Top

Published in:

15-07-2023 | Sleep Apnea | Dentistry • Original Article

Comparative study of anatomical features of primary and accessory maxillary ostia between patients with obstructive sleep apnea and healthy controls

Authors: Cansu Gül Efeoğlu Koca, Elif Bilgir, Gizem Çolakoğlu, Faruk Kadri Bakkal, Bengisu Yildirim, Mehmet Ali Güngör, Aras Erdil

Published in: Sleep and Breathing | Issue 1/2024

Abstract

Purpose

The purpose of this study was to examine how the size and shape of the maxillary sinus and its ostia (the primary maxillary ostium and accessory maxillary ostium) relate to each other in patients with OSA using computed tomography (CT) scans. Additionally, the study aimed to explore whether or not obstructive sleep apnea (OSA) had an effect on these structures.

Methods

CT images of patients diagnosed with OSAS and healthy participants were evaluated to compare the patency, location, dimension, and presence of PMOs and AMOs using the Mann–Whitney U, Student t, and chi-square tests. Also, intragroup correlations were analyzed by Spearman’s correlation test.

Results

Among 139 patients with OSA and healthy controls, there were significant variations in the average length (p = 0.001) and width (p = 0.008) of PMOs among the study groups. The mean maxillary sinus volume was significantly decreased in the OSA group (p = 0.001). A significant decrease in the maxillary sinus volume was observed in the OSA group (p = 0.001). In the OSA group, a significant correlation was observed between PMO obstruction and the presence of AMO (p = 0.004). The healthy group had significant correlations (r = 0.755, p = 0.000) between the vertical height and the distance between PMO and the maxillary sinus floor. Correlation analyses revealed positive, strong correlations between study variables such as the mean length and width of AMO and the vertical height of the maxillary sinus (r = 0.566, p = 0.000) in the OSA group.

Conclusions

The current study indicated significant differences in sinus volume, PMO occlusion, and AMO-related dimensions between patients with OSA and healthy controls.

Kim Y-J, Shin H-K, Lee D-Y, Ryu J-J, Kim TH (2020) Decreased maxillary sinus volume is a potential predictor of obstructive sleep apnea. Angle Orthod 90:556–563. https://doi.org/10.2319/080819-520.1CrossRefPubMedPubMedCentral

Costa E Sousa RA, dos Santos Gil NA (2013) Craniofacial skeletal architecture and obstructive sleep apnoea syndrome severity. J Cranio-Maxillo-Facial Surg Off Publ Eur Assoc Cranio-Maxillo-Facial Surg 41:740–6. https://doi.org/10.1016/j.jcms.2012.12.010

Neelapu BC, Kharbanda OP, Sardana HK, Balachandran R, Sardana V, Kapoor P et al (2017) Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: A systematic review and meta-analysis of cephalometric studies. Sleep Med Rev 31:79–90. https://doi.org/10.1016/j.smrv.2016.01.007CrossRefPubMed

Sadry S, Koca CG, Kurtulmuş H (2021) Cone beam computed tomography analysis results in patients with obstructive sleep apnoea syndrome. Int J Clin Pract 75:e14497. https://doi.org/10.1111/ijcp.14497CrossRefPubMed

Suratt PM, Turner BL, Wilhoit SC (1986) Effect of intranasal obstruction on breathing during sleep. Chest 90:324–329. https://doi.org/10.1378/chest.90.3.324CrossRefPubMed

Cisonni J, Lucey AD, King AJC, Islam SMS, Lewis R, Goonewardene MS (2015) Numerical simulation of pharyngeal airflow applied to obstructive sleep apnea: effect of the nasal cavity in anatomically accurate airway models. Med Biol Eng Comput 53:1129–1139. https://doi.org/10.1007/s11517-015-1399-zCrossRefPubMed

Oz U, Orhan K, Aksoy S, Ciftci F, Özdoğanoğlu T, Rasmussen F (2016) Association between pterygoid hamulus length and apnea hypopnea index in patients with obstructive sleep apnea: a combined three-dimensional cone beam computed tomography and polysomnographic study. Oral Surg Oral Med Oral Pathol Oral Radiol 121:330–339. https://doi.org/10.1016/j.oooo.2015.10.032CrossRefPubMed

Prasanna LC, Mamatha H (2010) The location of maxillary sinus ostium and its clinical application. Indian J Otolaryngol Head Neck Surg Off Publ Assoc Otolaryngol India 62:335–337. https://doi.org/10.1007/s12070-010-0047-zCrossRef

Timmenga NM, Raghoebar GM, Liem RSB, van Weissenbruch R, Manson WL, Vissink A (2003) Effects of maxillary sinus floor elevation surgery on maxillary sinus physiology. Eur J Oral Sci 111:189–197. https://doi.org/10.1034/j.1600-0722.2003.00012.xCrossRefPubMed

10.

Yeung AWK, Colsoul N, Montalvao C, Hung K, Jacobs R, Bornstein MM (2019) Visibility, location, and morphology of the primary maxillary sinus ostium and presence of accessory ostia: a retrospective analysis using cone beam computed tomography (CBCT). Clin Oral Investig 23:3977–3986. https://doi.org/10.1007/s00784-019-02829-9CrossRefPubMed

11.

Kumar H, Choudhry R, Kakar S (2001) Accessory maxillary ostia: topography and clinical application. J Anat Soc India 50:3–5

12.

Ali IK, Sansare K, Karjodkar FR, Vanga K, Salve P, Pawar AM (2017) Cone-beam computed tomography analysis of accessory maxillary ostium and Haller cells: Prevalence and clinical significance. Imaging Sci Dent 47:33CrossRefPubMedPubMedCentral

13.

Joe JK, Ho SY, Yanagisawa E (2000) Documentation of variations in sinonasal anatomy by intraoperative nasal endoscopy. Laryngoscope 110:229–235CrossRefPubMed

14.

Jones NS (2002) CT of the paranasal sinuses: a review of the correlation with clinical, surgical and histopathological findings. Clin Otolaryngol Allied Sci 27:11–17CrossRefPubMed

15.

Penttilä M (2018) Accessory maxillary ostium repair using middle turbinate flap: a case series of 116 patients with chronic rhinosinusitis. Int Forum Allergy Rhinol 8:1204–1210. https://doi.org/10.1002/alr.22159CrossRefPubMed

16.

Aramani A, Karadi RN, Kumar S (2014) A Study of Anatomical Variations of Osteomeatal Complex in Chronic Rhinosinusitis Patients-CT Findings. J Clin Diagn Res 8:KC01-4. https://doi.org/10.7860/JCDR/2014/9323.4923CrossRefPubMedPubMedCentral

17.

Rege ICC, Sousa TO, Leles CR, Mendonça EF (2012) Occurrence of maxillary sinus abnormalities detected by cone beam CT in asymptomatic patients. BMC Oral Health 12:30. https://doi.org/10.1186/1472-6831-12-30CrossRefPubMedPubMedCentral

18.

Akay G, Yaman D, Karadağ Ö, Güngör K (2020) Evaluation of the Relationship of Dimensions of Maxillary Sinus Drainage System with Anatomical Variations and Sinusopathy: Cone-Beam Computed Tomography Findings. Med Princ Pract Int J Kuwait Univ Heal Sci Cent 29:354–363. https://doi.org/10.1159/000504963CrossRef

19.

Yousefi Z, Dalili Kajan Z, Jalali MM, Khosravifard N, Rafiei E (2021) Computed Tomographic Comparison of Length, Width and Angulation of Ethmoidal Infundibulum in Patients With and Without Maxillary Sinusitis. Indian J Otolaryngol Head Neck Surg 1–12.

20.

Hung K, Montalvao C, Yeung AWK, Li G, Bornstein MM (2020) Frequency, location, and morphology of accessory maxillary sinus ostia: a retrospective study using cone beam computed tomography (CBCT). Surg Radiol Anat 42:219–228. https://doi.org/10.1007/s00276-019-02308-6CrossRefPubMed

21.

Dancey CP, Reidy J (2008) Statistics without maths or psychology: using SPSS for windows. 4^th ed. Pearson: Harlow, England

22.

Landis JR, Koch GG (1977) An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 363–74.

23.

Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191. https://doi.org/10.3758/BF03193146CrossRefPubMed

24.

Barrera JE, Pau CY, Forest V-I, Holbrook AB, Popelka GR (2017) Anatomic measures of upper airway structures in obstructive sleep apnea. World J Otorhinolaryngol - Head Neck Surg 3:85–91. https://doi.org/10.1016/j.wjorl.2017.05.002CrossRefPubMedPubMedCentral

25.

Thakkar K, Yao M (2007) Diagnostic studies in obstructive sleep apnea. Otolaryngol Clin North Am 40:785–805. https://doi.org/10.1016/j.otc.2007.04.005CrossRefPubMed

26.

Aktuna Belgin C, Colak M, Adiguzel O, Akkus Z, Orhan K (2019) Three-dimensional evaluation of maxillary sinus volume in different age and sex groups using CBCT. Eur Arch Oto-Rhino-Laryngology Off J Eur Fed Oto-Rhino-Laryngological Soc Affil with Ger Soc Oto-Rhino-Laryngology - Head Neck Surg 276:1493–1499. https://doi.org/10.1007/s00405-019-05383-yCrossRef

27.

Teke HY, Duran S, Canturk N, Canturk G (2007) Determination of gender by measuring the size of the maxillary sinuses in computerized tomography scans. Surg Radiol Anat 29:9–13. https://doi.org/10.1007/s00276-006-0157-1CrossRefPubMed

28.

Uthman AT, Al-Rawi NH, Al-Naaimi AS, Al-Timimi JF (2011) Evaluation of maxillary sinus dimensions in gender determination using helical CT scanning. J Forensic Sci 56:403–408. https://doi.org/10.1111/j.1556-4029.2010.01642.xCrossRefPubMed

29.

Souza AD, Rajagopal KV, Ankolekar VH, Souza ASD, Kotian SR (2016) Anatomy of maxillary sinus and its ostium: A radiological study using computed tomography. Chrismed J Heal Res 3:37CrossRef

30.

Butaric LN (2015) Differential Scaling Patterns in Maxillary Sinus Volume and Nasal Cavity Breadth Among Modern Humans. Anat Rec (Hoboken) 298:1710–1721. https://doi.org/10.1002/ar.23182CrossRefPubMed

31.

Uchida Y, Goto M, Katsuki T, Akiyoshi T (1998) A cadaveric study of maxillary sinus size as an aid in bone grafting of the maxillary sinus floor. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg 56:1158–1163. https://doi.org/10.1016/s0278-2391(98)90761-3CrossRef

32.

Kim YJ, Shin HK, Lee DY, Ryu JJ, Kim TH (2020) Decreased maxillary sinus volume is a potential predictor of obstructiv sleep apnea. Angle Orthod 90:556–563. https://doi.org/10.2319/080819-520.1CrossRefPubMedPubMedCentral

33.

Fried J, Yuen E, Gudis DA, Schlosser RJ, Nguyen SA, Rowan NR (2022) Changes in Sleep Quality Following Treatment for Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis. Am J Rhinol Allergy 36(3):386–396. https://doi.org/10.1177/19458924211061442CrossRefPubMed

34.

Butaric LN, Wadle M, Gascon J (2019) Anatomical Variation in Maxillary Sinus Ostium Positioning: Implications for Nasal-Sinus Disease. Anat Rec (Hoboken) 302:917–930. https://doi.org/10.1002/ar.24039CrossRefPubMed

35.

de Carvalho ABG, Ferreira Costa AL, Fuziy A, de Assis ACS, Castro Veloso JR, Coutinho Manhães LRJ et al (2018) Investigation on the relationship of dimensions of the maxillary sinus drainage system with the presence of sinusopathies: a cone beam computed tomography study. Arch Oral Biol 94:78–83. https://doi.org/10.1016/j.archoralbio.2018.06.021CrossRefPubMed

36.

El-Anwar MW, Raafat A, Almolla RM, Alsowey AM, Elzayat S (2018) Maxillary sinus ostium assessment: a CT study. Egypt J Radiol Nucl Med 49:1009–1013CrossRef

37.

Bani-Ata M, Aleshawi A, Khatatbeh A, Al-Domaidat D, Alnussair B, Al-Shawaqfeh R et al (2020) Accessory Maxillary Ostia: Prevalence of an Anatomical Variant and Association with Chronic Sinusitis. Int J Gen Med 13:163–168. https://doi.org/10.2147/IJGM.S253569CrossRefPubMedPubMedCentral

38.

Yenigun A, Fazliogullari Z, Gun C, Uysal II, Nayman A, Karabulut AK (2016) The effect of the presence of the accessory maxillary ostium on the maxillary sinus. Eur Arch Oto-Rhino-Laryngology 273:4315–4319. https://doi.org/10.1007/s00405-016-4129-8CrossRef

Title: Comparative study of anatomical features of primary and accessory maxillary ostia between patients with obstructive sleep apnea and healthy controls
Authors: Cansu Gül Efeoğlu Koca
Elif Bilgir
Gizem Çolakoğlu
Faruk Kadri Bakkal
Bengisu Yildirim
Mehmet Ali Güngör
Aras Erdil
Publication date: 15-07-2023
Publisher: Springer International Publishing
Keywords: Sleep Apnea
Computed Tomography
Computed Tomography
Published in: Sleep and Breathing / Issue 1/2024
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-023-02874-5

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

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.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2024

Patient-reported experience with hypoglossal nerve stimulation in the treatment of obstructive sleep apnea

Effects of traditional Chinese exercises on geriatric mental health

How to objectively measure snoring: a systematic review

The DS-14 questionnaire: psychometric characteristics and utility in patients with obstructive sleep apnea

Cerebellar volumes and the intrinsic cerebellar network in patients with obstructive sleep apnea

Evaluation of the relationship between the Mediterranean diet adherence and sleep quality in adults

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials