The Surgical Management of Snoring and Obstructive Sleep Apnoea
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
Although not routinely utilized, imaging can be useful under certain circumstances. For example, in patients being considered for radical surgery like maxillo--mandibular advancement, cephalometry provides vital information about upper airway dimensions.17 Disadvantages of this kind of imaging include the fact that it can only be performed whilst the patient is awake, the exposure to radiation and the cost. It only provides two--dimensional information and may also not be widely available. More detailed and sophisticated data can be obtained by using computed tomography (CT) scanning or magnetic resonance imaging (MRI), allowing objective volumetric dimensions of the upper airway to be calculated.18, 19 These are both expensive, and CT scans also involve radiation. The MRI scans are very useful in evaluating the soft tissue aspect of the upper airway. Using these routinely during sleep would not be cost-effective or practical.
Growth of the Cranial Base HHiH
D. Dixon Andrew, A.N. Hoyte David, Ronning Olli in Fundamentals of Craniofacial Growth, 2017
Moss (1983) in a characteristically challenging editorial entitled “Beyond roentgenographic cephalometry — What?” thought that the time had come to move beyond the confines of this technique. “It is arguable that any of the customary methods of roentgenographic cephalometry are intrinsically capable to most correctly displaying or of precisely analyzing, the translations and rotations of cranial skeletal material and anatomic points associated with craniofacial growth ....” He suggested that “finite element methods are able to provide, for the first time, absolute quantitative analyses of cranial skeletal shape and shape change independent of any external frame of reference and, by so doing, eliminate the principal source of methodologie error in customary roentgenographic cephalometry” (see Chapter 7, Coordinate Morphometries).
Clefts and craniofacial
Tor Wo Chiu in Stone’s Plastic Surgery Facts, 2018
Cephalometry is the measurement of the human head by imaging (Broadbent, 1931) and is used to evaluate dentofacial properties and clarify the anatomic basis for problems such as malocclusion. For example, if there is significant maxillary retrusion, then formal orthognathics are indicated rather than genioplasty.
An integrated haptic-enabled virtual reality system for orthognathic surgery planning
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
Jorge Zaragoza-Siqueiros, Hugo I. Medellin-Castillo, Héctor de la Garza-Camargo, Theodore Lim, James M. Ritchie
In the area of OGS, the traditional planning process started to evolve with the use of computer methods to carry out 2D cephalometric analyses (Haas et al. 2014). Since then, several systems for Computer-Aided cephalometry have been developed and are commercially available. In these systems, cephalometric analyses can be carried out in a very short time. The next evolution involved 3D scanning and engineering technologies, allowing the 3D reconstruction and visualization of the patient skull, the segmentation of the patient’s virtual model, the displacement and relocation of bone fragments, and the design and fabrication of surgical guides to assist the real surgical procedure (Chapuis et al. 2005; Swennen et al. 2009; Kim et al. 2011; Gelesko et al. 2012; Li et al. 2013; Swennen 2017). These modern OGS planning systems integrate engineering tools such as Computer-Aided Design and Computer Aided Manufacture (CAD/CAM) with model surgery to enable the inclusion of advanced fabrication techniques such as additive manufacturing (AM). Moreover, the integration of the sense of touch and force feedback into a virtual environment for OGS planning eases the bone sectioning and alignment, allowing users to explore anatomic features and reduce the skill learning curve for novice surgeons (Agus et al. 2003; Aboul-Hosn Centenero and Hernandez-Alfaro 2012; Olsson et al. 2013).
A three-dimensional soft tissue analysis of Class III malocclusion: a case-controlled cross-sectional study
Published in Journal of Orthodontics, 2018
Ama Johal, Amrit Chaggar, Li Fong Zou
The craniofacial diversity and unpredictable growth pattern make Class III malocclusion one of the most difficult facial deformities to be managed by the clinician (Guyer et al. 1986). In order to achieve an accurate diagnosis and an appropriate treatment plan for individuals with a developing Class III malocclusion, knowledge of the craniofacial growth pattern is important (Chang et al. 2006). Within orthodontics, the lateral cephalometry continues to be used reliably to aid diagnosis and treatment planning, providing a measure of the skeletal and dental relationships (Bruks et al. 1998). However, increasingly there is an acknowledgement that information on the soft tissue changes is needed for a reasonable expectation in terms of long-term stability and aesthetics following treatment (Baccetti et al. 2007). Most soft tissue analyses used in orthodontics are based on two-dimensional (2D) observations from standard lateral cephalometry, with inherent disadvantages and limitations in relation to evaluating the facial soft tissues (Nanda et al. 1990). Furthermore, clinicians recognise the importance of assessing and understanding the three-dimensional (3D) craniofacial complex.
Decision making for position-dependent obstructive sleep apnea syndrome on the basis of patient information and physical examinations of the upper airway, acquired on an outpatient basis
Published in Acta Oto-Laryngologica, 2018
Minoru Endo, Takahito Kondo, Rie Shimada, Kiyoaki Tsukahara
The real clinical utility, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of these criteria need further validation through tests in general population. In the future, we will apply our criteria in real clinical practice and to identify patients with suspected position-dependent OSAS. We will then administer positional therapy to these patients as the initial treatment and perform a prospective study to investigate the effects. It should be noted that we excluded from among our cohort those patients who did not have distinct position-dependent or position-independent OSASs. One of the limitations of this study was the definitions of PP and NPP. We used the criteria described by Saigusa et al. [5]. However, no consensus has yet been reached on PP-OSAS criteria. This study excluded 407 multifactorial patients (34%) from 1187 OSAS patients. In actual clinical settings, physicians encounter different types of OSASs that are induced by a variety of causes, including malfunction in the central nervous system. Careful examination must thus be conducted to identify these causes. Position-dependent OSAS is reportedly associated with skeletal changes, such as mandibular retraction [5]. Therefore, to improve the accuracy of diagnosing this syndrome, we will investigate the effectiveness of morphological tests (e.g. cephalometry) that can also be performed at outpatient clinics. At the same time, we will try to set up a simpler, points-based scale system for this proposed risk assessment model to increase the clinical utility and facilitate quick decision making for general physician practices.
Related Knowledge Centers
- Cephalometric Analysis
- Comparative Anatomy
- Craniometry
- Dentistry
- Skull
- Radiography
- Head
- Medical Imaging
- Phrenology
- Oral & Maxillofacial Surgery