarsdall R L,Vig K W L.Orthodontics current principles andtechnique.4thedition.2005
El H, Palomo JM. Airway volume for different dentofacial skeletal patterns. Am JOrthod Dentofacial Orthop. 2011 Jun;139(6):e511-21
El H, Palomo JM. An airway study of different maxillary and mandibular sagittalpositions. Eur J Orthod. 2011 Oct 31. [Epub ahead of print]
Aboudara C, Nielsen I, Huang JC, Maki K, Miller AJ, Hatcher D. Comparison ofairway space with conventional lateral headfilms and 3-dimensional reconstructionfrom cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2009
Apr;135(4):468-79
8/11/2019 Methods of Evaluation of Airway
61/62
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
German DS, German J. Cone-beam volumetric imaging: a two-minute drill. J Clin Orthod. 2010Apr;44(4):253-65
Valiathan M, El H, Hans MG, Palomo MJ. Effects of extraction versus non-extraction treatment onoropharyngeal airway volume. Angle Orthod. 2010 Nov;80(6):1068-74
Grgl S, Gokce SM, Olmez H, Sagdic D, Ors F. Nasal cavity volume changes after rapid maxillaryexpansion in adolescents evaluated with 3-dimensional simulation and modeling programs.Am JOrthod Dentofacial Orthop. 2011 Nov;140(5):633-40
Ucar FI, Uysal T. Orofacial airway dimensions in subjects with Class I malocclusion and differentgrowth patterns. Angle Orthod. 2011 May;81(3):460-8
Oh KM, Hong JS, Kim YJ, Cevidanes LS, Park YH. Three-dimensional analysis of pharyngeal airwayform in children with anteroposterior facial patterns. Angle Orthod. 2011 Nov;81(6):1075-82
Hong JS, Oh KM, Kim BR, Kim YJ, Park YH. Three-dimensional analysis of pharyngeal airway volume
in adults with anterior position of the mandible. Am J Orthod Dentofacial Orthop. 2011Oct;140(4):e161-9.
8/11/2019 Methods of Evaluation of Airway
62/62
2/15/2013
Department of Orthodontics and Dentofacial
Deformities, Centre for Dental Education and
Research, All India Institute of Medical Sciences
Grauer D, Cevidanes LS, Styner MA, Ackerman JL, Proffit WR.Pharyngeal airway volume and shape from cone-beam computed
tomography: relationship to facial morphology. Am J Orthod DentofacialOrthop. 2009 Dec;136(6):805-14
Alves M Jr, Baratieri C, Mattos CT, Brunetto D, Fontes Rda C, Santos JR,Ruellas AC. Is the airway volume being correctly analyzed? Am J OrthodDentofacial Orthop. 2012 May;141(5):657-61
Martin O, Muelas L, Vias MJ. Comparative study of nasopharyngealsoft-tissue characteristics in patients with Class III malocclusion. Am JOrthod Dentofacial Orthop. 2011 Feb;139(2):242-51
Oktay H, Ulukaya E. Maxillary protraction appliance effect on the size ofthe upper airway passage. Angle Orthod. 2008 Mar;78(2):209-14
El H, Palomo JM. Measuring the airway in 3 dimensions: a reliability andaccuracy study. Am J Orthod Dentofacial Orthop. 2010 Apr;137(4Suppl):S50.e1-9
Weissheimer A, Menezes LM, Sameshima GT, Enciso R, Pham J, GrauerD. Imaging software accuracy for 3-dimensional analysis of the upperairway. Am J Orthod Dentofacial Orthop. 2012 Dec;142(6):801-13