A simple appliance for the management of obstructive sleep apnoea--the MEDUNSA Anti-Snoring Device (MASD).
Obstructive sleep apnoea (OSA) is a breathing abnormality that occurs during sleep. It is characterised by snoring and episodes of sleep disturbance that can occur from 10 to 500 times per night causing excessive daytime exhaustion. A large tongue and a retrognathic mandible have been listed as aetiological factors. Orthodontic appliances that have been used to manage the condition are usually complicated, uncomfortable, expensive and delicate. The aim of this clinical procedure is to design a simple, inexpensive, durable and user-friendly appliance that can be used in the management of OSA. The procedure involves taking upper and lower impressions of a patient with OSA and articulating the study casts in a registered protrusive bite. Gum guards of the dental arches are then constructed and fused together in the protrusive position with a 5 to 10 mm open bite. The forward and downward advancement of the mandible caused by the appliance drags the tongue and other structures along, and thus opens the posterior pharyngeal airway during sleep. For ease of reference this appliance has been named the MEDUNSA Anti-Snoring Device (MASD) and it differs from similar appliances in that it is entirely toothborne and does not impinge on the surrounding soft tissues. The MASD was used in a patient with OSA at the MEDUNSA Oral Health Centre. Pre-treatment and post treatment airway dimensions from the lateral cephalograms confirm an increase of 50 per cent in airway size at the level of the epiglottis with a corresponding reduction in clinical symptoms. The MASD is an extremely valuable tool to dentists, orthodontists, as well as any other health professionals managing sleep-breathing abnormalities. While the MASD has been successful in this preliminary case, clinical trials are under way to further evaluate the MASD.