OBJECTIVE: To evaluate changes of the upper airway and oral cavity volumes in patients with skeletal Class III malocclusion undergoing bimaxillary orthognathic surgery, and to analyze the correlation between postoperative upper airway decrease and the amount of jaw movement and oral cavity volume reduction.
METHODS: Thirty patients (16 males and 14 females) undergoing bimaxillary surgery were included. Three-dimensional reconstruction of the upper airway and oral cavity were performed using preoperative (T0) and postoperative (T1) (6 months) cone-beam computed tomography scans.
RESULTS: The volume, sagittal area and minimum cross-sectional area of the upper airway were diminished (P < .001). The decrease in volume and minimum cross-sectional area in the oropharyngeal region of the upper airway were weakly correlated with B-point posterior movement (P < .05). Total oral cavity volume was decreased, with maxillary oral volume increasing and mandibular oral volume decreasing (P < .001). Upper airway decrease was highly correlated with total oral volume reduction and mandibular oral volume reduction, with the most significant correlation being with total oral volume reduction (P < .001).
CONCLUSIONS: Class III bimaxillary surgery reduced the volume, sagittal area, and minimum cross-sectional area of the upper airway as well as oral cavity volume. Upper airway changes were weakly correlated with anterior-posterior mandibular movement but significantly correlated with oral cavity volume changes. Thus, oral cavity volume reduction is a crucial factor of upper airway decrease in patients with skeletal Class III malocclusion undergoing bimaxillary orthognathic surgery.

Aims/Background: Mandibular advancement devices are effective in treating mild or moderate obstructive sleep apnea (OSA), but such devices that are commonly used in clinical settings require further improvement. In this study, we evaluated the clinical effects of personalized adjustable mandibular advancement devices on mild or moderate OSA. Methods: Forty patients with mild or moderate OSA were randomly divided into experimental (personalized adjustable device) and control (traditional device) groups. Side effects, including increased salivation, dry mouth, muscle aches, and temporomandibular joint discomfort, were assessed. Respiratory markers during sleep, including the apnea-hypopnea index, mean blood oxygen saturation, lowest blood oxygen saturation and maximum apnea time, were evaluated using polysomnography. The upper airway cross-sectional area and temporomandibular joint morphology and motion trajectory were evaluated using cone beam computed tomography. Results: Side effects were significantly lower in the experimental group than in the control group. Respiratory marker levels were significantly restored post-treatment. Soft palate- and tongue-pharyngeal cross-sectional areas were significantly increased in both groups, but temporomandibular joint morphology or motion trajectory remained unchanged. Conclusion: The personalized adjustable mandibular advancement devices may reduce side effects and are effective in treating patients with OSA. Clinical Trial Registration: The study was registered and approved by the Chinese Clinical Trial Registry (ChiCTR2400080306). https://www.chictr.org.cn/showproj.html?proj=206538.

Background: Bimaxillary surgeries (BiMax) are an essential part of the craniomaxillofacial specialty. The osteotomies and subsequent spatial rearrangement of the maxilla and the mandible enable the correction of facial deformities, asymmetry, and malocclusion. Moreover, the movements performed during the procedure affect the morphology of surrounding soft tissues, including the upper airway (UA). Objectives: The objective of this study was to radiologically assess the potential volumetric alterations of the UA in the supine position at various intervals following BiMax advancement surgeries. Methods: A group of 31 patients who underwent BiMax advancement surgery were included in the study. Medical computed tomography (CT) of the head and neck region was performed 2 weeks preoperatively, 1 day postoperatively, and 6 months postoperatively. The UA volumes were calculated and analyzed based on the acquired Digital Imaging and Communications in Medicine (DICOM) files using different software applications. The sella-nasion-A point (SNA) and sella-nasion-B point (SNB) angles were evaluated to measure the achieved maxillomandibular advancement. Results: When comparing the volume of the UA before surgery, post-surgery, and 6 months post-surgery, the p-value was <0.001, indicating statistically significant differences in UA volume between the successive examinations. A statistically significant difference was found between UA volume before surgery and 6 months post-surgery and between UA volume after surgery and 6 months post-surgery, with the obtained p-values being <0.001 and 0.001, respectively. A significantly larger UA volume was observed 6 months post-surgery (mean ± SD: 27.3 ± 7.3) compared to the volume before surgery (mean ± SD: 22.2 ± 6.4), as well as 6 months post-surgery compared to the volume assessed shortly after surgery (mean ± SD: 24.2 ± 7.3). Conclusions: BiMax advancement surgeries result in the significant enlargement of the UA. The volume of the UA does not diminish immediately following the procedure and is not constant; it increases significantly during the postoperative observation period.

暂无摘要。

Cone beam computed tomography (CBCT) can provide precise information about complex anatomical structures as it is characterised by rapid volumetric image acquisition with high resolution. The aim of this study was to provide measurements for 20 ancient skulls of the Samnite people found in the necropolis of Opi, a small and isolated mountain village in Abruzzo, a region in central Italy. All the images (left and right) of the 20 ancient skulls from Opi were acquired. All the data are the property of the Department of Innovative Technologies in Medicine and Dentistry of G. D\'Annunzio University, Chieti, and different parameters (area and volume) were measured and evaluated. The mean and standard deviation of the facial measurements were also calculated. All the data were subjected to statistical analysis. CBCT scan data of 20 fossil skulls did not show significant values regarding the MS area and the volume between the right and left sides. In the ancient skulls, no difference was found between the right and left sides.

OBJECTIVE: The purpose of this investigation is to demonstrate a multimodality approach to the surgical management of obstructive sleep apnea. Hypoglossal nerve stimulator (HGNS) implantation has been a lifechanging potion for many obstructive sleep apnea patients. When activated it produces tongue protrusion via electrical stimulation of the hypoglossal nerve. This advances the lingual tonsil, making the pharynx diameter greater. Unfortunately, for some patients the electrical stimulation required is too high and awakens the patient.
METHODS: Case report.
RESULTS: In this case the patient\'s fragmented sleep is not improved with the HGNS. Here we present a case where HGNS and CO2 laser lingual tonsil reduction are used in conjunction to reduce the HGNS setting required for airway patency, thereby allowing the patient to sleep through the night.
CONCLUSIONS: For those patients who are unable to tolerate hypoglossal nerve stimulator settings, a combined approach with lingual tonsil reduction may be an alternative.

Obstructive sleep apnea (OSA) is an airway disease caused by periodic collapse of the airway during sleep. Imaging-based subject-specific computational fluid dynamics (CFD) simulations allow non-invasive assessment of clinically relevant metrics such as total pressure loss (TPL) in patients with OSA. However, most of such studies use static airway geometries, which neglect physiological airway motion. This study aims to quantify how much the airway moves during the respiratory cycle, and to determine how much this motion affects CFD pressure loss predictions. Motion of the airway wall was quantified using cine MRI data captured over a single respiratory cycle in three subjects with OSA. Synchronously-measured respiratory airflow was used as the flow boundary condition for all simulations. Simulations were performed for full respiratory cycles with 5 different wall boundary conditions: (1) a moving airway wall, and static airway walls at (2) peak inhalation, (3) end inhalation, (4) peak exhalation, and (5) end exhalation. Geometric analysis exposed significant local airway cross-sectional area (CSA) variability, with local CSA varying as much as 300%. The comparative CFD simulations revealed the discrepancies between dynamic and static wall simulations are subject-specific, with TPL differing by up to 400% between static and dynamic simulations. There is no consistent pattern to which static wall CFD simulations overestimate or underestimate the airway TPL. This variability underscores the complexity of accurately modeling airway physiology and the importance of considering dynamic anatomical factors to predict realistic respiratory airflow dynamics in patients with OSA.

Background: Bimaxillary surgery is an elemental procedure in the field of cranio-maxillofacial surgery. It allows for the correction of even the most challenging cases of maxillomandibular disorders, malocclusion, facial asymmetry, and disproportion. The osteotomies and maneuvers carried out during the procedure result in changes to the surrounding tissues, including the maxillary sinuses (MS). The aim of this study was to assess the change in the maxillary sinus volume and the thickness of the mucosa after maxillomandibular advancement (MMA) surgeries. Methods: A group of 25 patients who underwent MMA surgery were included in the study. Computed tomography (CT) of the head and neck region was performed 2 weeks preoperatively and 6 months postoperatively. Acquired Digital Imaging and Communications in Medicine (DICOM) files were analyzed using different software programs to calculate the medium MS mucosa thickness and MS volume. Results: A statistically significant reduction in MS volume was observed (p = 0.015). The change in the median thickness of the MS mucosa was not statistically significant. The median sella-nasion-A point angle (SNA angle) value of the group increased from 80.2 to 83.4 degrees. A weak negative correlation between the SNA delta and the MS volume delta was observed. Spearman\'s rank coefficient: (ρ s = -0.381, p = 0.060). Conclusions: The MMA surgery results in a reduction in the MS volume. The amount of forward movement of the maxilla may be correlated with the extent of the MS volume reduction.

BACKGROUND: Yearling laryngeal function (YLF) is frequently assessed at the time of sale and the outcomes of these assessments can have significant economic implications. The YLF of horses that subsequently underwent a prosthetic laryngoplasty (PL) is unknown.
OBJECTIVE: We hypothesised horses with YLF ≥grade II.2 would be at increased risk of requiring PL, compared with YLF METHODS: Case-control.
METHODS: There were 150 PL cases from 2019 to 2021 with an available yearling post-sale videoendoscopic examination and 600 controls. Two observers unaware of the outcome graded YLF using the Havemeyer system. The risk of PL for each YLF grade was calculated using multivariable conditional logistic regression.
RESULTS: The proportions of each YLF grade in the control group and PL group, respectively, were grade I: 25.8% and 13.3%, grade II.1: 54.3% and 35.3%, grade II.2: 16.7% and 26%, grade III.1: 3% and 20.7%, grade III.2: 0.2% and 3.3%, grade III.3: 0% and 0.7%, grade IV: 0% and 0.7%. The odds ratio (OR, 95% confidence interval) of requiring PL compared with the referent grade I were: grade II.1: 1.2 (0.7, 2.2, p = 0.5), grade II.2: 3.4 (1.8, 6.1, p < 0.001), grade III.1: 13.8 (6.0, 31.6, p < 0.001), grade III.2: 55.5 (10.3, 299.2, p < 0.001), grade III.3: 2930,000 (398173.7, 21 600,000, p < 0.001), grade IV: 26300,000 (3 420 000, 202 000 000, p < 0.001). Yearling LF ≥grade II.2 had an OR of 4.61 (3.0, 7.1, p < 0.001) compared with CONCLUSIONS: Lack of performance data to compare the PL and control groups. The control group was not \'disease-free\' and may have developed disease and been retired or undergone surgery elsewhere.
CONCLUSIONS: Three-quarters of the PL group had ≤grade II.2 YLF, demonstrating deterioration in LF post-sale was common. The risk of requiring PL increased from YLF grade II.2 upwards.
背景: 一岁马驹喉功能(YLF)经常在出售时进行评估，这些评估的结果可能具有重要的经济意义。接受喉修补成形术的马驹的YLF以往是未知的。. 目的: 我们假设:一岁马驹喉功能YLF≥II.2级的马驹，需要喉修补成形术PL的风险增加。. 研究设计: 1:4病例对照研究. 方法: 对2019‐2021年的150例PL病例的周岁拍卖内窥镜检查结果，和600例对照。双盲法Havemeyer系统对YLF进行评分。使用多变量条件逻辑回归计算每个YLF等级的PL风险。. 结果: 对照组和PL组各YLF分级所占比例分别为:I级:25.8%和13.3%； II.1级:54.3%和35.3%； II.2级:16.7%和26%；III.1级:1.3%和20.7%；III.2级:0.2%和3.3%；III.3级:0%和0.7%；IV级:0%和0.7%。. 与I级参考相比，需要PL的比值(OR, 95%置信区间)为: II.1级:1.2 (0.7，2.2，p = 0.5)； ii.2级:3.4 (1.8，6.1，p < 0.001)， iii.1级:13.8 (6.0，31.6，p < 0.001)， iii.2级:55.5 (10.3，299.2，p < 0.001)； iii.3级:2930000 (398173.7，21 600 000，p < 0.001)， IV级:26300000 (3 420 000,202 000 000，p < 0.001)。与LF小于II.2级的马驹相比，LF≥II.2级的OR为4.61 (3.0，7.1，p < 0.001)；与 < III.1级相比，YLF≥III.1级的OR为10.7 (5.6，20.4，p < 0.001)。. 主要限制: 缺乏其他性能数据来比较试验组和对照组。对照组并非“无病”，可能也患病，退役或有其他位置手术。. 结论: PL组3 / 4患者的YLF≤II.2级，表明马驹拍卖后喉功能恶化较为常见。需要PL的风险从YLF II.2级上升。.

UNASSIGNED: Catathrenia is a rare sleeping disorder characterized by repetitive nocturnal groaning during prolonged expirations. Patients with catathrenia had heterogeneous polysomnographic, comorbidity, craniofacial characteristics, and responses to treatment. Identifying phenotypes of catathrenia might benefit the exploration of etiology and personalized therapy.
UNASSIGNED: Sixty-six patients diagnosed with catathrenia by full-night audio/video polysomnography seeking treatment with mandibular advancement devices (MAD) or continuous positive airway pressure (CPAP) were included in the cohort. Polysomnographic characteristics including sleep architecture, respiratory, groaning, and arousal events were analyzed. Three-dimensional (3D) and 2D craniofacial hard tissue and upper airway structures were evaluated with cone-beam computed tomography and lateral cephalometry. Phenotypes of catathrenia were identified by K-mean cluster analysis, and inter-group comparisons were assessed.
UNASSIGNED: Two distinct clusters of catathrenia were identified: cluster 1 (n=17) was characterized to have more males (71%), a longer average duration of groaning events (18.5±4.8 and 12.8±5.7s, p=0.005), and broader upper airway (volume 41,386±10,543 and 26,661±6700 mm3, p<0.001); cluster 2 (n=49) was characterized to have more females (73%), higher respiratory disturbance index (RDI) (median 1.0 [0.3, 2.0] and 5.2 [1.2, 13.3]/h, p=0.009), more respiratory effort-related arousals (RERA)(1 [1, 109] and 32 [13, 57)], p=0.005), smaller upper airway (cross-sectional area of velopharynx 512±87 and 339±84 mm2, p<0.001) and better response to treatment (41.2% and 82.6%, p=0.004).
UNASSIGNED: Two distinct phenotypes were identified in patients with catathrenia, primary catathrenia, and catathrenia associated with upper airway obstruction, suggesting respiratory events and upper airway structures might be related to the etiology of catathrenia, with implications for its treatment.