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At least 433 records · Page 24Linked to original sources

PubMed2004

Lack of efficacy for a cervicomandibular support collar in the management of obstructive sleep apnea.

STUDY OBJECTIVES: The effect of therapy using a cervicomandibular support collar (CMSC) to manage obstructive sleep apnea (OSA) was compared with standard therapy, nasal continuous positive airway pressure (nCPAP). DESIGN: Subjects received treatment with CMSC or nCPAP each for 1 month in random order. The study was analyzed on an intention-to-treat basis. SETTING: Tom McKendrick Sleep Laboratory, Dunedin Hospital. PARTICIPANTS: Ten adult subjects with mild-to-moderate OSA (apnea-hypopnea index [AHI], 24 +/- 13/h slept [mean +/- SD]) completed the study. INTERVENTIONS: The CMSC was designed to prevent mandibular movement and hold the head in slight extension, thus preventing the postural changes that might contribute to OSA. Positioning of the CMSC was confirmed by an externally applied cervical range of motion (CROM) instrument and by cephalometry. Subjects were carefully instructed in the use of each device and completed a symptom diary. After 1 month, subjects underwent polysomnography with each of the allocated devices in situ, and symptom questionnaires were administered. MEASUREMENTS AND RESULTS: Treatment success (AHI </= 10/h slept) with CMSC was achieved in only 2 of 10 subjects, partial success (AHI > 10/h to </= 15/h slept) was achieved in 2 subjects, and in 6 of 10 subjects there was no benefit. In contrast, treatment success was achieved in 7 of 10 subjects receiving nCPAP. Mean AHI was 29.4 +/- 13.4/h at baseline, 26.9 +/- 17.2/h slept with CMSC, and 9.9 +/- 8.0/h slept with nCPAP (p = 0.001). No significant differences in sleep architecture or sleep efficiency were achieved using nCPAP compared to CMSC. The efficacy of the CMSC in maintaining the desired head position was confirmed by cephalometry and the CROM instrument. CONCLUSIONS: Our results, although negative, provide important evidence that control of head and neck posture, perhaps adopted as a second-line treatment, is not helpful in the management of OSA. It appears that other anatomic and physiologic factors have a dynamic overriding influence on upper airway closure compared to simple skeletal relationships.

Adult↗

PubMed1976

Ultrasound and biochemical findings in intrauterine growth retardation.

An attempt was made to make an early diagnosis of intrauterine growth retardation due to chronic placental insufficiency using ultrasound cephalometry and biochemical tests of placental function. We examined 83 hospitalised patients in whom there was a risk or suspicion of chronic placental insufficiency. For each patient an average of 4 determinations were made of head diameter, 10 of estriol and 3 of pregnandiol urinary excretion, 6 serum HPL and 7 of heat stable alkaline phosphatase (HSAP). Fetal growth retardation was assumed if the last 2 determined head diameters were below the normal curve with the same tendency and with term being well predicted. Biochemical parameters were considered to indicate pathological changes if they were 95% below normal values, with 2 below this range or 3 continuously falling below the normal level. Infants were assessed after birth both neurologically and somatically according to DUBOWITZ. Small for date infants were those whose birth weight was below the 10th percentile (LUBCHENKO). This was found to be the case in 15 out of 83 newborns five of whom were younger than 37 weeks. These 15 could be diagnosed before birth with various degrees of certainty. For estriol and HPL this was 67% or 53% and these two parameters were found to be the most valuable. Cephalometry was found to be less valuable with 20%, pregnandiol levels with 9% and placental HSAP with 33%. Hence it is recommended to perform serial determinations of estriol and HPL in the third trimester of pregnancy in all patients with histories indicative of fetal growth retardation and in those in whom the uterus appears small for date.

Alkaline Phosphatase↗

PubMed1997

Comparison of the reliability of craniofacial anatomic landmarks based on cephalometric radiographs and three-dimensional CT scans.

OBJECTIVE: Conventional cephalometry is an inexpensive and well-established method for evaluating patients with dentofacial deformities. However, patients with major deformities, and in particular asymmetric cases are difficult to evaluate by conventional cephalometry. Both two- and three-dimensional computed tomography (CT) have been proposed to alleviate some of these difficulties. Only a few studies using metallic markers have indicated 3-D CT to be a useful diagnostic method, whereas no studies have evaluated the reliability of the anatomic cephalometric points used in 3-D CT. The aim of our study therefore was to compare the reliability of anatomic cephalometric points from conventional cephalograms and 3-D CT. METHODS: Nine human dry skulls were CT scanned. In addition standard lateral and frontal cephalograms were obtained. The CT scans were 3-D image reconstructed, and the cephalometric points were recorded as x, y, and z co-ordinates by two investigators. Computerized cephalometrics were performed-on the lateral and frontal cephalograms. Intra- and interindividual variations were calculated for each method and tested for statistical significance. RESULTS: Lateral cephalogram measures were more reliable than 3-D CT, with interobserver variations less than 1 mm for most points compared to about 2 mm for 3-D CT. Lateral cephalometrics also showed significantly less interobserver variation for six variables. This was, however, less obvious when 3-D CT was compared to frontal cephalograms. Frontal cephalometrics showed significantly less interobserver variation for three of the investigated variables. CONCLUSIONS: For standard lateral and frontal cephalometric points, there is no evidence that 3-D CT is more reliable than the conventional cephalometric methods in normal skull, and the benefit of 3-D CT cephalometric is indicated to be in the severe asymmetric craniofacial syndrome patients, as conventional cephalometrics is known to be inferior in these cases.

Adult↗

PubMed2000

Standardization of 3-D CT measurements for length and angles by matrix transformation in the 3-D coordinate system.

OBJECTIVE: We attempted to establish a new 3-D cephalometry with helical computed tomography (CT) by introducing the matrix transformation of the 3-D coordinate system. SUBJECTS AND METHODS: Three-dimensional cephalometric landmarks on the craniofacial bones were expressed as 3-D vectors originating from the center of the sella. These vectors were standardized by the matrix transformation so that the midsagittal plane and cranial base line coincided with the XZ plane and X axis of the 3-D coordinate system, respectively. We also applied this new method to trace the normal growth of the craniofacial bones in 44 patients with head and neck cancer (age range, 5 to 26 years; 19 women and 25 men). RESULTS: The accuracy for length measurements was less than 3% of standard error of means with a slice thickness of 1 or 3 mm for 28 out of the 29 length measurements recorded. The precision errors by repeated measurements were 0.8% to 1.0% coefficients of variation for intra- and interobserver variability. Standardization of 3-D vectors representing the cephalometric landmarks allowed us to assess successfully the age-related transition of these landmarks of the patients' craniofacial bones. CONCLUSION: A new assessment method for 3-D CT cephalometry has been developed by standardizing cephalometric landmarks using a matrix transformation of the 3-D coordinate system. This new assessment method may offer potential in planning plastic and reconstructive surgery.

Adolescent↗

PubMed2001

Changes in soft tissue facial profile of craniofacial microsomia patients: geometric morphometrics.

To analyze changes in the soft tissue profile associated with an inverted L osteotomy, preoperative, early postoperative, and late postoperative lateral cephalographs of 13 children with craniofacial microsomia (mean age 9 +/- 2 years) were scanned, and 11 soft tissue landmarks were digitized (digitization errors insignificant; P > 0.05). Cephalometry, Euclidean distance matrix analysis (EDMA), and thin-plate spline (TPS) analysis were carried out on the mean soft tissue landmark configurations. Cephalometry indicated that there were very few statistically significant differences in mean measurements pre- and postoperatively. In contrast, EDMA determined that there were significant differences (P < 0.05) between mean preoperative, early postoperative, and late postoperative soft tissue configurations, particularly in the labiomental region. Transformation grids obtained from TPS analysis indicated clockwise rotation of the soft tissue configurations with anteroinferior elongation in the labiomental region. Geometric morphometrics indicated that the soft tissue lower facial height increased secondary to the associated underlying skeletal change, improving the profile of patients treated with an inverted L osteotomy of the mandible for the correction of craniofacial microsomia.

Cephalometry↗

PubMedDate not supplied

[Orthodontic appliances in the treatment of sleep apnea: a cephalometric and polysomnographic study].

AIM: Effects of oral appliances on snoring in patients with obstructive sleep apnoea syndrome: correlation between cephalometry with and without oral appliance (OA) in place. SUBJECTS: 15 patients were treated with 3 types of OA: Herbst, tooth positioner and QuietKnight. METHODS: All patients underwent a full-night diagnostic polysomnography. They were asked to use their OA each night during one month. All the subjects then underwent a second polysomnography with the OA in place. Standard cephalometric analysis was done in each patient with and without the OA in place. RESULTS: Although average apnea-hypopnea index decreased significantly, snoring was not affected by the OA. Only in 7 patients a reduction was observed. There was a strong correlation between the change in snoring index during sleep and 2 cephalometric variables: ANB angle without, and overjet with the OA in place. No change in quality of sleep was observed. CONCLUSION: OA are indeed effective in decreasing the number of obstructive apneas and hypopneas, without affecting the quality of sleep. Snoring reduction with OA may be predicted by cephalometry.

Analysis of Variance↗

PubMed1986

Craniofacial changes in hemifacial microsomia.

Cephalometry, X-ray cephalometry, and somatoscopy were used in the studies of 65 adult males with a severe unilateral microtia subdivided into three groups: with marked asymmetry, with slight asymmetry, and without any obvious facial asymmetry. The group with marked asymmetries was designated as hemifacial microsomia. In this group the affected side of the face was depressed on the average from above and from below towards the level of the external auditory canal. The center of the anteroposterior reduction was situated in the region in front of the pterygomaxillar fissure. The anteroposterior and vertical facial dimensions on the affected side were reduced most markedly, while the width dimensions showed the slightest changes. Hypoplasia was most severe within the lower face and increased towards the otocephalic centre. The mandibular joint was displaced in an anteroinferior and medial direction. Hypertelorism did not occur, but the orbit on the affected side was smaller in height and was frequently vertically dislocated. The facial profile was unchanged except for retrusion of the chin and increased frequency of bite disorders. The mobility of the mandible was limited. Hemihypoplasia also exerted an influence on structures that were not of branchiogenic origin, e.g., the cranial base (narrowing, asymmetry, and more pronounced curvature), the neurocranium (depression in mastoid and tympanotemporal regions, posterior rotation of the vault), and the frontonasal component (deviation of the nose and premaxilla). The cranial vault and the bottom of the occipital bone showed on the average no asymmetries. The similar character of deviations in slightly affected groups revealed that in spite of the high variability of changes typical for branchiogenic malformations the development of the face in these defects was subjected to certain rules. Marked facial asymmetry occurred only in every fifth patient with a severe degree of microtia, while definite signs of asymmetry were absent in every third patient.

Adult↗

PubMed1985

[Computerized data collection and processing of graphic cephalometric data in dentomaxillofacial orthodontics].

The authors present a graphic program adapted to cartography for the acquisition and processing of graphic data from x-rays and graphics used in dento-maxillo-facial orthopaedic cephalometry. They demonstrate the performance obtained in the automation of cephalometry, in the real-time edition of the results, in the processing of graphic images and the resulting alpha-numerical results.

Cephalometry↗

PubMed1995

[Upper airways and sleep apnea syndrome].

The imaging techniques of the upper airway (UA) now permit a description of the characteristics of pharyngeal collapse during the course of obstructive apnoea. The start is oropharyngeal with active movements anterior and posterior of the soft palate and a falling back of the tongue. The extension occurs almost systematically towards the hypopharynx. A displacement of the hyoid bone and of the cervical spine is noted synchronously with thoracoabdominal movements. These imaging techniques of UA show the occurrence of passive pharyngeal collapse during certain types of central apnoea. In snorers and in apnoeics, there is a reduction of the calibre of the pharynx. However, these abnormalities are not specific and do not enable the diagnosis to be confirmed nor an estimate of the severity of the sleep apnoea syndrome. Cephalometry and computed tomography of the pharynx should be carried out particularly when a uvulopalatopharyngoplasty (UPPP) is envisaged. For practical purposes, the existence on cephalometry of retrognathism with an MP-H > 24 mm and a PAS distance of < 5 mm is associated with a poor result for UPPP. The same thing applies when macroglossia or a reduction of the surface of the hypopharynx is found on computed tomography.

Adult↗

PubMed1995

Reliability of computer-generated cephalometrics.

The use of computer-generated cephalometric analyses has gained popularity in both research and clinical applications. This study was conducted to determine the reliability of the computerized cephalometric methodology. A customized cephalometric analysis of 40 cephalometric radiographs was performed using 22 cephalometric landmarks to evaluate 40 measurements. Reproducibility studies were performed for each step of the computerized cephalometry used. The computer-generated measurements were also compared with those obtained through the conventional hand-measured method. The measurements obtained through the computerized methodology were reproducible for most parameters studied, although point B was found to be unreliable in the vertical plane. The combined errors from video imaging, digitization of the image, and the software were not methodologically significant. No statistically significant errors were found for the repeated measurements of the retrieved digital images. However, the absolute values of all parameters related to the horizontal plane from the computerized method were 0.7 to 1.0 mm greater than those from the conventional hand-measured method, indicating that some horizontal magnification occurred. This information is useful for the interpretation of data obtained from computerized cephalometry.

Cephalometry↗

PubMed2005

Velocardiofacial syndrome with single central incisor.

Three siblings and their mother are reported who all had cytogenetically proven velocardiofacial syndrome (VCFS). One boy had normal dental and craniofacial findings, except for an increased cranial base angle. His sister had only one central incisor in the maxilla. One central incisor had also been missing in the primary dentition. She had no labial frenulum present. Cephalometry showed a small maxillary unit length indicating mild maxillary hypoplasia, an increased anterior face height, steep mandibular plane angle, retruded chin, and a large cranial base angle. Dental measurements showed retroclined lower incisors and increased interincisal angle. A second sister had a cleft of the secondary palate. All permanent teeth were present with the exception of a missing central incisor in the lower jaw: the single lower central incisor was situated in the midline. Her cephalometry showed similar findings as in her sister. All three siblings required palate surgery for speech. Mother was not available for detailed dental and other oral investigations. A single maxillary central incisor has previously been reported in VCFS, but to our knowledge a single central incisor in the mandible has not been reported previously in this entity.

Abnormalities, Multiple↗

PubMed2000

Supine Cephalometric Analyses of an Adjustable Oral Appliance Used in the Treatment of Obstructive Sleep Apnea.

OBJECTIVE: To investigate the effects of the Klearway(TM) appliance on the upper airway in patients with obstructive sleep apnea (OSA) in the supine position. METHODS: Sixteen subjects (12 males and 4 females) were recruited on the basis of baseline polysomnography with a documented Apnea and Hypopnea Index (AHI) >15 per hour. A second overnight sleep study was performed for each subject with the appliance in place. Baseline supine cephalometry was performed for each subject before the initial insertion of the appliance, and follow-up supine cephalometry was undertaken with the appliance in place. RESULTS: The polysomnographic variables improved significantly, and the mean changes in overbite and overjet were 5.15 mm and 6.26 mm after insertion of the Klearway(TM) appliance. The supine sagittal cross-sectional areas of the pharynx and the tongue significantly increased, while the linear distance from the hyoid position to the mandibular plane or the RGN-C3 line significantly decreased after insertion of the appliance. The ratio of the vertical pharyngeal length to the sagittal cross-sectional area of nasopharynx or tongue decreased significantly. When the subjects were evaluated on the basis of the after-insertion AHI, the group with good response (n = 11) was found to be significantly younger than the group with the poor response (n = 5). Similarly, the good responders revealed less prominent chins, larger tongue heights, and an increase in hypopharyngeal sagittal cross-sectional area after insertion of the appliance. There was a significant correlation between the improvement in AHI (%) and the supine middle airway space (r = -0.52, p < 0.05). CONCLUSION: The mechanical effect of the Klearway(TM) appliance on the upper airway and the stabilization of jaw posture may be important determinants of the efficacy of the appliance.

Journal Article↗

PubMed1990

Obstructive sleep apnoea in children undergoing routine tonsillectomy and adenoidectomy.

Sleep screening was used to discover the incidence of sleep apnoea in 50 children undergoing routine adenotonsillectomy for recurrent upper respiratory tract infections, randomly selected from the waiting list. Preoperative assessment included a detailed parental history, physical examination, and lateral cephalometry, in order to identify factors that might alert the clinician to a diagnosis of obstructive sleep apnoea. There were 2 equal groups of snorers and non-snorers (grade 0); 1 patient was found to have the sleep apnoea syndrome (IV), 9 patients had obstructive snoring with apnoeic episodes (III), 3 patients had snoring with a disrupted sleep pattern (II), and 12 patients snored with no disruption of sleep (I). In identifying patients with apnoea, a history of snoring was unhelpful, whereas one of breathing irregularities was found to be highly specific. Nasal obstruction correlated poorly; however, there was a significant relationship between tonsillar position and size and sleep grade (Chi-squared P less than 0.01). Stepwise regression analysis showed a large contribution to the grading was made by the size of the oropharyngeal airway measured by lateral cephalometry. The children in grade II-IV were re-studied 3 months post-operatively and all reverted to grades 0 or I.

Adenoidectomy↗

PubMed2004

Effects of mandibular advancement on airway curvature and obstructive sleep apnoea severity.

In a curved tube, the amount of airflow appears to be influenced by the amount of curvature. The purpose of this study was to investigate changes in obstructive sleep apnoea (OSA) severity and awake velopharyngeal curvature in response to an anteriorly titrated mandibular position in 20 male OSA patients. Baseline supine cephalometry was obtained before the initial insertion of a titratable oral appliance and follow-up supine cephalometry was undertaken after titration of the mandibular position with the appliance in place. The mean apnoea/hypopnea index (AHI) before treatment (31.6 +/- 13.0 events x h(-1)) was significantly reduced (9.8 +/- 7.4 events x h(-1)) after titration of the mandibular position in all 20 patients. There was a significant increase in the anteroposterior calibre and the radius of the curvature of the anterior wall of the velopharynx in 14 good responders who exhibited an AHI reduction to < or = 15. Similar observations were not found in six poor responders. To conclude, an anteriorly titrated mandibular position reduced obstructive sleep apnoea severity, enlarged the velopharynx and diminished the curvature of the anterior velopharyngeal wall in good responders. It is proposed that this change in the upper airway curvature associated with mandibular advancement may effect obstructive sleep apnoea severity through its effect on airflow dynamics.

Adolescent↗

PubMed2006

Tooth loss and obstructive sleep apnoea.

BACKGROUND: Complete tooth loss (edentulism) produces anatomical changes that may impair upper airway size and function. The aim of this study was to evaluate whether edentulism favours the occurrence of obstructive sleep apnoea (OSA). METHODS: Polysomnography was performed in 48 edentulous subjects on two consecutive nights, one slept with and the other without dentures. Upper airway size was assessed by cephalometry and by recording forced mid-inspiratory airflow rate (FIF50). Exhaled nitric oxide (eNO) and oral NO (oNO), were measured as markers of airway and oropharyngeal inflammation. RESULTS: The apnoea/hypopnoea index (AHI) without dentures was significantly higher than with dentures (17.4 +/- 3.6 versus 11.0 +/- 2.3. p = 0.002), and was inversely related to FIF50 (p = 0.017) and directly related to eNO (p = 0.042). Sleeping with dentures, 23 subjects (48%) had an AHI over 5, consistent with OSA, but sleeping without dentures the number of subjects with abnormal AHI rose to 34 (71%). At cephalometry, removing dentures produced a significant decrease in retropharyngeal space (from 1.522 +/- 0.33 cm to 1.27 +/- 0.42 cm, p = 0.006). Both morning eNO and oNO were higher after the night slept without dentures (eNO 46.1 +/- 8.2 ppb versus 33.7 +/- 6.3 ppb, p = 0.035, oNO 84.6 +/- 13.7 ppb versus 59.2 +/- 17.4 ppb, p = 0.001). CONCLUSION: These findings suggest that complete tooth loss favours upper airway obstruction during sleep. This untoward effect seems to be due to decrease in retropharyngeal space and is associated with increased oral and exhaled NO concentration.

Aged↗

PubMed2006

Hard palate repair timing and facial growth in cleft lip and palate: a systematic review.

OBJECTIVE: To evaluate the effect of timing of hard palate repair on facial growth in patients with cleft lip and palate, with special reference to cranial base, maxilla, mandible, jaw relation, and incisor relation. DESIGN: A systematic review. METHODS: The search strategy was based on the key words "facial growth," "cleft lip palate," and "timing of (hard) palate repair." Case reports, case-series, and studies with no control or comparison group in the sample were excluded. RESULTS: Fifteen studies met the selection criteria. All the studies were retrospective and nonrandomized. Five studies used cephalometry and casts, seven used cephalometry, and three used casts. Methodological deficiencies and heterogeneity of the studies prevented major conclusions. CONCLUSION: The review highlights the importance of further research. Prospective well-designed, controlled studies, especially targeting long-term results, are required to elucidate the effect of timing of hard palate repair on facial growth in patients with cleft lip and palate.

Cleft Lip↗

PubMed1992

[What is the status of clinical examination in orthopedic surgery of the jaw in 1991?].

The author endeavours to make a detailed description of the clinical examination of the face, which, if performed systematically, allows establishing an accurate diagnosis of the lesions in dysmorphosis and thus locating the latter's seat. The precise modalities of the surgical procedure are defined on the basis of cephalometry and of casts. Cephalometry does not define the site of surgery; it merely confirms it. In our opinion, the esthetic study of the face with the detailed clinical examination remains the key element for the assessment of dysmorphosis.

Chin↗

PubMed2006

[Contrast analysis of different sagittal split ramus osteotomy methods in correcting mandibular prognathism].

OBJECTIVE: To explore the indication, advantage and disadvantage of modified or classical technique of intraoral sagittal split ramus osteotomy (SSRO) for correction of mandibular prognathism. METHODS: From January 1997 to January 2005, 95 patients suffering from mandibular prognathism or accompanied by other deformities were treated with modified or classical technique of intraoral SSRO. Of 95 cases, there were 34 males and 61 females, aging 15 to 44 years, including 53 cases of single mandibular prognathism, 28 cases accompanied with mandibular deviation, 11 cases accompanied with maxillary retrognathism, 2 cases accompanied with glossacele and 1 case accompanied with malar protrusion. X-ray cephalometry showed: sella-nasion-A point (SNA) 80-83 degrees, sella-nasion-B point (SNB) 80-84 degrees, A point-nasion-B point (ANB)--3-1 degrees. Forty-three cases were corrected by modified SSRO and 52 cases by classical SSRO. RESULTS: The face appearance and dental articulation of all the patients were improved greatly. In patients by classical SSRO, disorder of local sensibility occurred in 9 cases, mandibular fracture during the cleavage of the ascending ramus in 1 case, significant bleeding in 1 case, postoperative infection in 1 case and postoperative relapse in 3 cases. In patients by modified SSRO, disorder of local sensibility occurred in 2 cases and postoperative relapse in 1 case; no mandibular fracture, significant bleeding, postoperative infection and other complications occurred. With a follow-up of 3 months to 7 years, X-ray cephalometry showed SNA 81-83 degrees, SNB 78-81 degrees and ANB 1-4 degrees. CONCLUSION: Modified SSRO is an ideal method of correcting mandibular prognathism, especially severer mandibular prognathism accompanied by mandible deviation deformity.

Adolescent↗