• Journal of Oral Medicine and Pain
• /
• v.47 no.3
• /
• pp.135-143
• /
• 2022

Purpose: This study aimed to evaluate polysomnographic and cephalometric characteristics of patients with OSA according to obesity level based on the World Health Organization (WHO) Asian-Pacific BMI criteria. Methods: One hundred and thirty-one consecutive patients with obstructive sleep apnea (OSA) were evaluated using standard level 1 polysomnography and cephalometric analyses. The subjects were categorized into normal, overweight and obese groups according to the WHO Asian-Pacific BMI criteria. Respiratory indices and cephalometric parameters were compared among groups. Results: The 131 patients consisted of 111 males and 20 females, with a mean age of 44.1±12.4 years. The mean value of BMI was 25.3±3.4 kg/m² for all subjects, 20.6±2.2 kg/m² for normal (n=27), 24.0±0.5 kg/m² for overweight (n=33) and 27.6±2.2 kg/m² for obese (n=71). The obese group had a significantly higher apnea-hypopnea index (AHI) and respiratory arousal index and lower oxygen saturation level than the normal group (p<0.05). Total AHI, mean oxygen saturation level and respiratory arousal index were significantly correlated with BMI (p<0.001). A longer soft palate and anterior position of the hyoid bone were significantly correlated with BMI level (p ≤0.05). Conclusions: Obese patients have a higher risk of compromised craniofacial skeletal features and soft tissue structures, and severe OSA than non-obese patients.

• The korean journal of orthodontics
• /
• v.38 no.3
• /
• pp.202-213
• /
• 2008

Objective: The purpose of this study was to compare the cephalometric measurements of obese and non-obese Korean male patients with obstructive sleep apnea syndrome (OSA). Methods: Eighty-seven adults who had visited the Sleep Disorder Clinic Center in Keimyung University, Daegu, Korea were examined and evaluated with polysomnography (PSG) and lateral cephalogram. They were divided into 4 groups (non-obese simple snorers, obese simple snorers, non-obese OSA patients, obese OSA patients) according to AHI (Apnea-Hypopnea Index) and BMI (Body Mass Index). Results: The obese OSA group had the highest AHI among the 4 groups. The non-obese OSA group had a significantly steeper mandibular angle and shorter tongue length than the obese OSA group. The hyoid bone of the obese OSA group was positioned anterior and inferior as compared with the non-obese OSA group. Multiple regression analysis showed that tongue length in the obese OSA group and retroposition of hyoid bone in the non-obese OSA group were significant determinants for the severity of AHI. Conclusions: From a cephalometric point of view, the obese and non-obese pateints with OSA may be characterized by different pathogeneses. Therefore, they have to be managed by individualized treatment. For the obese OSA patients, weight control must be advised as a first choice and for the non-obese OSA patients, oral appliance, nasal CPAP, UPPP and others could be chosen according to the obstructive sites.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.46 no.4
• /
• pp.369-381
• /
• 2019

The aim of this study was to analyze the changes and improvements in symptoms of sleep-disordered breathing (SDB) using semi-rapid maxillary expansion (SRME) in children with narrow maxilla and SDB symptoms. Subjects were 15 patients with sleep disorder (apnea-hypopnea index, AHI ≥ 1) and narrow maxillary arch between 7 and 9 years of age. Before the SRME was applied, all subjects underwent pediatric sleep questionnaires (PSQ), lateral cephalometry, and portable sleep monitoring before expansion (T0). All subjects were treated with SRME for 2 months, followed by maintenance for the next 3 months. All subjects had undergone PSQ, lateral cephalometry, and portable sleep monitoring after expansion (T1). Adenoidal-nasopharyngeal ratio (ANR), upper airway width and hyoid bone position were measured by lateral cephalometry. The data before and after SRME were statistically analyzed with frequency analysis and Wilcoxon signed rank test. As reported by PSQ, the total PSQ scale was declined significantly from 0.45 (T0) to 0.18 (T1) (p = 0.001). Particularly, snoring, breathing, and inattention hyperactivity were significantly improved (p = 0.001). ANR significantly decreased from 0.63 (T0) to 0.51 (T1) (p = 0.003). After maxillary expansion, only palatopharyngeal airway width was significantly increased (p = 0.035). There was no statistically significant difference in position of hyoid bone after expansion (p = 0.333). From analysis of portable sleep monitoring, changes in sleep characteristics showed a statistically significant decrease in AHI and ODI, and the lowest oxygen desaturation was significantly increased after SRME (p = 0.001, 0.004, 0.023). In conclusion, early diagnosis with questionnaires and portable sleep monitoring is important. Treatment using SRME will improve breathing of children with SDB.

• Korean Journal of Ichthyology
• /
• v.31 no.4
• /
• pp.214-221
• /
• 2019

This study suggests basic data for taxonomic research among similar species by observing osteological development of larvae of Hemibarbus longirostris. Newly hatched yolk-sac larvae were 8.10±0.02 mm (n=5) in mean total length, and frontal, parasphenoid, and basioccipital in the cranium were ossified. On the 6 days after hatching, flexion-larvae were 10.9±0.26 mm (n=5) in mean total length, hyomandibular, sympletic, and ectopterygoid in the cranium were ossified. On the 12 days after hatching, post-larvae were 12.2±0.55 mm (n=5) in mean total length, interopercle in operculum region and postclavicle in shoulder girdle bone were ossified. On the 25 days after hatching, post-larvae were 16.1±0.27 mm (n=5) in mean total length, epihyal and interhyal in hyoid arch, two epural in caudal skeleton, interneural processes, and interhaemal processes were ossified. On the 40 days after hatching, juvenile were 27.9±3.74 mm (n=5) in mean total length, all skeletal development completed with hypural bone in the caudal skeleton region fused in three forms (1, 2+3, 4+5).

• Journal of Oral Medicine and Pain
• /
• v.34 no.3
• /
• pp.247-256
• /
• 2009

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.

• The korean journal of orthodontics
• /
• v.27 no.1
• /
• pp.119-127
• /
• 1997

The configuration of mandibular symphysis is likely to be dependent upon the genetic predeterminants and/or compensatory adjustments onto functional demands. The interrelation of morphological distinctives of symphysis in conjunction to the craniofacial skeleton had been scarcely anecdotal, therefore, the objective was to determine the correlation of morphological modifications between the mandibular symphysis and craniofacial complex. Lateral cephalometric headfilms of 212 subjects were employed for the conventional measurements. The proportion of chin height against chin depth length was referred as chin ratio, then, Low Symphysis (IS) and High Symphysis (HS) groups were turned out by means of the chin ratio. These samples yielded 35 in LS and 35 in HS groups. The data per capita were statistically analyzed and the following results were drawn ; 1. Overall characteristics of the craniofacial skeleton in HS group manifested hyperdivergence and LS group showed hypodivergence. 2. Gonial angle increased as chin ratio increased and was highly correlated to the chin ratio. 3. The chin ratio presented high correlation to the vertical face height, especially in terms of the chin height to anterior face height and the chin depth to posterior face height. 4. The morphological configuration of chin was hardly correlated with hyoid bone position.

• The korean journal of orthodontics
• /
• v.27 no.5 s.64
• /
• pp.733-741
• /
• 1997

As a result of surgical orthodontic treatment of mandibular prognathism, changes take place in the skeletal and soft orofacial components. Although some investigators had stated that permanent reduction of airway space was observed after mandibular setback surgery, it was not clear that this permanent reduction was sustained during long-term follow-up. The purpose of this study was to assess the changes in oropharyngeal airway space and soft tissue orofacial component following the mandibular setback surgery and during the follow-up period. The correlation between the changes of the oropharyngeal airway space and the changes of other soft tissue orofacial component was also assessed. The findings of this study were as follows ; 1. The oropharyngeal airway space area decreased following mandibular setback surgery for mandibular prognathism and continued to decrease during the follow-up period(p<0.05). 2. The pharyngeal depth at Xi point level and the 2nd cervical vertebra point level decreased after the surgery and remained during the follow-up period(p<0.05). The decrease of these pharyngeal depth was correlated with the decrease of oropharyngeal airway space area(p<0.01). 3. The decrease of pharyngeal depth at the 3rd and 4th cervical vertebra point level was not significant after the surgery and during the follow up period. 4. The hyoid bone moved downward after the surgery(p<0.05), but returned to its original position during the follow-up period. 5. The length & height of tongue and the Position of epiglottis base did not change significantly(p>0.05). 6. The soft palate was displaced posteriorly after the surgery and remained to its changed position during the follow-up period(p<0.05) due to posterior displacement of tongue. The changes of soft palate were significantly correlated with the decrease of oropharyngeal airway space area(p<0.01). 7. The narrowing of oropharyngeal airway space was due to the posterior displacement of tongue above the level of epiglottis tip. The posterior displacement of tongue following mandibular setback osteotomy remained during the follow-up period.

• The korean journal of orthodontics
• /
• v.28 no.4 s.69
• /
• pp.547-561
• /
• 1998

Obstructive sleep apnea (OSA) is a disorder characterized by repetitive episode of upper airway collapse during sleep. Recent studies showed that not only the anatomic factors but the physiologic factors of the upper airway also have effcts on the occurrence of apnea and that the genioglossus muscle also plays an important role in the maintenance of the upper airway. A variety of therapies were performed to treat OSA, and among them the use of mandibular repositioning appliances showed reasonable results. But there is still a lack of research on the structural and physiological mechanism upon the use of mandibular repositioning appliances. The author selected 26(male 17, female 9) OSA patients that came to the Yonsei University Dental Hospital, Department of Orthodontics, and 20 normal adults (male 10, female 10) and took cephalometric radiographs of them in a supine position before and after the placement of the mandibular repositioning appliance to see the structural changes of the upper airway and compare the therapeutic effects between the two groups. We also studied the waking genioglossus muscle activity in OSA patients and investigated the difference in the electromyogram of the genioglosssus muscle upon the change in body posture and the use of mandibular repositioning appliance. Following results were obtained. 1. Among the cephalometric measurements of the upper airway structure, the length of the soft palate, maximum thickness of the soft Palate and SPAS, MAS, VAL, H-H1, MP-H showed statistically significant differences between the normal and OSA groups, but the IAS and EAS showed no statistically significant differences between the two groups. 2. In both the normal and OSA groups, as the epiglottis moved forward on wearing the mandibular repositioning appliance, the epiglottis level of the upper airway increased and the maximum thickness of the soft palate changed and the hyoid bone also moved forward, but the IAS in both groups showed various results and the effect of the mandibular repositioning appliance on the structure of the upper airway was different in the two groups. 3. Upon changing the position, the electromyogram of the genioglossus muscle showed a increasing tendency but there was no statistically significant differences, and when the mandibular repositioning appliance were worn there was a statistically significant increase in the electromyogram of the genioglossus muscle in both the upright and supine positions. The mandibular repositioning appliances not only have an effect on the anatomical structure of the upper airway but also on the physiology of the upper airway. There are different responses to the use of mandibular repositioning appliance between the normal and OSA groups therefore it could be considered to have the different physiology of the upper airway between the two groups.