Maite Barbero1, Carlos Flores-Mir2, Juan Calvo Blanco3,4, Valentin Cabriada Nuño5, Joan Brunso Casellas6, Jose Luis Calvo Girado7, Julio Alvarez Amezaga6,8, Felix De Carlos9. 1. Surgery and Medical-Surgical Specialties Department, University of Oviedo, Oviedo, Spain. 2. School of Dentistry, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada. 3. Unit of Radiology, University Hospital Central of Asturias, Oviedo, Spain. 4. Department of Medicine, University of Oviedo, Oviedo, Spain. 5. Sleep and Ventilation Unit, Respiratory Division, Cruces University Hospital, Barakaldo, Spain. 6. Oral and Maxillofacial Unit, Cruces University Hospital, Barakaldo, Spain. 7. Surgery and Implantology Department, San Antonio Catholic University of Murcia, Murcia, Spain. 8. Stomatology I Department, Faculty of Medicine, University of the Basque Country, Leioa, Spain. 9. Surgery and Medical-Surgical Specialties Department, Area of Orthodontics, Faculty of Medicine, University of Oviedo, Oviedo, Spain.
Abstract
STUDY OBJECTIVES: Mandibular advancement devices (MADs) constitute an alternative treatment in selected patients with OSA. A mandibular advanced position has been suggested to be beneficial, whereas its combination with an increased bite-raise may increase its adverse effects. The objective of this study was to assess upper airway (UA) volume and inspiratory pressure gradient variations in a group of 17 patients with OSA. The study was performed under 3 mandibular positions: intercuspal position (P1), MAD position in closed mouth (P2), and MAD position with an increased bite-raise (P3). METHODS: We conducted a 3-dimensional reconstruction of the pharynx using the finite element method via a computed tomography scan and the subsequent calculation using fluid-dynamic analysis. RESULTS: One hundred percent of the patients showed an increase in UA volume in both P2 and the MAD position with an increased bite-raise, P2 being the position where 76.47% of the patients showed the largest UA volume. P2/velopharynx was the position/region where the largest UA volume increase was achieved (4.73 mm³). A better gradient in P2 (mean = 0.62) in 58.82% of the patients and a better gradient in P3 (mean = 0.74) in 41.18% of patients respect P1 was observed. In 82.35% of patients, a better volume-pressure gradient match was also found. CONCLUSIONS: The best efficiency scores for both volume increase and better inspiratory pressure gradient were obtained in P2. This study findings suggest that in a MAD, the minimal bite opening position necessary for mandibular protrusion is more effective in increasing airway volume and inspiratory gradient compared to a larger bite-raising (15 mm).
STUDY OBJECTIVES: Mandibular advancement devices (MADs) constitute an alternative treatment in selected patients with OSA. A mandibular advanced position has been suggested to be beneficial, whereas its combination with an increased bite-raise may increase its adverse effects. The objective of this study was to assess upper airway (UA) volume and inspiratory pressure gradient variations in a group of 17 patients with OSA. The study was performed under 3 mandibular positions: intercuspal position (P1), MAD position in closed mouth (P2), and MAD position with an increased bite-raise (P3). METHODS: We conducted a 3-dimensional reconstruction of the pharynx using the finite element method via a computed tomography scan and the subsequent calculation using fluid-dynamic analysis. RESULTS: One hundred percent of the patients showed an increase in UA volume in both P2 and the MAD position with an increased bite-raise, P2 being the position where 76.47% of the patients showed the largest UA volume. P2/velopharynx was the position/region where the largest UA volume increase was achieved (4.73 mm³). A better gradient in P2 (mean = 0.62) in 58.82% of the patients and a better gradient in P3 (mean = 0.74) in 41.18% of patients respect P1 was observed. In 82.35% of patients, a better volume-pressure gradient match was also found. CONCLUSIONS: The best efficiency scores for both volume increase and better inspiratory pressure gradient were obtained in P2. This study findings suggest that in a MAD, the minimal bite opening position necessary for mandibular protrusion is more effective in increasing airway volume and inspiratory gradient compared to a larger bite-raising (15 mm).
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