Notes d’avertissement sur les effets secondaires indésirables de la thérapeutique orthopédique et la ventilation par masque à long terme dans le traitement du SAOS

Le ronflement et l’apnée obstructive du sommeil (AOS) sont causés par la fermeture dynamique répétée des voies aériennes oro-pharyngées. Il existe des preuves avérées et de plus en plus nombreuses de l’association de l’AOS avec une variété d’atteintes systémiques, incluant, parmi d’autres, l’hypertension artérielle, les accidents vasculaires cérébraux, l‘insuffisance cardiaque, l’augmentation du risque d’accident de la route, l’altération de la qualité de vie, et une mortalité accrue. Il existe une égale profusion de publications sur l’usage des orthèses dans le traitement de l’AOS. Cet article a pour objet d’établir une revue de la littérature sur les trois aspects essentiels de cette maladie : a) l’étiologie et les séquelles de l’AOS ; b) la gestion de cette pathologie par orthèses, ainsi que leur mode d’action ; et enfin, c) les avantages et inconvénients de ces dispositifs

Cautionary notes on the undesirable secondary effects of long term orthopedic and ventilation mask therapy in the treatment of OSAS

Snoring and Obstructive Sleep Apnea (OSA) are caused by repetitive dynamic closure of the oropharyngeal airway. There exists substantial and growing epidemiologic evidence that OSA is associated with a variety of systemic conditions, including but not limited to, systemic hypertension, stroke, congestive heart failure, increased motor vehicle accidents, impaired quality of living and mortality. There is an equal amount of literature on the use of dental appliances as a treatment modality for OSA. The object of this report is to review the literature in regards to three vital aspects of this disease: a) the etiology and sequela of OSA; b) the dental management of the condition and its mode of action; and lastly, c) the positive and negative outcomes/risks, of dental management

Evaluation of airway volume changes in patients treated with distraction osteogenesis: a pilot study

The use of distraction osteogenesis to improve the airway volume of individuals affected by craniofacial anomalies is common practice today. The methods of assessing the outcomes of such surgical procedures have changed over the last several years. Objective : The objective of the present pilot study was to determine if the CBCT imaging modality may serve as a simple and reliable method for craniofacial practitioners to evaluate airway volume changes following distraction osteogenesis. Materials and Methods : Twelve patients who had previously undergone distraction osteogenesis for the primary purpose of improving their airways were enrolled in the current study. Pre (T0) and post-surgical (T1) CBCT’s volumes were analyzed to measure the nasopharyngeal (NP) and oropharyngeal (OP) volume changes. InVivoDental 4.0 (Anatomage Inc., San Jose, CA) (IVD) program was used to visualize and render the oropharyngeal (OP) and nasal passage (NP) volumes, separately. Means and standard deviations were calculated. Results : Of the 7 males and 5 females in the study, 4 patients underwent mandibular distraction (MandDO) and 8 underwent maxillary distraction (MaxDO). Four in the MaxDO group were treated with internal distractors and 4 were treated with external distractors. Individuals who underwent internal MaxDO greatly improved their NP volumes (1605 ± 1736 to 3273 ± 3130 mm3) as did patients who underwent external MaxDO (5763 ± 5077 to 9243 ± 9442 mm3). In comparison, the MandDO group’s NP volume showed modest gains (3519 ± 1944 to 3894 ± 2516 mm3). With regard to the OP volumes, the MandDO group gained substantially (4906 ± 2347 to 11385.8 ± 6393.5 mm3) while the MaxDO groups showed humble increases; internal MaxDO group (1779 ± 273.8 to 2639.5 ± 898.4 mm3) and the external MaxDO group (8959 ± 5311 to 9734.13 ± 7124.7 mm3). Conclusions : In the present preliminary study of assessing airway volume changes using CBCT on patients who have undergone different DO techniques, MandDO greatly increases OP volumes and MaxDO tends to increase NP volumes. The CBCT imaging modality holds great promise for craniofacial practitioners in its application to assess airways of individuals affected by craniofacial anomalies

Middleton et al Modeling craniofacial growth Supplemental Information

Supplemental Information for "Modeling craniofacial growth: Can cross-sectional data approximate true longitudinal growth?" Files included in this archive README.txt This file. CF_functions.R Miscellaneous functions common to both sets of analyses. This file is loaded by the others. CF_Growth_Cross_Sectional_Fitter.R R script to fit the cross-sectional model. This file can be executed directly to analyze a single sex/trait combination or via Rscript in a batch. CF_Growth_Longitudinal_Fitter.R R script to fit the longitudinal model. This file can be executed directly to analyze a single sex/trait combination or via Rscript in a batch. longitudinal_model.stan Stan code for the longitudinal model. Used by CF_Growth_Longitudinal_Fitter.R xs_model.stan Stan code for the cross-sectional model. Used by CF_Growth_Cross_Sectional_Fitter.R XS_Longitudinal_Comparison.Rmd Rmarkdown file that carries out post-processing on the samples for each of the sex/trait combinations. This file can be rendered using only the outputs saved in Generated_Data and Generated_Data_XS (without re-sampling the models). Data/DL_Priors.xlsx Contains the double logistic model priors Generated_Data The stan samples for the longitudinal models, with four files per sex/trait (one for each chain). Generated_Data_XS The stan samples for the cross-sectional models. To reduce the file count, these files are already saved in Rds format after combining the chains.</p

Geometric morphometric analysis of growth patterns among facial types

Introduction: Extreme patterns of vertical facial divergence are of great importance to clinicians because of their association with dental malocclusion and functional problems of the orofacial complex. Understanding the growth patterns associated with vertical facial divergence is critical for clinicians to provide optimal treatment. This study evaluates and compares growth patterns from childhood to adulthood among 3 classifications of vertical facial divergence using longitudinal, lateral cephalograms from the Craniofacial Growth Consortium Study. Methods: Participants (183 females, 188 males) were classified into 1 of 3 facial types on the basis of their adult mandibular plane angle (MPA): hyperdivergent (MPA \u3e39°; n = 40), normodivergent (28° ≤ MPA ≤ 39°; n = 216), and hypodivergent (MPA \u3c28°; n = 115). Each individual had 5 cephalograms between ages 6 and 20 years. A set of 36 cephalometric landmarks were digitized on each cephalogram. Landmark configurations were superimposed to align 5 homologous landmarks of the anterior cranial base and scaled to unit centroid size. Growth trajectories were calculated using multivariate regression for each facial type and sex combination. Results: Divergent growth trajectories were identified among facial types, finding more similarities in normodivergent and hypodivergent growth patterns than either share with the hyperdivergent group. Through the use of geometric morphometric methods, new patterns of facial growth related to vertical facial divergence were identified. Hyperdivergent growth exhibits a downward rotation of the maxillomandibular complex relative to the anterior cranial base, in addition to the increased relative growth of the lower anterior face. Conversely, normodivergent and hypodivergent groups exhibit stable positioning of the maxilla relative to the anterior cranial base, with the forward rotation of the mandible. Furthermore, the hyperdivergent maxilla and mandible become relatively shorter and posteriorly positioned with age compared with the other groups. Conclusions: This study demonstrates how hyperdivergent growth, particularly restricted growth and positioning of the maxilla, results in a higher potential risk for Class II malocclusion. Future work will investigate growth patterns within each classification of facial divergence

Estimating Craniofacial Growth Cessation: Comparison of Asymptote- and Rate-Based Methods

Objective: To identify differences between asymptote- and rate-based methods for estimating age and size at growth cessation in linear craniofacial measurements. Design: This is a retrospective, longitudinal study. Five linear measurements were collected from lateral cephalograms as part of the Craniofacial Growth Consortium Study (CGCS). Four estimates of growth cessation, including 2 asymptote- (GCasym, GCerr) and 2 rate-based (GCabs, GC10%) methods, from double logistic models of craniofacial growth were compared. Participants: Cephalometric data from participants in 6 historic longitudinal growth studies were included in the CGCS. At least 1749 individuals (870 females, 879 males), unaffected by craniofacial anomalies, were included in all analyses. Individuals were represented by a median of 11 images between 2.5 and 31.3 years of age. Results: GCasym consistently occurred before GCerr and GCabs consistently occurred before GC10% within the rate-based approaches. The ordering of the asymptote-based methods compared to the rate-based methods was not consistent across measurements or between males and females. Across the 5 measurements, age at growth cessation ranged from 13.56 (females, nasion-basion, GCasym) to 24.39 (males, sella-gonion, GCerr). Conclusions: Adolescent growth cessation is an important milestone for treatment planning. Based on our findings, we recommend careful consideration of specific definitions of growth cessation in both clinical and research settings since the most appropriate estimation method may differ according to patients’ needs. The different methods presented here provide useful estimates of growth cessation that can be applied to raw data and to a variety of statistical models of craniofacial growth

Clinical implications of age-related change of the mandibular plane angle

Objective: To identify trajectories of ontogenetic change in the mandibular plane angle (MPA) and to describe the influence of sex and other factors on MPA during growth. Setting/Sample: The data consisted of 7026 MPA measurements from lateral cephalographs representing longitudinal series from ages 6 to 21 for 728 individuals from the Craniofacial Growth Consortium Study (CGCS). Materials and Methods: Facial type was determined from MPA for each assessment, with the assessment closest to age 18 representing the adult facial type. The sample includes 366 males and 362 females, each with between 2 and 15 cephalographs. The mean number of cephalographs per individual is 10. Variation in childhood MPA (earliest assessment between 6 and 9 years of age) and adult MPA (closest assessment to age 18 between 15 and 21 years of age), and change in MPA from childhood to adulthood were compared by sex and adult facial type using ANOVA and post hoc t tests. Results: Mandibular plane angle decreased from childhood to adulthood in 92% of males and 81% of females, yet increased in 36% of males and 50% of females with the hyper-divergent adult facial type. Childhood MPA and overall change in MPA were significantly different by adult facial type. Conclusions: Adult facial type is associated with differences in childhood MPA and change in MPA during growth. There are multiple ontogenetic pathways by which an individual can achieve a normo-divergent adult facial type, and an individual\u27s childhood MPA does not necessarily correspond to his or her adult facial type

Geometric morphometric analysis of growth patterns among facial types

Introduction: Extreme patterns of vertical facial divergence are of great importance to clinicians because of their association with dental malocclusion and functional problems of the orofacial complex. Understanding the growth patterns associated with vertical facial divergence is critical for clinicians to provide optimal treatment. This study evaluates and compares growth patterns from childhood to adulthood among 3 classifications of vertical facial divergence using longitudinal, lateral cephalograms from the Craniofacial Growth Consortium Study. Methods: Participants (183 females, 188 males) were classified into 1 of 3 facial types on the basis of their adult mandibular plane angle (MPA): hyperdivergent (MPA \u3e39°; n = 40), normodivergent (28° ≤ MPA ≤ 39°; n = 216), and hypodivergent (MPA \u3c28°; n = 115). Each individual had 5 cephalograms between ages 6 and 20 years. A set of 36 cephalometric landmarks were digitized on each cephalogram. Landmark configurations were superimposed to align 5 homologous landmarks of the anterior cranial base and scaled to unit centroid size. Growth trajectories were calculated using multivariate regression for each facial type and sex combination. Results: Divergent growth trajectories were identified among facial types, finding more similarities in normodivergent and hypodivergent growth patterns than either share with the hyperdivergent group. Through the use of geometric morphometric methods, new patterns of facial growth related to vertical facial divergence were identified. Hyperdivergent growth exhibits a downward rotation of the maxillomandibular complex relative to the anterior cranial base, in addition to the increased relative growth of the lower anterior face. Conversely, normodivergent and hypodivergent groups exhibit stable positioning of the maxilla relative to the anterior cranial base, with the forward rotation of the mandible. Furthermore, the hyperdivergent maxilla and mandible become relatively shorter and posteriorly positioned with age compared with the other groups. Conclusions: This study demonstrates how hyperdivergent growth, particularly restricted growth and positioning of the maxilla, results in a higher potential risk for Class II malocclusion. Future work will investigate growth patterns within each classification of facial divergence

Growth-related change in the mandibular plane angle with clinical implications

Mandibular plane angle (MPA) is used clinically to diagnose malocclusion and dysmorphology and assess treatment. Numerous cephalometric systems use MPA to categorize individuals into facial types. Accurate models of ontogenetic change in MPA will maximize the efficacy of orthodontic treatment by elucidating normal variation in MPA at different time points. Change in MPA captures several aspects of mandibular and craniofacial development, including mandibular growth rotation and changing anterior and posterior facial heights, resulting in considerable variation between individuals in the rate and magnitude of growth-related change in the MPA. Previous studies demonstrate a tendency for MPA to decrease during childhood and adolescence (1-3), although the timing and rate of these changes vary by study. To evaluate patterns of growth-related change, we examine MPA using cephalometric data compiled from six longitudinal studies of human growth and development.Anna M. Hardin (1), Ryan P. Knigge (1,2), Heesoo Oh (3), Dana L. Duren (2), Manish Valiathan (4), Kieran P. McNulty (5), Emily V. Leary (2) and Richard J. Sherwood (1,2,4) Department of Pathology and Anatomical Sciences (1), Department of Orthopaedic Surgery, Missouri Orthopaedic Institute (2), University of Missouri; Department of Orthodontics, University of the Pacific (3); Department of Orthodontics, Case Western Reserve University (4); Department of Anthropology, University of Minnesota (5)