Incremental Maxillomandibular Advancement: The Relationship Between Skeletal Advancement and Airway Volume
Notice bibliographique
Résumé
Introduction Obstructive sleep apnea (OSA) is characterized by repetitive episodes of supra‐laryngeal airway collapse during sleep, causing increased airflow resistance and reduced respiration. Obstruction and reduced volume mainly occurs in the retropalatal (RPS) and/or retroglossal space (RGS). The most effective surgical treatment (save tracheostomy) is maxillomandibular advancement (MMA). During MMA, the skeletal framework is modified, thereby reducing airway collapse upon inspiration. A clear mechanistic understanding of MMA surgery describing airway dimensions and resulting volumetric increases does not yet exist. The primary objective of the study was to define volume changes during incremental MMA. The secondary objective was to measure where maximal airway tissue movement occurs. Methods An oral surgeon performed MMA on three fresh cadaveric heads (n=3). The mandible and maxilla were advanced by four implanted distraction devices (KLS Martin Inc.). The devices were bilaterally advanced by 2mm increments to 14mm to encompass the full range of clinical advancements. Computerized tomography (CT) scans, (0.6 mm isotropic, Siemens, O‐arm), were taken at baseline (no advancement) and each advancement level (2, 4, 6, 8, 10, 12, 14mm). For the primary objective, total airway volume and linear anteroposterior (AP) and lateral (LAT) 2D dimensions of the RPS and RGS were analyzed at each incremental advancement using Amira™ (Thermo Fisher Scientific). To address the secondary objective, translation of airway tissues, radiopaque microbeads (800 μm, Ortech) were implanted at borders of the RPS and RGS using a syringe and endoscope and their movement was tracked through each advancement. Results During incremental MMA, airway volume increased at each increment compared to baseline. For 0–2, 2–4 & 4–6mm, normalized volume increases were incrementally larger with each advancement [mean 0–2mm = 20.3 ± 22.8%; mean 2–4mm = 34.9 ± 13.8%; mean 4–6mm = 62.4 ± 17.2%]. Consistent volumetric increases occurred during the advancements from 6mm to 10mm [mean 6–8mm = 50.8 ± 27.0%; mean 8–10mm = 45.6 ± 28.7%]. Preliminary analysis (n=1) shows that during early MMA (2mm–6mm), lateral dimensions increased at a greater magnitude compared to later advancements (8–14mm). Microbead migration supports these findings while highlighting airway wall movement. Conclusion While volumetric increases occur at each advancement, the greatest relative change occurs at the advancement from 4–6mm. Relative volumetric increases show a consistent increase in airway volume with each incremental advancement throughout 6–10mm. Lateral wall widening is the chief mechanism for early volume change, at advancements between 2–6mm, while AP dimensions are affected at 8–14mm advancements. The relationships between 2D (AP/LAT) changes and 3D (volume) demonstrate that volume change in initial advancements are primarily due to lateral enlargement. Depending on OSA severity, clinicians may exploit these relationships when performing MMA. This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».