Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Oral Health
Published in: BMC Oral Health 1/2021

Open Access 01-12-2021 | Digital Volume Tomography | Research article

The effect of rapid maxillary expansion on the upper airway’s aerodynamic characteristics

Authors: Xin Feng, Yicheng Chen, Kristina Hellén-Halme, Weihua Cai, Xie-Qi Shi

Published in: BMC Oral Health | Issue 1/2021

Login to get access

Abstract

Background

The effect of rapid maxillary expansion (RME) on the upper airway (UA) has been studied earlier but without a consistent conclusion. This study aims to evaluate the outcome of RME on the UA function in terms of aerodynamic characteristics by applying a computational fluid dynamics (CFD) simulation.

Methods

This retrospective cohort study consists of seventeen cases with two consecutive CBCT scans obtained before (T0) and after (T1) RME. Patients were divided into two groups with respect to patency of the nasopharyngeal airway as expressed in the adenoidal nasopharyngeal ratio (AN): group 1 was comprised of patients with an AN ratio < 0.6 and group 2 encompassing those with an AN ratio ≥ 0.6. CFD simulation at inspiration and expiration were performed based on the three-dimensional (3D) models of the UA segmented from the CBCT images. The aerodynamic characteristics in terms of pressure drop (ΔP), maximum midsagittal velocity (Vms), and maximum wall shear stress (Pws) were compared by paired t-test and Wilcoxon test according to the normality test at T0 and T1.

Results

The aerodynamic characteristics in UA revealed no statistically significant difference after RME. The maximum Vms (m/s) decreased from 2.79 to 2.28 at expiration after RME (P = 0.057).

Conclusion

The aerodynamic characteristics were not significantly changed after RME. Further CFD studies with more cases are warranted.
Literature
1.
Pereira L, Monyror J, Almeida FT, Almeida FR, Guerra E, Flores-Mir C, Pacheco-Pereira C. Prevalence of adenoid hypertrophy: a systematic review and meta-analysis. Sleep Med Rev. 2018;38:101–12.CrossRef
2.
Tatlipinar A, Biteker M, Meric K, Bayraktar GI, Tekkesin AI, Gokceer T. Adenotonsillar hypertrophy: correlation between obstruction types and cardiopulmonary complications. Laryngoscope. 2012;122(3):676–80.CrossRef
3.
Pagella F, De Amici M, Pusateri A, Tinelli G, Matti E, Benazzo M, Licari A, Nigrisoli S, Quaglini S, Ciprandi G, et al. Adenoids and clinical symptoms: epidemiology of a cohort of 795 pediatric patients. Int J Pediatr Otorhinolaryngol. 2015;79(12):2137–41.CrossRef
4.
Fujioka M, Young LW, Girdany BR. Radiographic evaluation of adenoidal size in children: adenoidal–nasopharyngeal ratio. AJR Am J Roentgenol. 1979;133(3):401–4.CrossRef
5.
Duan H, Xia L, He W, Lin Y, Lu Z, Lan Q. Accuracy of lateral cephalogram for diagnosis of adenoid hypertrophy and posterior upper airway obstruction: a meta-analysis. Int J Pediatr Otorhinolaryngol. 2019;119:1–9.CrossRef
6.
Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, Friedman NR, Giordano T, Hildrew DM, Kim TW, et al. Clinical practice guideline: tonsillectomy in children (update). Otolaryngol Head Neck Surg. 2019;160(1):S1–42.CrossRef
7.
Chohan A, Lal A, Chohan K, Chakravarti A, Gomber S. Systematic review and meta-analysis of randomized controlled trials on the role of mometasone in adenoid hypertrophy in children. Int J Pediatr Otorhinolaryngol. 2015;79(10):1599–608.CrossRef
8.
Baik G, Brietzke SE. Cost benefit and utility decision analysis of turbinoplasty with adenotonsillectomy for pediatric sleep-disordered breathing. Otolaryngology Head and Neck Surgery. 2019;161(2):343–7.CrossRef
9.
Guilleminault C, Monteyrol PJ, Huynh NT, Pirelli P, Quo S, Li K. Adeno-tonsillectomy and rapid maxillary distraction in pre-pubertal children, a pilot study. Sleep Breath. 2011;15(2):173–7.CrossRef
10.
Schendel SA, Eisenfeld J, Bell WH, Epker BN, Mishelevich DJ. The long face syndrome: vertical maxillary excess. Am J Orthod. 1976;70(4):398–408.CrossRef
11.
Macari AT, Bitar MA, Ghafari JG. New insights on age-related association between nasopharyngeal airway clearance and facial morphology. Orthod Craniofac Res. 2012;15(3):188–97.CrossRef
12.
Garetz SL, Mitchell RB, Parker PD, Moore RH, Rosen CL, Giordani B, Muzumdar H, Paruthi S, Elden L, Willging P, et al. Quality of life and obstructive sleep apnea symptoms after pediatric adenotonsillectomy. Pediatrics. 2015;135(2):e477-486.CrossRef
13.
Huynh NT, Desplats E, Almeida FR. Orthodontics treatments for managing obstructive sleep apnea syndrome in children: a systematic review and meta-analysis. Sleep Med Rev. 2016;25:84–94.CrossRef
14.
Hamoda MM, Kohzuka Y, Almeida FR. Oral appliances for the management of OSA: an updated review of the literature. Chest. 2018;153(2):544–53.CrossRef
15.
Di Carlo G, Saccucci M, Ierardo G, Luzzi V, Occasi F, Zicari AM, Duse M, Polimeni A. Rapid maxillary expansion and upper airway morphology: a systematic review on the role of cone beam computed tomography. Biomed Res Int. 2017;2017:5460429.CrossRef
16.
Kilic N, Oktay H. Effects of rapid maxillary expansion on nasal breathing and some naso-respiratory and breathing problems in growing children: a literature review. Int J Pediatr Otorhinolaryngol. 2008;72(11):1595–601.CrossRef
17.
Roland PS, Rosenfeld RM, Brooks LJ, Friedman NR, Jones J, Kim TW, Kuhar S, Mitchell RB, Seidman MD, Sheldon SH, et al. Clinical practice guideline: polysomnography for sleep-disordered breathing prior to tonsillectomy in children. Otolaryngol Head Neck Surg. 2011;145(1 Suppl):S1-15.CrossRef
18.
De Backer JW, Vanderveken OM, Vos WG, Devolder A, Verhulst SL, Verbraecken JA, Parizel PM, Braem MJ, Van de Heyning PH, De Backer WA. Functional imaging using computational fluid dynamics to predict treatment success of mandibular advancement devices in sleep-disordered breathing. J Biomech. 2007;40(16):3708–14.CrossRef
19.
Martínez A, Muñiz AL, Soudah E, Calvo J, Suárez AÁ, Cobo J, Cobo T. Physiological and geometrical effects in the upper airways with and without mandibular advance device for sleep apnea treatment. Sci Rep. 2020;10(1):5322–5322.CrossRef
20.
Iwasaki T, Saitoh I, Takemoto Y, Inada E, Kanomi R, Hayasaki H, Yamasaki Y. Improvement of nasal airway ventilation after rapid maxillary expansion evaluated with computational fluid dynamics. Am J Orthod Dentofac Orthop. 2012;141(3):269–78.CrossRef
21.
Iwasaki T, Takemoto Y, Inada E, Sato H, Suga H, Saitoh I, Kakuno E, Kanomi R, Yamasaki Y. The effect of rapid maxillary expansion on pharyngeal airway pressure during inspiration evaluated using computational fluid dynamics. Int J Pediatr Otorhinolaryngol. 2014;78(8):1258–64.CrossRef
22.
Rana SS, Kharbanda OP, Agarwal B. Influence of tongue volume, oral cavity volume and their ratio on upper airway: a cone beam computed tomography study. J Oral Biol Craniofac Res. 2020;10(2):110–7.CrossRef
23.
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(11):1129–39.CrossRef
24.
Powell NB, Mihaescu M, Mylavarapu G, Weaver EM, Guilleminault C, Gutmark E. Patterns in pharyngeal airflow associated with sleep-disordered breathing. Sleep Med. 2011;12(10):966–74.CrossRef
25.
Faramarzi M, Baradaranfar MH, Abouali O, Atighechi S, Ahmadi G, Farhadi P, Keshavarzian E, Behniafard N, Baradaranfar A. Numerical investigation of the flow field in realistic nasal septal perforation geometry. Allergy Rhinol (Providence). 2014;5(2):70–7.CrossRef
26.
Katritsis D, Kaiktsis L, Chaniotis A, Pantos J, Efstathopoulos EP, Marmarelis V. Wall shear stress: theoretical considerations and methods of measurement. Prog Cardiovasc Dis. 2007;49(5):307–29.CrossRef
27.
Murata N, Hiro T, Takayama T, Migita S, Morikawa T, Tamaki T, Mineki T, Kojima K, Akutsu N, Sudo M, et al. High shear stress on the coronary arterial wall is related to computed tomography-derived high-risk plaque: a three-dimensional computed tomography and color-coded tissue-characterizing intravascular ultrasonography study. Heart Vessels. 2019;34(9):1429–39.CrossRef
28.
Verbraecken JA, De Backer WA. Upper airway mechanics. Respiration. 2009;78(2):121–33.CrossRef
29.
Tamisier R, Pepin JL, Wuyam B, Deschaux C, Levy P. Expiratory changes in pressure: flow ratio during sleep in patients with sleep-disordered breathing. Sleep. 2004;27(2):240–8.CrossRef
30.
Chen H, Li Y, Reiber JH, de Lange J, Tu S, van der Stelt P, Lobbezoo F, Aarab G. Analyses of aerodynamic characteristics of the oropharynx applying CBCT: obstructive sleep apnea patients versus control subjects. Dentomaxillofac Radiol. 2018;47(2):20170238.CrossRef
31.
Zhao M, Barber T, Cistulli P, Sutherland K, Rosengarten G. Computational fluid dynamics for the assessment of upper airway response to oral appliance treatment in obstructive sleep apnea. J Biomech. 2013;46(1):142–50.CrossRef
32.
Jeong S-J, Kim W-S, Sung S-J. Numerical investigation on the flow characteristics and aerodynamic force of the upper airway of patient with obstructive sleep apnea using computational fluid dynamics. Med Eng Phys. 2007;29(6):637–51.CrossRef
33.
Lambeth C, Wang Z, Kairaitis K, Moshfegh A, Jabbarzadeh A, Amis TC. Modelling mucosal surface roughness in the human velopharynx: a computational fluid dynamics study of healthy and obstructive sleep apnea airways. J Appl Physiol. 2018;125:1821–31.CrossRef
34.
Mortazavy Beni H, Hassani K, Khorramymehr S. In silico investigation of sneezing in a full real human upper airway using computational fluid dynamics method. Comput Methods Programs Biomed. 2019;177:203–9.CrossRef
Metadata
Title
The effect of rapid maxillary expansion on the upper airway’s aerodynamic characteristics
Authors
Xin Feng
Yicheng Chen
Kristina Hellén-Halme
Weihua Cai
Xie-Qi Shi
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2021
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-021-01488-1

Other articles of this Issue 1/2021

BMC Oral Health 1/2021 Go to the issue

Research article

Evaluation of salivary biomarkers for the diagnosis of periodontitis

Research article

Dental caries thresholds among adolescents in England, Wales, and Northern Ireland, 2013 at 12, and 15 years: implications for epidemiology and clinical care

Research

Effect of microthread design on the preservation of marginal bone around immediately placed implants: a 5-years prospective cohort study

Research

Effect of epinephrine on the absorption of lidocaine following application to the oral mucosa in rats

Research

Associations between psychological wellbeing, depression, general anxiety, perceived social support, tooth brushing frequency and oral ulcers among adults resident in Nigeria during the first wave of the COVID-19 pandemic

Research

Patient-reported outcome measures for masticatory function in adults: a systematic review