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      Rapid Maxillary Expansion and Upper Airway Morphology: A Systematic Review on the Role of Cone Beam Computed Tomography

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          Abstract

          Objective

          This study aimed to investigate the quality of cone beam computed tomography (CBCT) studies evaluating the effects of rapid maxillary expansion on upper airway morphology.

          Materials and Methods

          A database search was conducted using PubMed, Ovid, and Cochrane Library up to December 2016. Studies in which CBCT was adopted to visualize the upper airway before and after rapid maxillary expansion were included. The population target was growing patients. Methodological quality assessment was performed.

          Results

          The screening process resulted in the exclusion of 1079 references, resulting in only 9 remaining papers that fulfilled the inclusion criteria. No randomized clinical trials were found. The quality scores ranged from 36% to 68% of the maximum achievable, and the mean quality score of the studies was 50%. No good quality studies were detected in our sample.

          Conclusions

          Inconsistencies in the CBCT protocols utilized were detected between studies. Head posture, tongue position, and segmentation protocols were not consistent. These discrepancies were reflected in the different results obtained in the studies. A valid and consistent protocol with regard to head and tongue positioning, as well as nasal cavity volume segmentation, is required.

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          Most cited references30

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          An analysis of different approaches to the assessment of upper airway morphology: a CBCT study.

          Upper airway morphology and respiration have been assigned an important role in the development of the craniofacial complex. Several studies advocate lateral cephalograms to evaluate the upper airway. Although this method has been widely used, a two-dimensional projection of a three-dimensional anatomical structure is questionable. To correlate linear measurements (sagittal and transversal), cross-sectional areas, and volumes of the upper airway determined on Cone Beam CT (CBCT) data sets. CBCT-scans of 34 patients were used to perform a 3D evaluation of the upper airway. Linear sagittal measurements reproducing those usually performed on lateral cephalograms, linear transversal measurements, cross-sectional areas, partial and total volumes (TV) were computed. The analysis showed a weak correlation (r 0.9) with sagittal measurement and with area. The upper part of the velopharynx presented a good correlation (0.8 < r < 0.9) between area and volume. Good correlation between most transversal measurements and the corresponding areas was found. Minimal sagittal, minimal transversal, and minimal area were weakly correlated with TV. Upper airway cannot be accurately expressed by single linear measurements as performed on cephalograms. The TV alone does not depict the morphology of the airway. A CBCT-based 3D analysis gives a better picture of the anatomical characteristics of the upper airways and therefore can lead to an improvement of the diagnosis.
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            Cone-beam computerized tomography imaging and analysis of the upper airway: a systematic review of the literature.

            A systematic review of the literature concerning upper airway imaging and analysis using cone-beam computed tomography (CBCT) was performed. A PubMed search (National Library of Medicine, NCBI; revised 9th January 2011) yielded 382 papers published between 1968 and 2010. The 382 full papers were screened in detail. 46 articles were considered clinically or technically relevant and were included in this systematic review. These were classified as articles on accuracy and reliability of CBCT imaging of the upper airway (n=4), accuracy and reliability of DICOM viewers (n=2), synopsis (n=10), technical (n=7) and clinical applications (n=27). When one paper was considered related to two or more categories, it was assigned to each relevant group. Results indicate that three-dimensional (3D) analysis of the upper airway using CBCT can be achieved in an accurate and reliable manner. Important obstacles still need to be addressed, including the impact of respiration phase, influence of tongue position and mandible morphology, longitudinal and cross-sectional 3D CBCT upper airway evaluation, and 3D CBCT definition of the anatomical boundaries of the upper airway.
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              A predictive morphometric model for the obstructive sleep apnea syndrome.

              Mathematical formulas have been used to clinically predict whether patients will develop the obstructive sleep apnea syndrome (OSAS). However, these models do not take into account the disproportionate craniofacial anatomy that accompanies OSAS independently of obesity. To determine the accuracy of a morphometric model, which combines measurements of the oral cavity with body mass index and neck circumference, in predicting whether a patient has OSAS. 6-month prospective study. University-based tertiary referral sleep clinic and research center. 300 consecutive patients evaluated for sleep disorders for the first time. Body mass index, neck circumference, and oral cavity measurements were obtained, and a model value was calculated for each patient. Polysomnography was used to determine the number of abnormal respiratory events that occurred during sleep. Sleep apnea was defined as more than five episodes of apnea or hypopnea per hour of sleep. The morphometric model had a sensitivity of 97.6% (95% CI, 95% to 98.9%), a specificity of 100% (CI 92% to 100%), a positive predictive value of 100% (CI, 98.5% to 100%), and a negative predictive value of 88.5% (CI, 77% to 95%). No significant discrepancies were revealed in tests of intermeasurer and test-retest reliability. The morphometric model provides a rapid, accurate, and reproducible method for predicting whether patients in an ambulatory setting have OSAS. The model may be clinically useful as a screening tool for OSAS rather than as a replacement for polysomnography.
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                Author and article information

                Journal
                Biomed Res Int
                Biomed Res Int
                BMRI
                BioMed Research International
                Hindawi
                2314-6133
                2314-6141
                2017
                16 July 2017
                : 2017
                : 5460429
                Affiliations
                1Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
                2Department of Pediatrics, Sapienza University of Rome, Rome, Italy
                Author notes

                Academic Editor: Eiichi Honda

                Author information
                http://orcid.org/0000-0002-8039-7022
                http://orcid.org/0000-0003-3635-281X
                http://orcid.org/0000-0001-9538-6468
                http://orcid.org/0000-0002-2502-6077
                http://orcid.org/0000-0001-9160-5782
                http://orcid.org/0000-0002-2476-1790
                http://orcid.org/0000-0002-2679-7607
                Article
                10.1155/2017/5460429
                5534278
                28791305
                d363fb51-bf92-45eb-8521-f37672163fa6
                Copyright © 2017 Gabriele Di Carlo et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 28 March 2017
                : 22 May 2017
                : 8 June 2017
                Categories
                Review Article

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