Biomedical subjects

Kirsti Hurmerinta

Publications and source records attributed to Kirsti Hurmerinta.

9 recordsLinked to original sources

PubMed2006

Craniofacial structures and dental development in three patients with Nager syndrome.

In Finland, 3 patients have been diagnosed with Nager syndrome (NS) during the last 17 years. Thus the incidence for NS in Finland is 3:1,000,000. The craniofacial structures and dental development of these patients were studied clinically and radiographically at the age of 3-4 years, and compared to age-matched controls and to the norms of the Finnish population. The striking structural finding was a severely short, retrognathic and posteriorly rotated mandible. Especially the ramus was deficient; its height was, on average, less than one-third of that of the control group. All children were tracheostomized neonatally. At the age of 3-4, the lower pharyngeal airway was still severely obstructed or completely closed. Nasopharyngeal airway was wide and the soft palate was missing in all patients. All patients had a complete deciduous dentition, but agenesis of permanent teeth (ranging from 2-10 missing teeth) was observed in each patient. Accelerated dental development was found in two subjects. Condylar ankylosis or severely limited mouth opening were observed. The present findings give new information and quantify earlier observations of craniofacial structures and dental development in NS. Analysis of facial structures suggests that if surgical intervention is needed to enable better breathing, the goal of the structural correction should be aimed at the most deficient structure, namely the ramus height. As a result of severe dentofacial deviation, a treatment process through the growth requires multidisciplinary teamwork of surgeons, pediatrists, orthodontists and prosthodontists.

Airway Obstruction↗

PubMed2006

Snoring is not relieved by nasal surgery despite improvement in nasal resistance.

OBJECTIVES: In the present study, we evaluated the effect of nasal surgery on snoring time, snoring intensity, and sleep-disordered breathing. The role of abnormal cephalometry in treatment outcome was assessed. DESIGN: A cross-sectional prospective study. SETTING: University teaching hospital. PATIENTS: Forty consecutive snoring men who were referred to ENT Hospital because of a snoring problem or suspicion of sleep apnea. INTERVENTIONS: The patients underwent anterior rhinomanometry and polysomnography (PSG) with recording of snoring before and after operative treatment of nasal obstruction. Cephalometric radiographs were obtained before surgery. RESULTS: Nasal resistance decreased significantly in the overall patient group. Snoring time, snoring intensity, nocturnal breathing, and sleep architecture did not change after nasal surgery. Cephalometry did not predict operative outcome in these patients. Snoring intensity was found to be significantly higher during non-rapid eye movement (NREM) sleep than during rapid eye movement sleep. CONCLUSIONS: Operative treatment of mainly structural nasal obstruction did not seem to decrease snoring intensity, snoring time, or sleep-disordered breathing in an objective assessment by PSG performed after surgery. The effect of treating inflammatory nasal changes during nocturnal breathing, as well as the role of cephalometry in the prediction of treatment outcome will need further evaluation. Higher snoring intensity related to NREM sleep may add to the sleep disturbance of a bed partner in the evening.

Adult↗

PubMed2004

Mouth closing device (chinstrap) reduces mouth leak during nasal CPAP.

BACKGROUND AND PURPOSE: Mouth leak occasionally complicates continuous positive airway pressure (CPAP) therapy, which leads to discomfort. While a chinstrap prevents the mouth from opening during sleep, its efficacy in diminishing mouth leak has not been studied. PATIENTS AND METHODS: Fifteen patients with mouth leak complaining of mouth dryness and nasal obstruction underwent two consecutive overnight polysomnographies, one with a chinstrap, in random order. Cephalometry with and without a chinstrap was randomly performed on six patients. RESULTS: With the chinstrap, both mouth leak and the arousal index decreased significantly, from (mean+/-SD) 42.9+/-23.5 to 23.8+/-13.3% of total sleep time (TST), and from 33.4+/-18.6 to 23.6+/-9.3/sleep hour, respectively. However, snoring time showed a concomitant increase from 6.7+/-14.3 to 24.0+/-13.2% of TST. The arousal index was significantly higher during leak periods, and its changes correlated positively with changes in mouth leak. Cephalometric measures showed a significant decrease in anterior lower facial height. CONCLUSIONS: The chinstrap, by closing the mouth during CPAP, reduces mouth leak and therefore the arousal index in most patients. Nevertheless, the indices remained unacceptably high. The chinstrap may also increase snoring and, in rare cases, can worsen the respiratory disturbance index. Consideration of these potential effects is important before instituting regular home use of the chinstrap.

Adult↗

PubMed2004

Unexpected events during mandibular distraction osteogenesis.

Various unexpected events during mandibular distraction osteogenesis are described in 16 syndromic children with severely retrognathic or asymmetric lower jaws who were treated with unilateral or bilateral extraoral distraction. The mean total time with the distraction devices attached was 14 weeks (range 10-19). Although improvement in facial aesthetics and the desired occlusion was achieved in all but one case, there were unexpected events associated with mandibular distraction. These included pain not related to the operation, functional disturbance in movement of the jaw, dietary problems, weight loss, unfulfilled expectations of decannulation, temporary unilateral facial nerve palsy, and transient unilateral hypoaesthesia of the inferior alveolar nerve. Reoperation was required in 5 of the 16. In addition to these events, psychosocial problems within one family complicated the procedure. Patients and their families should be informed of the lesser-known aspects of distraction osteogenesis before the procedure is used.

Adolescent↗

PubMed2004

Cephalometric comparison of pharyngeal changes in subjects with upper airway resistance syndrome or obstructive sleep apnoea in upright and supine positions.

The aim of the present study was to cephalometrically compare pharyngeal changes between upright and supine positions in patients with upper airway resistance syndrome (UARS) or obstructive sleep apnoea (OSA). Eighty-two OSA patients, 70 men (mean age 49 +/- 11.8 years) and 12 women (45.9 +/- 8.3 years), underwent cephalometric sleep apnoea analysis. One upright and one supine radiograph were taken of each patient (a total of 164 cephalometric radiographs). The results showed no significant changes either in naso- or hypopharyngeal soft tissues between the two positions. In contrast, the shortest distance from the soft palate (ve1-ve2) and the tip of the soft palate (u1-u2) to the posterior oropharyngeal wall was significantly narrower (P < 0.001) in the supine position. Furthermore, in the supine position a slight thickening in the soft palate (sp1-sp2, P < 0.05) was detected with no change in the length of the soft palate (PNS-u1). The form of the tongue changed significantly: it was shorter (Tt-Tgo, P < 0.001; Tt-va, P < 0.001) and thicker (Ts/Tt-Tgo, P < 0.05) in the supine position. The present results suggest that OSA patients are prone to significant narrowing of their oropharyngeal, but not of their naso- or hypopharyngeal, airways in the supine position. Thus, treatment of OSA and UARS patients should mainly be aimed at preventing further oropharyngeal airway narrowing as a result of supine-dependent sleep.

Adolescent↗

PubMed2003

Trunk asymmetry and facial symmetry in young adults.

The aim of the present study was to detect possible associations between trunk and cervical asymmetry and facial symmetry. Frontal cephalograms prepared in the natural head position, representing 79 subjects (40 males, 39 females) with mild to moderate trunk asymmetry, were analyzed separately for thoracic humps, lumbar prominences, and cervical inclination by discriminating two groups: right-sided-dominant and left-sided-dominant. The differences between the groups were analyzed using an unpaired 2-group t test. The results showed that location of the thoracic humps and inclination of the cervical spine was predominantly right-sided, while the location of lumbar prominence was predominantly left-sided. Craniofacial morphological variables of the head and face were nearly equal for right-sided and left-sided thoracic humps and lumbar prominences, showing that moderate trunk asymmetry does not affect facial symmetry. Further, it was found that frontal head position in relation to the true vertical (VER/ORB) is stable in that the angle between the supraorbital and vertical lines is constantly maintained close to 90 degrees regardless of moderate trunk asymmetry, indicating that visual perception control is most important in orienting the head in frontal plane. Maintenance of the head position takes place by cervical spine adaptation.

Adaptation, Physiological↗

PubMed2003

Postural cephalometric analysis and nasal resistance in sleep-disordered breathing.

OBJECTIVES: The study was designed to compare upright and supine cephalometric measurements in snorers and to evaluate the effects of mandibular position and nasal resistance on pharyngeal dimensions. Anthropometric, rhinomanometric, and cephalometric measurements were used to investigate predictors of apnea-hypopnea index. STUDY DESIGN: Prospective, cross-sectional. METHODS: Forty consecutive habitually snoring men waiting for nasal surgery (mean age, 44 y; mean body mass index, 28 kg/m2) underwent an overnight polysomnographic, anterior rhinomanometric, and cephalometric analysis in upright and supine positions. RESULTS: Nasal resistance correlated positively with minimal pharyngeal airspace at the level of tongue. The opening of jaws after voluntary relaxation of the mandibular position on lying down correlated with decrease in pharyngeal airway measurements at both velopharyngeal and tongue-base levels. In stepwise multiple regression analysis the overall patient model explained 68% of the variation in apnea-hypopnea index with body mass index as the largest predictor. In the nonobese patients, the model explained 86% of variation in apnea-hypopnea index with change in anteroposterior position of the lower jaw in upright and supine measurements and combined nasal resistance after mucosal decongestion as independent determinants. In selected skeletal subtypes the models predicted 83%, 79%, 61%, and 90% of the variation in apnea-hypopnea index. CONCLUSIONS: In the nonobese patients nasal resistance and change in mandibular position on lying down were found to be independent contributing factors to the apnea-hypopnea index. Further research on supine cephalometry and relaxed mandibular position may improve prediction of sleep-disordered breathing in snorers.

Adult↗

PubMed2002

Pinhole osteotomy in distraction osteogenesis - a technical note.

A new surgical approach for performing the mandibular osteotomy for distraction osteogenesis is described. In order to minimize trauma to bone caused by the osteotomy - and adjacent soft tissue - caused by excessive stretching - an additional transbuccal pinhole incision is made. The shaft of the saw blade is passed through this incision. This allows a precise cut of the mandibular ramus at the planned angle and easy guidance of the saw during the procedure. The method can be used both with extraoral or intraoral distraction devices in children and adults.

Adult↗

PubMed2002

Maximal bite force and its associations with spinal posture and craniofacial morphology in young adults.

Maximal bite force (MBF) and its associations with craniofacial morphology and spinal posture were studied in a group of young adults (46 M and 38 F) aged 21 to 23 years. MBF was recorded in molar and incisal regions. Sagittal spinal posture was measured by spinal pantography and trunk asymmetry at thoracic and lumbar levels by a forward-bending test. Craniofacial variables and posture of the cervical spine were examined from lateral cephalograms taken in a natural head position. No statistically significant correlations existed between MBF and spinal posture, but significant correlations did exist between MBF and craniofacial variables, especially in women.

Adult↗