Browse > Article
http://dx.doi.org/10.4041/kjod.2017.47.6.353

Investigation of the effects of miniscrew-assisted rapid palatal expansion on airflow in the upper airway of an adult patient with obstructive sleep apnea syndrome using computational fluid-structure interaction analysis  

Hur, Jae-Sik (Department of Orthodontics, School of Dentistry, Seoul National University)
Kim, Hyoung-Ho (Department of Mechanical Engineering, Soongsil University)
Choi, Jin-Young (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University)
Suh, Sang-Ho (Department of Mechanical Engineering, Soongsil University)
Baek, Seung-Hak (Department of Orthodontics, School of Dentistry, Seoul National University)
Publication Information
The korean journal of orthodontics / v.47, no.6, 2017 , pp. 353-364 More about this Journal
Abstract
Objective: The objective of this study was to investigate the effects of miniscrew-assisted rapid palatal expansion (MARPE) on changes in airflow in the upper airway (UA) of an adult patient with obstructive sleep apnea syndrome (OSAS) using computational fluid-structure interaction analysis. Methods: Three-dimensional UA models fabricated from cone beam computed tomography images obtained before (T0) and after (T1) MARPE in an adult patient with OSAS were used for computational fluid dynamics with fluid-structure interaction analysis. Seven and nine cross-sectional planes (interplane distance of 10 mm) in the nasal cavity (NC) and pharynx, respectively, were set along UA. Changes in the cross-sectional area and changes in airflow velocity and pressure, node displacement, and total resistance at maximum inspiration (MI), rest, and maximum expiration (ME) were investigated at each plane after MARPE. Results: The cross-sectional areas at most planes in NC and the upper half of the pharynx were significantly increased at T1. Moreover, airflow velocity decreased in the anterior NC at MI and ME and in the nasopharynx and oropharynx at MI. The decrease in velocity was greater in NC than in the pharynx. The airflow pressure in the anterior NC and entire pharynx exhibited a decrease at T1. The amount of node displacement in NC and the pharynx was insignificant at both T0 and T1. Absolute values for the total resistance at MI, rest, and ME were lower at T1 than at T0. Conclusions: MARPE improves airflow and decreases resistance in UA; therefore, it may be an effective treatment modality for adult patients with moderate OSAS.
Keywords
Miniscrew-assisted rapid palatal expansion; Obstructive sleep apnea syndrome; Computational fluid dynamics; Fluid-structure interaction;
Citations & Related Records
Times Cited By KSCI : 2  (Citation Analysis)
연도 인용수 순위
1 Mylavarapu G, Mihaescu M, Fuchs L, Papatziamos G, Gutmark E. Planning human upper airway surgery using computational fluid dynamics. J Biomech 2013;46:1979-86.   DOI
2 Zhao M, Barber T, Cistulli PA, Sutherland K, Rosengarten G. Simulation of upper airway occlusion without and with mandibular advancement in obstructive sleep apnea using fluid-structure interaction. J Biomech 2013;46:2586-92.   DOI
3 Pirnar J, Dolenc-Groselj L, Fajdiga I, Zun I. Computational fluid-structure interaction simulation of airflow in the human upper airway. J Biomech 2015;48:3685-91.   DOI
4 Shah DH, Kim KB, McQuilling MW, Movahed R, Shah AH, Kim YI. Computational fluid dynamics for the assessment of upper airway changes in skeletal Class III patients treated with mandibular setback surgery. Angle Orthod 2016;86:976-82.   DOI
5 Liu SY, Huon LK, Iwasaki T, Yoon A, Riley R, Powell N, et al. Efficacy of maxillomandibular advancement examined with drug-induced sleep endoscopy and computational fluid dynamics airflow modeling. Otolaryngol Head Neck Surg 2016;154:189-95.   DOI
6 Cheng GC, Koomullil RP, Ito Y, Shih AM, Sittitavornwong S, Waite PD. Assessment of surgical effects on patients with obstructive sleep apnea syndrome using computational fluid dynamics simulations. Math Comput Simul 2014;106:44-59.   DOI
7 Iwasaki T, Saitoh I, Takemoto Y, Inada E, Kanomi R, Hayasaki H, et al. Improvement of nasal airway ventilation after rapid maxillary expansion evaluated with computational fluid dynamics. Am J Orthod Dentofacial Orthop 2012;141:269-78.   DOI
8 Cisonni J, Lucey AD, King AJ, Islam SM, Lewis R, Goonewardene MS. Numerical simulation of pharyngeal airflow applied to obstructive sleep apnea: effect of the nasal cavity in anatomically accurate airway models. Med Biol Eng Comput 2015;53:1129-39.   DOI
9 Gurani SF, Di Carlo G, Cattaneo PM, Thorn JJ, Pinholt EM. Effect of head and tongue posture on the pharyngeal airway dimensions and morphology in three-dimensional imaging: a systematic review. J Oral Maxillofac Res 2016;7:e1.
10 Cheng S, Gandevia SC, Green M, Sinkus R, Bilston LE. Viscoelastic properties of the tongue and soft palate using MR elastography. J Biomech 2011; 44:450-4.   DOI
11 Iwasaki T, Saitoh I, Takemoto Y, Inada E, Kakuno E, Kanomi R, et al. Tongue posture improvement and pharyngeal airway enlargement as secondary effects of rapid maxillary expansion: a cone-beam computed tomography study. Am J Orthod Dentofacial Orthop 2013;143:235-45.   DOI
12 Neeley WW 2nd, Edgin WA, Gonzales DA. A review of the effects of expansion of the nasal base on nasal airflow and resistance. J Oral Maxillofac Surg 2007;65:1174-9.   DOI
13 Katyal V, Pamula Y, Daynes CN, Martin J, Dreyer CW, Kennedy D, et al. Craniofacial and upper airway morphology in pediatric sleep-disordered breathing and changes in quality of life with rapid maxillary expansion. Am J Orthod Dentofacial Orthop 2013; 144:860-71.   DOI
14 Ahn HW, Cho IS, Cho KC, Choi JY, Chung JW, Baek SH. Surgical treatment modality for facial esthetics in an obstructive sleep apnea patient with protrusive upper lip and acute nasolabial angle. Angle Orthod 2013;83:355-63.   DOI
15 Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009;5:263-76.
16 Kim T, Kim HH, Hong So, Baek SH, Kim KW, Suh SH, et al. Change in the upper airway of patients with obstructive sleep apnea syndrome using computational fluid dynamics analysis: Conventional maxillomandibular advancement versus modified maxillomandibular advancement with anterior segmental setback osteotomy. J Craniofac Surg 2015;26:e765-70.   DOI
17 Jaipal PR, Rachala MR, Rajan R, Jhawar DK, Ankush B. Management of adult transverse malocclusion with surgically assisted rapid palatal expansion. J Clin Diagn Res 2016y;10:ZJ10-2.
18 Villa MP, Rizzoli A, Rabasco J, Vitelli O, Pietropaoli N, Cecili M, et al. Rapid maxillary expansion outcomes in treatment of obstructive sleep apnea in children. Sleep Med 2015;16:709-16.   DOI
19 Taddei M, Alkhamis N, Tagariello T, D'Alessandro G, Mariucci EM, Piana G. Effects of rapid maxillary expansion and mandibular advancement on upper airways in Marfan's syndrome children: a home sleep study and cephalometric evaluation. Sleep Breath 2015;19:1213-20.   DOI
20 Pereira-Filho VA, Monnazzi MS, Gabrielli MA, Spin-Neto R, Watanabe ER, Gimenez CM, et al. Volumetric upper airway assessment in patients with transverse maxillary deficiency after surgically assisted rapid maxillary expansion. Int J Oral Maxillofac Surg 2014;43:581-6.   DOI
21 Vinha PP, Faria AC, Xavier SP, Christino M, de Mello-Filho FV. Enlargement of the pharynx resulting from surgically assisted rapid maxillary expansion. J Oral Maxillofac Surg 2016;74:369-79.   DOI
22 Park JJ, Park YC, Lee KJ, Cha JY, Tahk JH, Choi YJ. Skeletal and dentoalveolar changes after miniscrewassisted rapid palatal expansion in young adults: A cone-beam computed tomography study. Korean J Orthod 2017;47:77-86.   DOI
23 Wilmes B, Nienkemper M, Drescher D. Application and effectiveness of a mini-implant- and toothborne rapid palatal expansion device: the hybrid hyrax. World J Orthod 2010;11:323-30.
24 Choi SH, Shi KK, Cha JY, Park YC, Lee KJ. Nonsurgical miniscrew-assisted rapid maxillary expansion results in acceptable stability in young adults. Angle Orthod 2016;86:713-20.   DOI
25 Park JJ, Park YC, Lee KJ, Cha JY, Tahk JH, Choi YJ. Skeletal and dentoalveolar changes after miniscrewassisted rapid palatal expansion in young adults: a cone-beam computed tomography study. Korean J Orthod 2017;47:77-86.   DOI
26 Suzuki H, Moon W, Previdente LH, Suzuki SS, Garcez AS, Consolaro A. Miniscrew-assisted rapid palatal expander (MARPE): the quest for pure orthopedic movement. Dental Press J Orthod 2016;21:17-23.   DOI
27 Kabalan O, Gordon J, Heo G, Lagravere MO. Nasal airway changes in bone-borne and tooth-borne rapid maxillary expansion treatments. Int Orthod 2015;13:1-15.