Search Results (32)

Objectives: Rapid maxillary expansion (RME) is widely used in orthodontics to correct transverse maxillary deficiencies. Beyond its skeletal and dental effects, RME may influence upper airway dimensions and respiratory function, particularly in growing individuals. This study aimed to evaluate the impact of RME on pulmonary function in adolescents using spirometric measurements. Materials and Methods: Fifteen adolescent patients (8 females, 7 males; mean age: 13.93 ± 2.89 years) diagnosed with maxillary transverse constriction underwent orthodontic treatment with acrylic-bonded RME appliances over a mean duration of 3.56 ± 0.67 months. Respiratory function was assessed via spirometry at baseline (T0) and one day after appliance removal (T1). Parameters recorded included peripheral oxygen saturation (SpO₂), forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), FEV₁/FVC ratio, and vital capacity (VC). Data were analyzed using the paired-samples t-test (for normally distributed variables) or the Wilcoxon signed-rank test (for non-normal distributions), with statistical significance set at p < 0.05. Results: Following RME treatment, all respiratory parameters showed a consistent upward trend but did not reach statistical significance. SpO₂ increased from 96.98 ± 0.96% to 97.01 ± 0.98% (p = 0.925). VC rose from 2.86 ± 1.07 L to 3.03 ± 0.80 L (p = 0.626). The FEV₁/FVC ratio improved from 90.88 ± 12.17% to 92.34 ± 7.37% (p = 0.742). Mean FEV₁ increased from 2.61 ± 0.72 L to 2.72 ± 0.68 L (p = 0.518), while FVC rose from 2.87 ± 0.75 L to 2.96 ± 0.69 L (p = 0.547). No adverse effects were reported during the treatment period. Conclusions: This study identified a non-significant but consistent trend toward improved pulmonary function following RME in adolescents. These preliminary findings should be considered hypothesis-generating rather than confirmatory evidence, as none of the outcomes reached statistical significance. While the observed upward trends in oxygen saturation, lung volumes, and expiratory performance suggest potential respiratory benefits, larger-scale, controlled, and long-term studies incorporating both spirometric and anatomical airway assessments are needed to validate these observations. Full article

Background: Obstructive sleep apnea syndrome (OSAS) and impaired nasal breathing are common in children and are frequently linked to maxillary constriction. Rapid maxillary expansion (RME) is an orthopedic treatment used to increase upper airway dimensions and improve respiratory function. It has been hypothesized that RME could contribute to improvements in behavior and cognition, possibly through enhanced sleep and respiratory function. It also promotes the shift from oral to nasal breathing, supporting craniofacial development and neuromuscular stability, and it is increasingly recognized as a multidisciplinary intervention that can improve pediatric health outcomes. With increasing evidence supporting its efficacy, RME should be considered not only for its orthodontic benefits but also as a multidisciplinary treatment option within pediatric care protocols. This underscores the importance of integrated care among orthodontists, ENT specialists, and pediatricians. Aim: To systematically assess the impact of RME on nasal respiratory parameters and sleep-disordered breathing, particularly OSAS, in pediatric patients. Methods: Following PRISMA guidelines, a systematic review was conducted using 12 clinical studies evaluating anatomical and functional respiratory changes after RME in children with mouth breathing or OSAS. Parameters included airway volume (CBCT, cephalometry), nasal resistance (rhinomanometry), and polysomnography (PSG) data. Results: RME consistently resulted in significant increases in nasal cavity volume and upper airway dimensions. Multiple studies reported reductions in the apnea–hypopnea index (AHI), improved oxygen saturation, and better subjective sleep quality. Longitudinal studies confirmed the stability of these benefits. However, variability in study protocols limited meta-analytical comparison. Conclusions: RME is effective in enhancing nasal breathing and mitigating OSAS symptoms in children. While results are promising, further high-quality randomized controlled trials are needed to validate these findings and guide standardized treatment protocols. 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

Objectives: This study aimed to evaluate the effects of AMCOP^® elastodontic appliances on cephalometric parameters of skeletal divergence and upper airway dimensions in growing patients, comparing treated individuals with an untreated control group. Methods: A total of 60 subjects (30 treated with AMCOP^® devices and 30 controls) were selected, with mean ages of 8.67 ± 1.3 and 9.19 ± 0.8 years, respectively. The AMCOP^® appliances, designed for mixed dentition, were worn for 1 h during the day and throughout the night for 6–8 months. Cephalometric analyses were conducted at the beginning (T0) and end (T1) of treatment. Statistical analyses were performed using multivariable linear regression models to assess changes in skeletal and airway parameters, with significance set at p < 0.05. Results: Significant reductions were observed in Ans-Snp^Go-Gn (p = 0.0351), SN^Go-Gn (p = 0.0091), and FMA (p < 0.001) in the treated group compared to controls, indicating improved mandibular rotation. Upper airway spaces (SPAS, MAS, IAS) increased significantly, suggesting enhanced airway patency. Regression models confirmed the positive impact of AMCOP^® therapy on skeletal and airway outcomes, particularly in subjects with pronounced vertical discrepancies. Conclusions: AMCOP^® elastodontic devices effectively promote anterior mandibular rotation and reduce mandibular plane inclination in hyperdivergent patients, contributing to balanced craniofacial growth. The expansion of pharyngeal spaces indicates potential respiratory benefits. Future research is needed to confirm long-term stability and address variability in treatment response. Full article

Background: This preliminary case series aimed to evaluate the clinical and morphometric outcomes of maxillomandibular advancement (MMA) surgery in patients with severe obstructive sleep apnea (OSA) using virtual surgical planning (VSP), patient-specific cutting guides, and customized titanium plates. Primary outcomes included changes in the Apnea–Hypopnea Index (AHI), airway dimensions, surgical accuracy, and quality of life. Methods: In this preliminary case series, six patients with severe OSA underwent MMA surgery planned using three-dimensional VSP, and executed with the aid of CAD-/CAM-generated surgical guides and patient-specific osteosynthesis. Clinical variables included AHI, Epworth Sleepiness Scale (ESS), and computed tomography-based airway morphometry. Surgical accuracy was assessed by comparing planned and achieved skeletal movements. Statistical analysis was performed using Wilcoxon signed-rank tests and Spearman’s correlation. Results: The mean preoperative AHI decreased significantly from 48.8 ± 23.6 to 12.4 ± 10.0 (p = 0.035), and ESS scores improved from 14.5 ± 4.6 to 7.8 ± 2.1 (p = 0.029). Mean airway area increased significantly from 51.8 ± 9.0 mm² to 91.8 ± 26.6 mm² (p = 0.035). A strong but non-significant correlation was observed between airway gain and ESS improvement (p = 0.754, p = 0.084). No patients required CPAP at 6-month follow-up, and all were asymptomatic. The anteroposterior accuracy of skeletal movements was high: 82.6% for the maxilla and 85.8% for the pogonion, with mean absolute errors of 1.25 mm and 1.95 mm, respectively. Vertical accuracy was lower, particularly in the chin region, where error analysis showed greater variability. No statistically significant differences were found between planned and achieved movements in any vector. Conclusions: MMA surgery performed with VSP, cutting guides, and customized titanium plates offers a highly effective, safe, and precise treatment modality for selected OSA patients. This approach leads to a significant reduction in AHI, expansion of the upper airway, and improvement in patient-reported daytime functioning. High accuracy in skeletal repositioning—particularly in anteroposterior vectors—supports the reliability and reproducibility of digitally guided orthognathic surgery. These findings reinforce the role of technologically assisted MMA as a definitive treatment for severe OSA. Full article

Background/Objectives: This retrospective study used computer fluid dynamics (CFD) to evaluate the medium-term changes in the upper airways (UA) airflow after rapid maxillary expansion (RME) in three age-matched groups with different degrees of adenoidal obstruction. Methods: The sample included Cone-Beam Computed Tomography (CBCT) of 67 adolescents taken before (T0) and 12 months after RME (T1) and divided into three cohorts: Control Group (CG, <25% obstruction: 24 subjects, mean age = 11.8 ± 1.3), Adenoids Group 1 (AG1, >25% <75% obstruction: = 22 subjects, mean age = 10.9 ± 1.5), Adenoids Group 2 (AG2, >75% obstruction: = 21 subjects, mean age = 11.2 ± 1.6). The airflow pressure, velocity and obstruction were simulated using computer fluid dynamics (CFD). Results: The pressure significantly improved in CG and AG1 groups while the velocity improved in AG1 as well as the prevalence of obstruction improvement. The airflow pressure and velocity changes could be attributed to the reduction of the resistances in the adenotonsillar region, which was remarkably more marked in the AG1. Conclusions: Alterations in the adenotonsillar region likely represent the most substantial factors influencing airflow changes after RME. The integration of anatomical and functional data, along with the identification of baseline patient characteristics, may facilitate the characterization of phenotypes most appropriate for initial management through either Rapid Maxillary Expansion (RME) or otolaryngologic (ENT) interventions. Full article

Aim: This study aimed to assess the impact of rapid palatal expansion (RPE) treatment on vertical craniodentofacial characteristics and upper airway dimensions in individuals with crossbites and skeletal discrepancies. Subjects and Methods: The study involved 38 participants, including 15 boys and 23 girls who received treatment with RPE. Lateral cephalograms were taken before and after the treatment and were analyzed both before and after the treatment using the AudaxCeph version 6.6.12.4731 and Facad software version 3.15.0.1167. For airway dimensions, McNamara analysis was used, and for craniofacial characteristics, cephalometric analysis was used. The study measured 14 parameters in the standard cephalometric analysis and 6 parameters in the airway analysis. Results: The findings indicated a significant decrease in the mandibular angle (MeGoAr, p < 0.001). The angle between the cranial base and the nasal line (SNNL, p = 0.96), intermaxillary angle (p = 0.58), Björk’s polygon (p = 0.67) and the angle between the cranial base and the mandibular angle (SNGoGn, p = 0.96) did not change significantly. A significant increase in the upper pharynx was found after treatment in both the RPE group (p = 0.033) and the RPE + Face Mask (FM) group (p = 0.016) The increase in the upper airway in the RPE group was borderline significant (p = 0.048). Conclusion: No significant differences were found between the experimental groups for changes in airway dimensions after treatment. RPE treatment did not led to an increase in vertical craniodentofacial characteristics. Both RPE and RPE + FM treatments induced an increase in upper pharynx dimensions. Full article

Background/Objectives: Obstructive sleep apnea syndrome (OSAS) is a global condition usually associated with poor health. While common, it appears underdiagnosed due to repeated episodes of upper airway obstruction during the sleep cycle. It is accompanied by other health risks like cardiovascular issues and conditions. Identifying craniofacial characteristics linked to OSAS may enhance diagnostic precision and treatment planning. The aim of our study was to examine the relationship between cephalometric variables and OSAS and determine whether craniofacial features influence the syndrome’s development and severity. Methods: Thirty participants were split into two groups: 15 diagnosed with OSAS and 15 controls. Cephalometric evaluations were performed using standardized lateral imaging, with craniofacial, dental, and hyoid bone parameters assessed. Statistical analysis compared these variables between groups to identify significant differences. Results: OSAS patients exhibited significantly shorter maxillary and mandibular lengths, increased anterior facial height, and reduced posterior facial height compared to controls. Dental analysis revealed reduced interincisal angles and lower mandibular incisor positions in the OSAS group. The hyoid bone was positioned lower and more posteriorly in OSAS patients, with significant differences in its distance to the C3 vertebra and mandibular plane. Although the soft palate dimensions were larger in OSAS patients, the differences were not statistically significant. Conclusions: OSAS is associated with distinct craniofacial features, including shorter maxillary and mandibular lengths, altered facial height proportions, and lower hyoid bone positioning. These findings suggest that craniofacial morphology plays a significant role in OSAS pathophysiology. Future studies hinting at three-dimensional imaging could provide deeper insights into these associations. Full article

Background and Objectives: The main objectives of our study were to assess sexual dimorphism and to compare the facial height, as well as the anteroposterior width of the upper airway, within adult Caucasians diagnosed with skeletal Class I and skeletal Class III malocclusion, based on a number of angular and linear cephalometric parameters. Materials and Methods: One hundred lateral cephalograms were selected from orthodontic adult Caucasian patients from western Romania. Several angular parameters (SNA, SNB, ANB, FMA, Y–FH, Ba–S–PNS and NL–ML angles) and linear parameters (total, upper and lower anterior facial height—TAFH, UAFH, LAFH; total posterior facial height—TPFH) were analysed for each case. The upper airway width parameters included the width of the nasopharynx, as well as the upper, middle and lower pharyngeal airway width (UPAW, MPAW and LPAW). Results: Distinct sexual dimorphism was observed regarding the vertical cephalometric parameters within both Class I and Class III groups, with males exhibiting significantly larger facial height parameters, while females demonstrated larger nasopharyngeal depth angles (Ba–S–PNS). The Y–FH angle had significantly higher values in Class I than in Class III subjects, regardless of sex. Upper airway dimensions showed sexual dimorphism specifically in Class III subjects, with females exhibiting larger UPAW values than males. The inter-class comparisons showed larger values for LPAW, especially in females. Correlation analyses revealed no statistically significant relationships between the vertical and the upper airway parameters in Class I subjects. UPAW showed a tendency to decrease in Class III subjects as TAFH and LAFH increased. Ba–S–PNS showed consistent negative correlations with the vertical dimensions in both groups. Conclusions: These findings suggest that skeletal Class I and Class III malocclusions exhibit not only different sagittal relationships, but also distinctive, sex-related vertical skeletal patterns within each group, and therefore it would be advised that male and female patients should be diagnosed and treated according to separate protocols. In our population, Class III males are more likely to require orthognathic surgery, in addition to orthodontic treatment, with a more reserved prognosis and they might have a higher risk of OSA or other respiratory disorders in comparison with Class III females. Full article

Objective: This study aimed to investigate the correlation between condylar volume and airway dimensions in skeletal Class I malocclusion patients with different vertical growth patterns. Cone-beam computed tomography (CBCT) files were analyzed using AI-performed segmentation to ensure accurate measurements. Materials and Methods: A total of 93 individuals with skeletal Class I malocclusion (55 females and 38 males; average age 21.3 ± 3.0 years) were classified into three groups (normodivergent, hyperdivergent, and hypodivergent) according to their vertical growth patterns. Upper airway and condylar volumes were calculated following AI-assisted segmentation, and their correlation was evaluated. Results: In the hyperdivergent group, both airway volume (11.2 ± 5.0 cm³) and condylar volume (1.2 ± 0.2 cm³) were significantly lower compared to the normodivergent (airway: 14.4 ± 4.9 cm³; condyle: 1.5 ± 0.3 cm³) and hypodivergent groups (airway: 14.1 ± 6.3 cm³; condyle: 1.5 ± 0.3 cm³) (p < 0.05). Although no statistically significant correlation was detected between airway volume and right condylar volume across the three groups (normodivergent: r = −0.204, p = 0.280; hypodivergent: r = 0.015, p = 0.936; hyperdivergent: r = −0.007, p = 0.971), a strong positive correlation was identified between the right and left condylar volumes in all groups (r > 0.8, p < 0.01). Conclusions: No significant statistical correlation was detected between condylar volume and airway volume across the evaluated groups. However, hyperdivergent individuals were found to have smaller condylar volumes and narrower airway volumes, which may contribute to increased airway resistance and a higher risk of respiratory dysfunctions. These findings highlight the importance of considering vertical growth patterns in orthodontic and orthopedic treatment planning, especially when evaluating airway dimensions. Additionally, a strong and statistically notable positive correlation was detected between the right and left condylar volumes across all groups. Full article

Introduction: Obstructive Sleep Apnea Syndrome (OSAS) is a sleep-related breathing disorder common in children, often linked to craniofacial anomalies like retrognathic mandibles in Class II malocclusions. Functional appliances (FAs) have been proposed as non-invasive treatments to improve OSAS symptoms by modifying upper airway dimensions. Objective: this systematic review evaluates the effectiveness of functional appliances in improving upper airway structures in children with OSAS. Materials and Methods: the study was conducted according to PRISMA guidelines, analyzing studies published between 2004 and 2024 on PubMed, Scopus, Web of Science, Embase, and Cochrane Library databases. Inclusion criteria focused on growing patients (≤14 years) with OSAS and Class II skeletal malocclusions treated with FAs. Results: Of 1298 articles screened, four studies met the inclusion criteria. All studies reported a significant increase in upper airway dimensions of approximately 21% after treatment with FAs. Specifically, the cephalometric and tomographic evaluations revealed a clear enlargement of the superior posterior airway space of about 0.5 mm and a consequent improvement of the respiratory function. Discrepancies arose regarding changes in soft palate length and hyoid bone position, perhaps due to the measurement methods’ variation. Conclusions: Functional appliances appear effective in improving upper airway dimensions and alleviating OSAS symptoms in children. However, the limited number of studies, small sample sizes, and short follow-up periods emphasize the need for further research to confirm long-term efficacy and standardize evaluation protocols. Full article

Class III patients have classically been managed through monomaxillary techniques, mainly involving mandibular setback movements. More recently, according to the upper incisor to soft tissue plane (UI-STP) or Barcelona Line (BL) planning protocol, bimaxillary procedures for upper maxilla advancement and reduced mandibular setback have been recommended in order to secure better aesthetic outcomes and avoid upper airway constriction. The present study describes the jaw movements in the sagittal plane performed in class III patients subjected to bimaxillary surgery following the BL protocol. A retrospective evaluation was performed on 124 class III patients subjected to bimaxillary surgery. All subjects underwent upper maxilla advancement. A total of 112 patients received mandible advancement movement (90.3%), nine received mandibular setback (7.25%), and the mandible underwent no movement along the sagittal dimension in the three remaining patients (2.4%). Mandibular advancement was significantly the most frequent treatment option. The presented results suggest that when the BL planning protocol is used as an aesthetic and functional reference, class III occlusion appears mostly related to maxillary sagittal hypoplasia instead of mandible hyperplasia, so bimaxillary advancement surgery should be considered as one of the first-choice procedures for the treatment of these patients. 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

Background: Assessing the morphology of the superior airway space is a crucial diagnostic step in the treatment planning of patients with obstructive sleep apnea syndrome (OSAS) or prior to orthognathic surgery. The aim of this study is to evaluate the necessary scope of a two-dimensional cephalometric assessment and the necessity of three-dimensional imaging in the identification of superior airway space narrowing (SASN). Methods: The computed tomography studies of 100 non-obese, non-OSAS patients were evaluated and analyzed retrospectively. Multiplanar reconstructions were created and underwent cephalometric evaluation. The three-dimensional superior airway morphology was segmented and measured for the minimal cross-sectional area (A_min) and volume (V₀). Patients were grouped according to A_min < 80 mm² and V₀ < 12 cm³. Cephalometric parameters (CPs) were analyzed according to A_min and V₀ with an unpaired t-test, Pearson correlation, and ROC-curve analysis. Results: The CPs regarding sagittal airway space dimensions (IPAS, MPAS, SPAS) and mandibular body length (GoGn) show the strongest correlation to the three-dimensional minimal cross-sectional area (A_min). The ROC-curve analysis classifying for SASN led to an AUC of 0.86 for IPAS, 0.87 for MPAS, 0.88 for SPAS, and 0.63 for GoGn. Three-dimensional imaging may further improve the diagnostic accuracy in the identification of SASN for IPAS below 13.5 mm, MPAS below 10.2 mm, SPAS below 12.5 mm, and GoGn below 90.2 mm. Conclusions: Two-dimensional cephalometric sagittal airway space diameters and mandibular body length are useful initial screening parameters in the identification of superior airway space narrowing. Nevertheless, as the correlation of two-dimensional cephalometric parameters with three-dimensional upper airway space narrowing is varying and highly dependent on acquisition circumstances, indications for three-dimensional imaging, if possible, in the supine position to evaluate upper airway space morphology should be provided generously, especially in patients with low but normal airway space parameters in two-dimensional cephalometry. Full article