A three-dimensional airway assessment for the treatment of snoring and/or sleep apnea with jaw repositioning intraoral appliances: a case study.
The purpose of this snoring/sleep apnea study was to assess the role of 3-D magnetic resonance imaging (MRI) of the airway correlated to jaw reposturing/intraoral appliance design. A clinical case is presented utilizing this technology, integrating a diagnostic baseline and follow-up sleep study/ polysomnograph. The baseline polysomnography, prior to jaw repositioning appliance design, indicated a respiratory disturbance index (RDI) of 21.5 hypopnea/apneas per hour. The follow-up sleep study, with use of an intraoral repositioning appliance, showed a 3.9 per hour RDI, an 82% RDI reduction/improvement. Magnetic resonance TMJ and airway images were done. The MRI enhanced airway assessment computer software program analyzed the 3-dimensional volume and cross sectional area changes from hard/soft palate junction to epiglottis. Imaged were the oropharynx nasopharynx and hypopharynx regional anatomy. The baseline, without mandibular positioning device, showed a total airway volume of 5,801.31 cubic mm, whereas with the mandibular positioning device in place, the total airway volume was increased to 8,657.22 cubic mm or a total increased volume of 32%. The largest improvement site in the airway was the mid-soft palatal uvula/nasopharynx region, with base of tongue moving forward. Along with traditional polysomnography, 3-dimensional MRI airway imaging should be considered as a diagnostic procedure in assessing sleep apnea patients. The necessity of a combined medical/dental team approach is emphasized.
Smith
S D
SD
Department of Otorhinolaryngology and Orofacial Plastic Surgery, Philadelphia College of Osteopathic Medicine, Pennsylvania, USA.
D000328:Adult; D000402:Airway Obstruction / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008334:Mandible / Q000503:physiopathology; D017090:Occlusal Splints; D017286:Polysomnography; D012891:Sleep Apnea Syndromes / Q000628:therapy*; D012913:Snoring / Q000628:therapy*