Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
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Changes of the Pharyngeal Space by Various Oral Appliances for Snoring

수종의 코골이장치 장착에 따른 인두공간의 변화

  • Jo, Chul-Bae (Dept. of Oral Medicine, Dankook University School of Dentistry) ;
  • Kim, Mee-Eun (Dept. of Oral Medicine, Dankook University School of Dentistry) ;
  • Kim, Ki-Suk (Dept. of Oral Medicine, Dankook University School of Dentistry)
  • 조철배 (단국대학교 치과대학 구강내과학교실) ;
  • 김미은 (단국대학교 치과대학 구강내과학교실) ;
  • 김기석 (단국대학교 치과대학 구강내과학교실)
  • Published : 2009.09.30
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Abstract

The purpose of this study was to investigate the changes of the pharyngeal space when the following appliances were inserted: the mandibular advancement appliance (MAA), tongue retaining appliance (TRA), and mandibular advancement-tongue retaining appliance (MATRA). Nine male dental students exhibiting Class I occlusion, normal body mass index (BMI), and no signs and symptoms of snoring were selected for this study. The three kinds of snoring appliances (MAA, TRA and MATRA) were fabricated for each subject. The mandibular advancement of the MAA and MATRA was set at a distance of 5 mm, and the TRA and MATRA were made to hold the tongue in front of the maxillary incisors by 10 to 20 mm. Lateral cephalometric radiographs of the following four states - with no appliance, MAA, TRA, and MATRA - were taken to examine any anatomical changes resulting from the application of the appliances. All four radiographs were traced and analyzed for twenty selected variables related to the pharyngeal space, cranio-cervical posture, and position of the soft palate and hyoid bone. According to the results of this study, there were significant increases in both the upper and lower oropharyngeal spaces when the mandible and tongue were protruded simultaneously, although there was a significant increase only in upper oropharyngeal space when the mandible or tongue was advanced separately. In conclusion, it is suggested that the MATRA may result in more positive effect on the control of snoring and OSA compared to a single use of the MAA or TRA, especially for the patients whose upper airway obstruction occurs in the lower oropharynx.

코골이와 수면무호흡증은 대부분 상기도의 인두부위의 폐쇄에 의해 발생되므로, 이 부위의 폐쇄를 방지하기 위해 혀나 하악을 전방으로 이동시키는 다양한 구강내 장치가 코골이 및 수면무호흡증의 치료에 사용되고 있다. 본 연구는 세 종류의 코골이장치 즉, 하악전방이동장치(mandibular advancement appliance, MAA), 혀견인장치(tongue retaining appliance, TRA), 하악-혀전방이동장치(mandibular advancement-tongue retaining appliance, MATRA )가 구인두와 하인두 공간을 어떻게 변화시키는지를 비교하고자 하였다. Class I 교합을 갖고 코골이 및 수면무호흡증의 증상이 없으며 체질량지수 (BMI)가 정상인 남성 9명을 대상으로 상기 세종류의 코골이장치를 제작하였으며, 이때 MAA, MATRA의 하악전방이동량은 5mm로 TRA, MATRA의 혀전방이동량은 10-20mm로 설정하였다. 그리고, 코골이장치를 장착하지 않은 CO상태와 MAA, TRA, MATRA를 장착한 상태에서 측모두부 규격방사선사진을 촬영한 후, 구인두와 하인두 공간, 두경부 자세, 연구개와 설골의 위치와 관련된 20가지 측정항목에 대해 통계분석을 시행하였다. 분석결과 MAA, TRA, MATRA 모두 상부 구인두 공간을 유의성 있게 증가시켰으나, MATRA 만이 하부 구인두 공간을 유의성 있게 증가시켰다. 이러한 결과는 코골이와 수면무호흡증을 개선시키는데 있어 MATRA가 MAA와 TRA에 비해 효과적일 수 있음을 시사한다.

Keywords

References

  1. Suratt PM, Dee P, Atkinson RL, Armstrong P, WilhoitSC. Fluoroscopic and computed tomographic features of the pharyngeal airway in obstructive sleep apnea. Am Rev Respir Dis 1983;127:487-492 https://doi.org/10.1164/arrd.1983.127.4.487
  2. Waller PC, Bhopal RS. Is snoring a cause of vascular disease? An epidemiological review. Lancet 1989;1:143-146 https://doi.org/10.1016/S0140-6736(89)91153-7
  3. Robin P. Glossoptosis due to atresia and hypotrophy of the mandible. Am J Dis Child 1934;48:541-547
  4. Ferguson KA. Oral appliance therapy for the management of sleep-disordered breathing. Semin Respir Crit Care Med 1998;19:157-164
  5. Schmidt-Nowara W, Lowe A, Wiegand L et al. Oral appliances for the treatment of snoring and sleep apnea: a review. Sleep 1995;18:501-510 https://doi.org/10.1093/sleep/18.6.501
  6. Mohsenin N, Mostofi MT, Mohsenin V. The role of oral appliances in treating obstructive sleep apnea. JADA 2003;134:442-449 https://doi.org/10.14219/jada.archive.2003.0193
  7. Yeo IS, Han KS, Kim CH. Change of pharyngeal space and mandibular position by intraoral appliance for snoring. Korean J Oral Med 2002;27:271-283
  8. Lowe AA, Ono T, Ferguson KA et al. Cephalometric comparisons of craniofacial and upper airway structure by skeletal subtype and gender in patients with obstructive sleep apnea. Am J Orthod Dentofa .Orthop 1996;110:653-664 https://doi.org/10.1016/S0889-5406(96)80043-6
  9. Ferguson KA, Love LL, Ryan CF. Effect of mandibualr and tongue protrusion on upper airway size during wakefulness. Am J Respir Crit Care Med 1997;155:1748-1754 https://doi.org/10.1164/ajrccm.155.5.9154887
  10. Linder-Aronson S, Woodside DG. Excessive face height malocclusion: Etiology, diagnosis, and treatment. Chicago, 2000, Quintessence Co., pp
  11. Schwab RJ, Gefter WB, Hoffman EA et al. Dynamic upper airway imaging during awake respiration in normal subjects and patients with sleep disordered breathing. Am Rev Respir Dis 1993;148:1385-1400 https://doi.org/10.1164/ajrccm/148.5.1385
  12. Eveloff SE, Rosenberg CL, Carlisle CC, Millman RP. Efficacy of a Herbst mandibular advancement device in obstructive sleep apnea. Am J Respir Crit Care Med 1994;149:905-909 https://doi.org/10.1164/ajrccm.149.4.8143054
  13. Schmidt-Nowara W, Mead TE, Hays MB. Treatment of snoring and obstructive sleep apnea with dental orthosis. Chest 1991;99:1378-1385 https://doi.org/10.1378/chest.99.6.1378
  14. Ahn HK, Chung SC, Kim YK, Lee SW. Treatment of snoring and obstructive sleep apnea with dental orthosis. Korean J Oral Med 1997;22:383-394
  15. Lowe AA. The tongue and airway. Otolaryngol Clin N Am 1990;23:677-695
  16. Choi JK, Kee WC, Lee JM, Ye MK. Variable site of oropharyngeal narrowing and regional variations of oropharyngeal collapsibility among snoring patients during wakefulness and sleep. J Craniomandib Disord 2001;19:252-259
  17. Bonham PE, Currier GF, Orr WC, Othman J, Nanda RS. The effect of a modified functional appliance on obstructive sleep apnea. Am J Orthod Dentofacial Orthop 1988;94:384-392 https://doi.org/10.1016/0889-5406(88)90127-8
  18. Ryan CF, Love LL, Peat D, Fleetham JA, Lowe AA. Mandibular advancement oral appliance therapy for obstructive sleep apnoea: effect on awake calibre of velopharynx. Thorax 1999;54:972-977 https://doi.org/10.1136/thx.54.11.972
  19. Smith SD. A three-dimensional airway assessment for the treatment of snoring and/or sleep apnea with jaw repositioning intraoral appliances: A case study. J Craniomandib Practice 1996;14:332-343
  20. Johal A, Battagel JM. An investigation into the changes in airway dimension and the efficacy of mandibular advancement appliances in subjects with obstructive sleep apnoea. Br J Orthod 1999;26:205-210 https://doi.org/10.1093/ortho/26.3.205
  21. Choi JK, Kee WC, Kang DS. The effect of mandibular anterior repositioning on the upper airway volume. Korean J Oral Med 1999;24:69-80
  22. Tsuiki S, Ono T, Kuroda T. Mandibular advancement of modulates respiratory- related genioglossus electromyographic activity. Sleep 2000;4:53-58 https://doi.org/10.1007/BF03045024
  23. Pae EK, Lowe AA, Sasaki K et al. A cephalometric and electromyographic study of upper airway structures in the upright and supine positions. Am J Dentofac Orthop 1994;106:52-59 https://doi.org/10.1016/S0889-5406(94)70021-4