Search Results (41)

The objective of this study was to assess the transverse maxillary skeletal, dental, and nasal effects of quad-helix treatment (slow maxillary expansion) in comparison to an untreated group. This study was performed on 24 patients. Before and after treatment, CBCT images for children who were treated with Wilson quad-helix were retrieved. The treatment group included 12 children with a mean age of 11.4 ± 1.2 years. The untreated control group had 12 matching patients aged 11.7 ± 0.7 years. AVIZO software (version 9.1) was utilized to place specific 3D anatomical landmarks. The segmentation of the nasal airway was performed using Mimics. The maxillary inter-molar width and inter-premolar widths increased significantly in the treatment group but not in the comparison group. These increases were statistically greater between groups. This study showed statistically significant increases in maxillary inter-molar and inter-premolar widths in patients who were treated with Wilson quad-helix to expand their upper arch. Buccal translation in the upper molars resulted after treatment. Quad-helix treatment caused more dental than skeletal effects. The nasal volume and surface area in the quad-helix group significantly increased. Full article

A detailed picture of how an aerosol is transported and deposited in the self-affine bronchial tree structure of patients is fundamental to design and optimize orally inhaled drug products. This work describes a Monte Carlo-based statistical deposition model able to simulate aerosol transport and deposition in a 3D human bronchial tree. The model enables working with complex and realistic inhalation maneuvers including breath-holding and exhalation. It can run on fully stochastically generated bronchial trees as well as on those whose proximal airways are extracted from patient chest scans. However, at present, a mechanical breathing model is not explicitly included in our trees; their ventilation can be controlled by means of heuristic airflow splitting rules at bifurcations and by an alveolation index controlling the distal lung volume. Our formulation allows us to introduce different types of pathologies on the trees, both those altering their morphology (e.g., bronchiectasis and chronic obstructive pulmonary disease) and those impairing their function (e.g., interstitial lung diseases and emphysema). In this initial activity we describe deposition and ventilation models as well as the stochastic tree construction algorithm, and we validate them against total, regional, lobar, and sub-lobar deposition for healthy subjects. Full article

Background: Obstructive Sleep Apnea Syndrome (OSAS) is a prevalent and underdiagnosed condition with significant systemic and quality-of-life impacts. While polysomnography remains the gold standard for diagnosis, cone-beam computed tomography (CBCT) presents a potential adjunctive imaging tool for anatomical airway evaluation. Objective: We aimed to assess the effectiveness of three-dimensional airway evaluation via CBCT as a complementary diagnostic tool for OSAS. Methods: A diagnostic test study (experimental pilot study) was conducted using CBCT scans of 30 patients, divided into two groups: 15 scans from patients with a confirmed OSAS diagnosis through polysomnography and 15 scans from healthy controls. Five tomographic variables were analyzed: anteroposterior distance, lateral distance, minimum cross-sectional area, airway volume, and airway shape. Statistical analysis was performed comparing both groups. Results: The minimum cross-sectional area and airway volume showed statistically significant differences between the OSAS and control groups (p = 0.038 and p = 0.0055, respectively). Anteroposterior and lateral distances showed trends toward significance but were not statistically significant. Conclusions: CBCT-based airway analysis, particularly focusing on volumetric and cross-sectional area parameters, demonstrates strong potential as a complementary tool in the diagnosis of peripheral-type OSAS. However, it cannot replace polysomnography, especially for central OSAS diagnosis. Full article

Introduction: Maxillary setback in orthognathic surgery has been extensively discussed regarding its effects on bone healing and facial soft tissue profile; however, its impact on upper airway volume remains unclear. Objective: We evaluate the influence of maxillary setback combined with counterclockwise (CCW) rotation of the occlusal plane on upper airway dimensions. Methods: A retrospective observational case series was conducted with eight patients diagnosed with Class II malocclusion who underwent orthognathic surgery involving maxillary setback and CCW mandibular rotation. All procedures were performed by the same surgeon. Preoperative (T1) and 6-month postoperative (T2) facial CT scans were analyzed using Dolphin Imaging software11.7 to measure airway volume (VOL), surface area (SA), and linear distances D1, D2 and D3. Statistical analysis was performed using the Wilcoxon test with a 5% significance level. Results: Significant skeletal changes were observed, including 10.2 mm of mandibular advancement, 5.2 mm of hyoid advancement, and 4.1° of CCW rotation. Although increases in airway volume and surface area were noted, they did not reach statistical significance (p = 0.327 and p = 0.050, respectively), but suggesting a favorable trend toward airway adaptation. Conclusions: Maxillary setback combined with CCW rotation appears to safely correct Class II skeletal deformities without compromising upper airway space. These preliminary findings highlight the technique’s potential for both functional and aesthetic outcomes, warranting further long-term studies. Full article

Orthognathic surgery, particularly maxillomandibular advancement (MMA), has emerged as an effective therapeutic option for patients with moderate to severe OSA who are refractory to conventional treatments. The wedge osteotomy of the maxilla, often performed in combination with mandibular surgery, can be a surgical treatment for obstructive sleep apnea (OSA). This case series report describes 6 OSA patients without anteroposterior maxillary deficiency who were treated with wedge osteotomy of the maxilla. Material and Methods: We conducted a retrospective analysis of 6 patients who underwent maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA), all operated on consecutively by the same surgeon between 2018 and 2024 at the Maxillofacial Surgery of San Camillo-Forlanini Hospital, in Rome, Italy. Patients were evaluated using a CAD/CAM-assisted approach. A pre- and postoperative comparative analysis was conducted to assess the effectiveness of the surgical treatment in improving OSA-related parameters. Maxillary wedge osteotomy and bilateral sagittal split osteotomies (BSSO) of the mandibular ramus were digitally planned. Results: The comparison between preoperative and postoperative CT scans, along with 3D reconstructions generated using dedicated software, revealed a counterclockwise rotation of the occlusal plane, resulting in a mandibular advancement of approximately 13 mm. The CT shows a significant increase in airway volume following the skeletal repositioning. The airway volume increased from 20.665 ± 546 mm³ to 27.177 ± 446 mm³. Conclusions: Counterclockwise rotational orthognathic surgery without maxillary advancement has been shown to effectively enlarge the posterior pharyngeal space while also delivering excellent esthetic outcomes. Full article

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder characterized by a reduction or complete interruption of airflow during sleep, with episodes lasting at least 10 s. In severe cases, blood oxygen saturation can drop significantly, reaching levels as low as 40%. The aim of this study was to compare CAD/CAM-assisted maxillomandibular advancement (MMA) with traditional surgical techniques in the treatment of obstructive sleep apnea (OSA). We conducted a retrospective analysis of patients who underwent maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA), all operated on consecutively by the same surgeon between 2022 and 2024 at the Maxillofacial Surgery of Policlinico Hospital San Camillo-Forlanini, Rome, Italy. This study included 18 patients with severe obstructive sleep apnea syndrome (OSAS) who underwent maxillomandibular advancement (MMA) surgery. The patients had a mean age of 38 years; 11 were male and 7 were female. Patients were divided into two groups: Group A, treated using a CAD/CAM-assisted surgical approach (five male and four female), and Group B, treated with conventional surgical techniques (six male and three female). Results: The comparison between preoperative and postoperative CT scans, along with 3D reconstructions using dedicated software, demonstrated a significant increase in airway volume following the skeletal repositioning. Notably, airway volume increased from 19.25 ± 0.5 mm³ to 26.14 ± 1.264 mm³ in group A and 20.564 ± 0.71 mm³ to 25.425 ±1.103 mm³ in group B. Conclusion: No significant differences were observed between the CAD/CAM-assisted and conventional surgical techniques for maxillomandibular advancement (MMA) in the treatment of severe obstructive sleep apnea (OSA). Both approaches led to a reduction in the apnea–hypopnea index (AHI) and an increase in posterior airway space (PAS). However, the use of software and digital planning through CAD/CAM technology allows for greater precision and shorter operative times, making the procedure more efficient overall. Full article

Background/Objectives. With a rapid palatal expander (RPE) is reported to be effective in increasing the volume of nasal cavities, with a restoration of physiological nasal airflow. The purpose of this retrospective clinical study was to evaluate, using Cone Beam Computed Tomography (CBCT), the volumetric changes and airflow velocity changes in the nasal cavities, retro-palatal and retro-glossal airways, resulting from the use of RPE with dental anchorage (group A), also comparing these data with patients non treated with RPE (group B). Methods. Sixteen subjects (aged 9.34 years) with transverse maxillary deficiency and unilateral posterior crossbite were treated with RPE with dental anchorage. Additionally, 8 patients (aged 11.11 years) with juvenile idiopathic arthritis, who did not undergo any orthodontic treatment, were selected as a control group. Expansion was performed until overcorrection was achieved, and the device was left in place for 6 months as fixed retention, followed by another 6 months of night-time removable retention. From the retrospective evaluation, all patients presented two CBCT scans at baseline (T0) and 1-year follow-up (T1). The 3D-Slicer software was used for each CBCT to measure the nasal (VN), retropalatal (VRP), and retroglossal (VRG) volumes, while an iterative Excel spreadsheet allowed for a pilot approximated modeling and calculation of airway flow-related data. Results. Regarding mean age, a statistically significant difference (p = 0.01 *) was found between groups, suggesting that group B is closer to the pubertal growth peak. Analysis between T0 and T1 revealed: (i) a statistically significant increase for volumes VN, VRP and VRG in group A; (ii) a statistically significant increase for VN in group B; (iii) a statistically significant decrease for all variables related to airflow velocity in both groups. Furthermore, comparison between group A and B, regarding variations between T0 and T1, found a statistically significant difference only for VN. Conclusions. Within the limitations of this pilot evaluation, the treatment with RPE revealed promising outcomes for retro-palatal, retro-glossal and nasal volumes, together with clinical changes in airflow velocities. Full article

Quantification of the severity of chest wall deformation in children with spinal deformities is essential for understanding the effects on trunk appearance and cardiopulmonary function. Magnetic resonance imaging (MRI) is particularly valuable for this purpose, as it does not employ ionizing radiation and can provide three-dimensional (3D) imaging of thoracic anatomy. Acquiring sufficient quality images of the chest wall, lungs and airways at key stages of the respiratory cycle, such as end-inspiratory or expiratory phase, is crucial for accurately assessing chest wall deformation and pulmonary function and mechanics. Regarding image quality, low proton density and short relaxation times of the lung tissues result in poor quality images, and long acquisition times result in blurring caused by respiratory and cardiac motion. This overview summarizes strategies developed to address the inherent challenges of visualization of lung tissue and respiratory motion in MRI acquisition of the chest of pediatric patients with spinal deformities. An overview of the main methods for motion-resolved image acquisition and measurement of chest wall motion and thoracic volumes is presented and discussed. It is concluded that despite the development of multiple techniques and diverse strategies for obtaining high-quality, motion-resolved chest MRI, further validation of these methods is required before their implementation in clinics for routine evaluation of chest deformation in pediatric spinal deformity patients. Full article

On-chip microfluidics are advanced in vitro models that simulate lung tissue’s native 3D environment more closely than static 2D models to investigate the complex lung architecture and multifactorial processes that lead to pulmonary disease. Current microfluidic systems can be restrictive in the quantities of biological sample that can be retrieved from a single micro-channel, such as RNA, protein, and supernatant. Here, we describe a newly developed large-scale airway-on-chip model that employs a surface area for a cell culture wider than that in currently available systems. This enables the collection of samples comparable in volume to traditional cell culture systems, making the device applicable to any workflow utilizing these static systems (RNA isolation, ELISA, etc.). With our construction method, this larger culture area allows for easier handling, the potential for a wide range of exposures, as well as the collection of low-quantity samples (e.g., volatiles or mitochondrial RNA). The model consists of two large polydimethylsiloxane (PDMS) cell culture chambers under an independent flow of medium or air, separated by a semi-permeable polyethylene (PET) cell culture membrane (23 μm thick, 0.4 μm pore size). Each chamber carries a 5 × 18 mm, 90 mm² (92 mm² with tapered chamber inlets) surface area that can contain up to 1–2 × 10⁴ adherent structural lung cells and can be utilized for close contact co-culture studies of different lung cell types, including airway epithelial cells, fibroblasts, smooth muscle cells, and endothelial cells. The parallel bi-chambered design of the chip allows for epithelial cells to be cultured at the air–liquid interface (ALI) and differentiation into a dense, multi-layered, pseudostratified epithelium under biological flow rates. This millifluidic airway-on-chip advances the field by providing a readily reproducible, easily adjustable, and cost-effective large-scale fluidic 3D airway cell culture platform. Full article

The increasing use of cone beam computed tomography (CBCT) has led to a growing demand for DICOM software that enables the assessment and measurement of craniofacial structures. This study aimed to compare the airway volume and the minimum axial area in patients with cleft lip and palate using five different imaging software programs: Dolphin3D, InVivo Dental, ITK Snap, InVesalius, and NemoFAB. Initially, 100 CBCT scans were selected by an examiner, and their corresponding DICOM files were collected. The oropharyngeal segments were delineated following the manufacturer’s guidelines, using two different segmentation techniques: interactive and fixed threshold. The results were analyzed using the Friedman test and Wilcoxon post hoc test, with a 5% significance level for all statistical tests. The findings for both the minimum axial area and total volume revealed that the median values across the software groups were higher than expected, and significant differences were observed when comparing the groups (p < 0.001). All five software programs showed notable differences in their outputs. Specifically, a statistically significant difference in volume was found across all groups, except between InVivo and ITK-Snap. It is recommended that pre- and post-treatment comparisons be performed using the same software for consistency. Full article

Background and Objectives: The aim of this prospective study was to assess the effects of rapid maxillary expansion (RME) and/or face mask (FM) treatments on the pharyngeal airway in patients with skeletal Class III malocclusion caused by maxillary deficiency. This study utilized cone beam computed tomography (CIBT) for a three-dimensional (3D) analysis of airway changes, comparing the results with those of a control group consisting of untreated skeletal Class III patients. Materials and Methods: The study included 60 participants (34 boys, 26 girls) aged 9 to 14 years, all diagnosed with skeletal Class III malocclusion due to maxillary underdevelopment. The participants were divided into four treatment groups, each consisting of 15 individuals: Group 1—RME; Group 2—RME/FM; Group 3—FM; Group 4—Control group. The pharyngeal airway measurements were evaluated using CBCT and analyzed with Dolphin 3D software (version 11.9). Volumetric parameters and minimal axial area (MAA) were measured in the nasopharyngeal, retropalatal, retroglossal, and total airway regions. The collected data were statistically analyzed using SPSS 20.0 software. Results: The results indicated significant changes in pharyngeal airway volumes across all treatment groups compared to the control group. A statistically significant increase in nasopharyngeal, retropalatal, and total airway volume were observed in all treatment groups. Only the RME group demonstrated a significant increase in retroglossal volume. Significant increases in MAA were found in the RME/FM and FM groups in the nasopharyngeal and retropalatal regions. However, minimal changes were observed in the retroglossal region across all treatment groups. The control group showed no significant changes in any of the measured parameters, underscoring the effects of the treatments. Conclusions: The findings of this study suggest that both RME and/or FM treatments result in significant positive changes in the pharyngeal airways, particularly in the nasopharyngeal and retropalatal regions. The retroglossal region showed more limited response to the treatments. The combined RME/FM therapy was found to be particularly effective in improving airway dimensions in the anterior and mid-pharyngeal regions. These results highlight that early orthodontic interventions, such as RME and FM, can improve both airway patency and overall respiratory function, in addition to addressing skeletal Class III malocclusion. Full article

Background: Obstructive sleep apnea is a sleep-related breathing disorder associated with craniofacial morphology and dental arches. The aim of this study was to evaluate the correlation between obstructive sleep apnea and the morphometry of dental arches and upper airways. Methods: Forty patients were enrolled in the study, and the polysomnographic parameters evaluated were the apnea hypopnea index (AHI) and the oxygen desaturation index (ODI). Dental measurements taken from the 3D models included anterior arch widths, posterior arch widths, maxillary and mandibular arch lengths, and palatal surface area. A cone beam computed tomography (CBCT) evaluation was also performed. Results: In patients with moderate OSA, posterior maxillary width was significantly correlated with both minimal airway area (rho = 0.65, p < 0.01) and its transverse diameter (rho = 0.68, p < 0.01). Similarly, in patients with severe OSA, posterior maxillary width showed a significant correlation with total airway volume (rho = 1, p < 0.01), minimal airway area (rho = 1, p < 0.01), and its transverse diameter (rho = 1, p < 0.01). Conclusions: Craniofacial morphology and malocclusion can contribute to obstructive sleep apnea syndrome. Full article

Swine influenza A viruses (IAVsw) are important causes of disease in pigs but also constitute a public health risk. IAVsw strains show remarkable differences in pathogenicity. We aimed to generate airway organoids from the porcine lower respiratory tract and use these to establish well-differentiated airway epithelial cell (WD-AEC) cultures grown at an air–liquid interface (ALI) for in vitro screening of IAVsw strain virulence. Epithelial cells were isolated from bronchus tissue of juvenile pigs, and airway organoids were cultured in an extracellular matrix in a culture medium containing human growth factors. Single-cell suspensions of these 3D organoids were seeded on Transwell filters and differentiated at ALI to form a pseudostratified epithelium containing ciliated cells, mucus-producing cells and tight junctions. Inoculation with a low dose of IAVsw in a low volume inoculum resulted in virus replication without requiring the addition of trypsin, and was quantified by the detection of viral genome loads in apical washes. Interestingly, inoculation of an H3N2 strain known to cause severe disease in pigs induced a greater reduction in trans-epithelial resistance and more damage to tight junctions than H1N2 or H1N1 strains associated with mild disease in pigs. We conclude that the porcine WD-AEC model is useful in assessing the virulence of IAVsw strains. Full article

Introduction: This study aimed to investigate differences in the three-dimensional (3D) upper airway dimensions in Vietnamese participants. Methods: This study included 341 Vietnamese participants grouped based on the vertical growth pattern (ANB angle) (skeletal Class I, 123; Class II, 124; Class III, 94). The patients were categorized into subgroups based on the horizontal growth pattern according to the Frankfort mandibular angle (hypodivergent, 35; normodivergent, 175; hyperdivergent, 131) to compare the frequency distribution of the three growth patterns in each skeletal class. The airway dimensions of the three skeletal classes were divided into four volumes using 3D virtual software (In VivoDental Software 6.0). The height, width, and cross-sectional area (CSA) of each part, as well as the total volume and minimum CSA, were measured and analyzed. Results: The airway space was reduced in hyperdivergent Class II individuals, underscoring an important connection between upper airway dimensions and vertical skeletal patterns, which suggests that vertical growth patterns contribute to pharyngeal narrowing and subsequent upper airway obstruction. Significant differences (p < 0.001) in the minimum CSAs and volumes of the middle and inferior pharyngeal airways were observed based on Angle’s skeletal classification. Conclusions: Our insights are valuable for orthodontics, especially in diverse populations, such as the Vietnamese, due to differences in the influence of genetic and environmental factors on skeletal and airway characteristics. Full article

Background: Whether Hyrax maxillary expander is an effective treatment for maxillary transverse deficiency as well as expansion of the upper airway is still controversial. The study’s purpose was to evaluate 3D changes in upper airway dimensions of adolescent patients measured primarily by cone-beam computed tomography (CBCT) after rapid maxillary expansion (RME) with the Hyrax maxillary expander. Methods: Studies up to 1 April 2024 were searched in the following databases: PubMed/MEDICINE, Web of Science, Cochrane Library, and Embase. Inclusion criteria were clinical trials and cohort studies that assessed the effect of RME in adolescent patients with upper airway stenosis using CBCT-based three-dimensional analysis. The risk of bias in the study outcomes was assessed using the Cochrane Collaboration’s risk of bias tool, the GRADE method, and a tool for evaluating non-randomized controlled study (non-RCT) literature from a previous systematic review, depending on the types of articles. The study was reported in accordance with PRISMA guidelines. Results: The study conducted a random effects meta-analysis of mean differences and 95% confidence intervals for changes in upper airway volumes, including the nasal cavity (NC), in the outcomes of 16 included studies, followed by subgroup analyses. Conclusion: A significant increase in nasopharynx volume was observed after rapid maxillary expansion (RME) by Hyrax maxillary expander (MD = 0.69, 95% CI (0.09~1.28), p = 0.02). Full article