Pharyngeal Airspace Alterations After Using the Mandibular Advancement Device in the Treatment of Obstructive Sleep Apnea Syndrome

Overview

Journal Life (Basel)

Specialty Biology

Date 2022 Jun 24

PMID 35743866

Authors

Pedro Dias Ferraz

Ines Francisco

Maria Ines Borges

Adriana Guimaraes

Fatima Carvalho

Francisco Caramelo

Jose Pedro Figueiredo

Francisco Vale

Affiliations

Soon will be listed here.

Abstract

Background: Mandibular Advancement Devices (MADs), inserted in non-surgical treatments for obstructive sleep apnea and hypopnea syndrome (OSAHS), are used intra-orally during the sleep period, with the aim of promoting mandibular protrusion. The aim of the study is to analyze the changes in the upper airway after the use of an MAD in the treatment of OSAHS.

Methods: 60 patients diagnosed with OSAHS, as established by the Sleep Medicine Service, underwent treatment with the Silensor SL device at the Stomatology Service of the University Hospital Center of Coimbra, from January 2018 to January 2019. All patients completed two polysomnographies and two lateral teleradiographies: one before starting treatment (T0) and one after 1 year of treatment (T1). In the lateral teleradiography performed after one year of treatment, the patient had the MAD placed intra-orally. The linear measurements of the airspace proposed by the Arnett/Gunson FAB Surgery cephalometric analysis were measured at four craniometric points: A, MCI, B, Pog.

Results: The results demonstrate an anteroposterior airway enlargement in two of the four points studied with the MAD placed intra-orally (B and Pog point). The greatest average increase is observed at point Pog (3 mm), followed by B (1 mm), and finally, point A (0.6 mm).

Conclusions: This study proved that there is an improvement in anteroposterior measurements at various points in the upper airways after treatment with MAD.

References

Mehta A, Qian J, Petocz P, Darendeliler M, Cistulli P . A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. Am J Respir Crit Care Med. 2001; 163(6):1457-61. DOI: 10.1164/ajrccm.163.6.2004213. View

Vigie du Cayla G, Collet J, Attali V, Kerbrat J, Benslama L, Goudot P . Long-term effectiveness and side effects of mandibular advancement devices on dental and skeletal parameters. J Stomatol Oral Maxillofac Surg. 2019; 120(1):7-10. DOI: 10.1016/j.jormas.2018.09.005. View

Schendel S, Broujerdi J, Jacobson R . Three-dimensional upper-airway changes with maxillomandibular advancement for obstructive sleep apnea treatment. Am J Orthod Dentofacial Orthop. 2014; 146(3):385-93. DOI: 10.1016/j.ajodo.2014.01.026. View

Chan A, Sutherland K, Schwab R, Zeng B, Petocz P, Lee R . The effect of mandibular advancement on upper airway structure in obstructive sleep apnoea. Thorax. 2010; 65(8):726-32. DOI: 10.1136/thx.2009.131094. View

Hudgel D . Sleep Apnea Severity Classification - Revisited. Sleep. 2016; 39(5):1165-6. PMC: 4835315. DOI: 10.5665/sleep.5776. View

Ingman T, Nieminen T, Hurmerinta K . Cephalometric comparison of pharyngeal changes in subjects with upper airway resistance syndrome or obstructive sleep apnoea in upright and supine positions. Eur J Orthod. 2004; 26(3):321-6. DOI: 10.1093/ejo/26.3.321. View

Flores-Orozco E, Tiznado-Orozco G, Diaz-Pena R, Orozco E, Galletti C, Gazia F . Effect of a Mandibular Advancement Device on the Upper Airway in a Patient With Obstructive Sleep Apnea. J Craniofac Surg. 2019; 31(1):e32-e35. DOI: 10.1097/SCS.0000000000005838. View

Shen H, Wen Y, Chen N, Liao Y . Craniofacial morphologic predictors of oral appliance outcomes in patients with obstructive sleep apnea. J Am Dent Assoc. 2012; 143(11):1209-17. DOI: 10.14219/jada.archive.2012.0066. View

Basyuni S, Barabas M, Quinnell T . An update on mandibular advancement devices for the treatment of obstructive sleep apnoea hypopnoea syndrome. J Thorac Dis. 2018; 10(Suppl 1):S48-S56. PMC: 5803051. DOI: 10.21037/jtd.2017.12.18. View

10.

Duran-Cantolla J, Crovetto-Martinez R, Alkhraisat M, Crovetto M, Municio A, Kutz R . Efficacy of mandibular advancement device in the treatment of obstructive sleep apnea syndrome: A randomized controlled crossover clinical trial. Med Oral Patol Oral Cir Bucal. 2015; 20(5):e605-15. PMC: 4598931. DOI: 10.4317/medoral.20649. View

11.

Hoekema A, Doff M, de Bont L, van der Hoeven J, Wijkstra P, Pasma H . Predictors of obstructive sleep apnea-hypopnea treatment outcome. J Dent Res. 2007; 86(12):1181-6. DOI: 10.1177/154405910708601208. View

12.

Skinner M, Robertson C, Kingshott R, Jones D, Taylor D . The efficacy of a mandibular advancement splint in relation to cephalometric variables. Sleep Breath. 2002; 6(3):115-24. DOI: 10.1007/s11325-002-0115-z. View

13.

Carberry J, Amatoury J, Eckert D . Personalized Management Approach for OSA. Chest. 2017; 153(3):744-755. DOI: 10.1016/j.chest.2017.06.011. View

14.

do Vale F, Rodrigues M, Francisco I, Roseiro A, Santos I, Caramelo F . Short-term pharyngeal airway space changes after mandibular advancement surgery in Class II patients-a two-dimensional retrospective study. Orthod Craniofac Res. 2019; 22(2):81-86. DOI: 10.1111/ocr.12264. View

15.

Vanderveken O, Devolder A, Marklund M, Boudewyns A, Braem M, Okkerse W . Comparison of a custom-made and a thermoplastic oral appliance for the treatment of mild sleep apnea. Am J Respir Crit Care Med. 2007; 178(2):197-202. DOI: 10.1164/rccm.200701-114OC. View