{"id":3491,"date":"2015-10-25T10:10:27","date_gmt":"2015-10-25T10:10:27","guid":{"rendered":"http:\/\/biomedpharmajournal.org\/?p=3491"},"modified":"2020-04-25T09:05:43","modified_gmt":"2020-04-25T09:05:43","slug":"airway-problems-and-its-related-disorders-an-orthodontist-perspective","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol8octoberspledition\/airway-problems-and-its-related-disorders-an-orthodontist-perspective\/","title":{"rendered":"Airway Problems and its Related Disorders- An Orthodontist Perspective"},"content":{"rendered":"<p><strong>Introduction<\/strong><\/p>\n<p><strong>Mouth Breathing<\/strong><\/p>\n<p><strong>Etiology<\/strong><\/p>\n<p>anatomical-dns, congenital<\/p>\n<p>microgenia<\/p>\n<p>pathological-adenoids, tonsils,<\/p>\n<p><strong>Habitual<\/strong><\/p>\n<p><strong>\u201c<\/strong>Adenoid Facies\u201d\u2014coined at GUY\u2019S hospital,London,<\/p>\n<p>constitutes the following- long face, constricted upper dental arch, exposed upper incisors,\u00a0 receded lower jaw, short upper lip, associated habits<\/p>\n<p><strong>Obstructive Sleep Apnea<\/strong><\/p>\n<p><strong>Definition<\/strong><\/p>\n<p>Condition caused either by complete occlusion or partial collapse of the upper airway despite the presence of simultaneous respiratory effort. Cessation occurs at the level of nostrils and mouth. Condition is considered pathologic when the episodes last for at least ten seconds and at a frequency of 30 times or more during 7 hrs. of nocturnal sleep in REM and especially in non REM stages of sleep.<\/p>\n<p><strong>Types<\/strong><\/p>\n<ul>\n<li>Central Apnea: cessation of diaphragmatic excursions<\/li>\n<li>Upper Airway Apnea: obstruction to air flow pass the oro-pharynx but with persistent diaphragm movements.<\/li>\n<li>Mixed Apnea: cessation of air flow and absent respiratory effort early in the episode, followed by unsuccessful attempts at respiration later in the episode.<\/li>\n<\/ul>\n<p><strong>Role of Genioglossus Muscle in Osa<\/strong><\/p>\n<p>OSA is characterized by recurrent upper air way occlusion during inspiration. The genioglossus muscle is believed to contribute to this. \u00a0genioglossus\u00a0 muscle activity has been demonstrated in phase with inspiration during sleep.<\/p>\n<p>Preferential activation of this muscle is correlated with pharyngeal opening and resolution of apnea. A dynamic relationship between supraglottic pressure and genioglossus muscle amplitude has been postulated to explain upper airway occlusion in subjects with OSA.<\/p>\n<p><strong>Effects of Osa<\/strong><\/p>\n<ul>\n<li>SYMPTOMS during sleep<\/li>\n<li>Snoring<\/li>\n<li>Abnormal motor activity<\/li>\n<li>Disturbed nocturnal sleep<\/li>\n<li>Sensation of choking<\/li>\n<li>Heart burn<\/li>\n<li>Nocturia<\/li>\n<li>Heavy sweating<\/li>\n<\/ul>\n<p><strong>Signs<\/strong><\/p>\n<ul>\n<li>large tongue<\/li>\n<li>elongated soft palate<\/li>\n<li>reduced pharyngeal length<\/li>\n<li>decreased posterior air space<\/li>\n<li>increased gonial angle<\/li>\n<li>increased upper and lower facial height<\/li>\n<li>steep occlusal plane<\/li>\n<li>elongated upper and lower incisors<\/li>\n<\/ul>\n<p><strong>Diagnosis<\/strong><\/p>\n<p>Is by Polysomnography<\/p>\n<p>Measurements are made to assess sleep stages of breathing and gas exchange to detect sleep stages.<\/p>\n<p>PSG ensures the no. of apnic episodes per hour of sleep expressed by respiratory (Disturbance Index)measurements of chest and abdominal efforts and oxygen saturation.<\/p>\n<p>Airway measurement by cephalometric 3D imaging \u2013 lateral pharyngeal dimension.<\/p>\n<p><strong>Treatment<\/strong><\/p>\n<p><strong>Medical<\/strong><\/p>\n<ul>\n<li>Weight loss is beneficial<\/li>\n<li>Nasal vaso constriction sprays<\/li>\n<li>Withdrawal of respiratory depressing alcohol (antihistamines and tranquilizers)<\/li>\n<\/ul>\n<p><strong>Surgical<\/strong><\/p>\n<ul>\n<li>Uvulo palato pharnygoplasty<\/li>\n<li>Tracheostomy<\/li>\n<li>Expansion hyoid plasty<\/li>\n<li>Mandibular advancement<\/li>\n<li>Sectioning of hyoid<\/li>\n<\/ul>\n<p><strong>Diagnosis of Mouth Breathing<\/strong><\/p>\n<ul>\n<li><em>Clinical Examination<\/em>:<\/li>\n<li>ask patient to hold water in the mouth<\/li>\n<li>use double sided mouth mirror orcotton wisps<\/li>\n<li>facial pattern \u2013 long face with incompetent lips not necessary indicate mouth breathing pattern.<\/li>\n<\/ul>\n<p><strong>Cephalometric Analysis<\/strong><\/p>\n<p>Mc NAMARA airway analysis upper,lower<\/p>\n<ul>\n<li>Upper pharyngeal width \u2013 the point on posterior outline on soft palate to closest point on pharyngeal wall \u2013 15 to 20 mm in width.values 2mm or less indicate airway impairment<\/li>\n<li>Lower pharyngeal width from point of intersection of posterior border of tongue and inferior border of mandible to the closet point on posterior pharyngeal wall \u2013 11 to 14mm usually values are high due to anteriorly positioned tongue as the adenoids are enlarged.<\/li>\n<\/ul>\n<p><strong>Other Cephalometric Findings<\/strong><\/p>\n<ul>\n<li>vertical growth pattern<\/li>\n<li>increased ANB<\/li>\n<li>increased gonial angle<\/li>\n<li>decreased mandibular length<\/li>\n<li>steep MP angle<\/li>\n<li>over erupted upper posterior Segments<\/li>\n<\/ul>\n<table style=\"width: 70%;\" border=\"1\" cellpadding=\"5\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><img decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3492\" src=\"https:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_Airw_Sunil_fig1-150x150.jpg\" alt=\"Figure 1\" width=\"150\" height=\"150\" srcset=\"https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_Airw_Sunil_fig1-150x150.jpg 150w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_Airw_Sunil_fig1.jpg 208w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/td>\n<td><strong>Figure 1<\/strong><\/p>\n<p><a href=\"http:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_Airw_Sunil_fig1.jpg\" target=\"_blank\">Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><strong>Other Diagnostic Tests<\/strong><\/p>\n<ul>\n<li><strong>Spirometry<\/strong><\/li>\n<li><strong>Oximeter<\/strong>&#8211; to evaluate oxy-Hb level<\/li>\n<li><strong>Rhinomanometry<\/strong>-instrument used to measure nasal patency<\/li>\n<\/ul>\n<p>STEDMAN\u2019S medical dictionary defines it as \u201cstudy of nasal obstruction and nasal airflow characteristics<\/p>\n<ul>\n<li><strong>Pneumotachograph<\/strong>&#8211; device consisting of flow meter, pressure measuring manifold, and a recording instrument.<\/li>\n<li><strong>Respirometry<\/strong><strong>-study of both nasal and oral respiratory function<\/strong><\/li>\n<li><strong>SNORT \u2013 simultaneous nasal and oral respiratory technique<\/strong><\/li>\n<\/ul>\n<p><strong>Effects of Airway Obstructions<\/strong><\/p>\n<p><strong>Head Posture Changes<\/strong><\/p>\n<p><strong>Beni Solow and Antje Tallgren<\/strong><\/p>\n<p>Extension of the head in relation to the cervical column was found in connection to large anterior facial ht. and small post. Facial height, small anterio-posterior dimension, large mandibular inclination to anterior cranial base &amp; to nasal plane, facial retrognathism, large cranial base angle and small nasopharyngeal space.<\/p>\n<ul>\n<li><strong>Ricketts<\/strong><strong>(1968)- <\/strong><\/li>\n<\/ul>\n<p>reported subjects with enlarged adenoid with extension of head &amp;forward and downwardly positioned tongue.<\/p>\n<ul>\n<li><strong>Ninima &amp; Cole<\/strong><\/li>\n<\/ul>\n<p>noted 5 degree increase in cranio facial angle associated with nasal obstruction.<\/p>\n<ul>\n<li><strong>Mandubular Rotation<\/strong><\/li>\n<\/ul>\n<p>In response to enlarged adenoids which occupy the posterior pharyngeal space the tongue gets anteriorly positioned leading to downward and backward rotation of the mandible. The ANB angle increases, MP angle increases, LAFH increases-Long Face Syndrome.<\/p>\n<p><strong>Treatment Options<\/strong><\/p>\n<ul>\n<li><strong>Treating the etiologic factors<\/strong><\/li>\n<\/ul>\n<p>Tonsillectomy<\/p>\n<p>Adenoidectomy<\/p>\n<p>Correction of DNS<\/p>\n<p>Nasal polyps<\/p>\n<ul>\n<li><strong>Orthodontic<\/strong><\/li>\n<\/ul>\n<p>Oral Screen<\/p>\n<p>Rapid Maxillary Expansion<\/p>\n<p>Mandibular Advancement<\/p>\n<ul>\n<li><strong>Surgical<\/strong><\/li>\n<\/ul>\n<p>hyoid bone repositioning<\/p>\n<p>Bi-jaw advancement<\/p>\n<p>mandibular advancement<\/p>\n<p><strong>References<\/strong><\/p>\n<ol>\n<li>Wong ML, Sandham A, Ang PK, Wong DC, Tan WC, Huggare J. Craniofacial morphology, head posture, and nasal respiratory resistance in obstructive sleep apnoea: An inter-ethnic comparison.\u00a0Eur J Orthod.\u00a02005;27:91\u201397.<\/li>\n<li>Schlenker WL, Jennings BD, Jeiroudi MT, Caruso JM. The effects of chronic absence of active nasal respiration on the growth of the skull: A pilot study.\u00a0Am J Orthod Dentofacial Orthop.\u00a02000;117:706\u2013713.<\/li>\n<li>Lopatiene K, Babarskas A. [malocclusion and upper airway obstruction]\u00a0Medicina (Kaunas)\u00a02002;38:277\u2013283.<\/li>\n<li>Lyberg T, Krogstad O, Djupesland G. Cephalometric analysis in patients with obstructive sleep apnoea syndrome: Ii. Soft tissue morphology.\u00a0J Laryngol Otol.\u00a01989;103:293\u2013297.<\/li>\n<li>Tangugsorn V, Skatvedt O, Krogstad O, Lyberg T. Obstructive sleep apnoea: A cephalometric study. Part ii. Uvulo-glossopharyngeal morphology.\u00a0Eur J Orthod.\u00a01995;17:57\u201367.<\/li>\n<li>Maltais F, Carrier G, Cormier Y, Series F. Cephalometric measurements in snorers, non-snorers, and patients with sleep apnoea.\u00a0Thorax.\u00a01991;46:419\u2013423.<\/li>\n<li>Zucconi M, Ferini-Strambi L, Palazzi S, Orena C, Zonta S, Smirne S. Habitual snoring with and without obstructive sleep apnoea: The importance of cephalometric variables.\u00a0Thorax.1992;47:157\u2013161.<\/li>\n<li>Pae EK, Lowe AA, Sasaki K, Price C, Tsuchiya M, Fleetham JA. A cephalometric and electromyographic study of upper airway structures in the upright and supine positions.\u00a0Am J Orthod Dentofacial Orthop.\u00a01994;106:52\u201359.<\/li>\n<li>Guilleminault C, Stoohs R. Obstructive sleep apnea syndrome in children.\u00a0Pediatrician.\u00a01990;17:46\u201351.<\/li>\n<li>Bacon WH, Turlot JC, Krieger J, Stierle JL. Cephalometric evaluation of pharyngeal obstructive factors in patients with sleep apneas syndrome.\u00a0Angle Orthod.\u00a01990;60:115\u2013122.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Introduction Mouth Breathing Etiology anatomical-dns, congenital microgenia pathological-adenoids, tonsils, Habitual  [&#8230;]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[20],"tags":[],"class_list":["post-3491","post","type-post","status-publish","format-standard","hentry","category-vol8octoberspledition"],"_links":{"self":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/3491","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/comments?post=3491"}],"version-history":[{"count":5,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/3491\/revisions"}],"predecessor-version":[{"id":33006,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/3491\/revisions\/33006"}],"wp:attachment":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/media?parent=3491"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/categories?post=3491"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/tags?post=3491"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}