Application of patient‐specific simulation workflow for obstructive sleep apnea diagnosis and treatment with a mandibular advancement device

Pugachev, A G; Arnold, M.; Burgmann, Sebastian; Janoske, Uwe; Bicsák, Ákos; Abel, Dietmar; Linssen, Johannes; Bonitz, Lars

doi:10.1002/cnm.3350

Cited by 8 publications

(5 citation statements)

References 25 publications

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“…Because of the susceptibility of tongue collapse in supine position, mandibular advancement devices (MAD) have been developed to target this anatomical structure. 113 …”

Section: Upper Airway Analysis On Cbct Scansmentioning

confidence: 99%

“… 11 Lastly, limited to research applications, finite element analysis (FEA) can be paired with computational fluid dynamics (CFD) to simulate the airflow in the upper airway of a patient. 113 This said, segmentation, superimposition, and computations are possible when the clinical settings of CBCTs—that are indication-oriented and patient-specific—satisfy the research requirements—that are hypothesis-oriented and aim-specific.…”

Section: Upper Airway Analysis On Cbct Scansmentioning

confidence: 99%

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The use of CBCT in orthodontics with special focus on upper airway analysis in patients with sleep-disordered breathing

Savoldi,

Dagassan-Berndt,

Patcas

et al. 2024

Dentomaxillofacial Radiology

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Applications of cone-beam computed tomography (CBCT) in orthodontics have been increasingly discussed and evaluated in science and practice over the last two decades. The present work provides a comprehensive summary of current consolidated practice guidelines, cutting-edge innovative applications, and future outlooks about potential use of CBCT in orthodontics with a special focus on upper airway analysis in patients with sleep-disordered breathing (SDB). The present scoping review reveals that clinical applications of CBCT in orthodontics are broadly supported by evidence for the diagnosis of dental anomalies, temporomandibular joint disorders, and craniofacial malformations. On the other hand, CBCT imaging for upper airway analysis—including soft tissue diagnosis and airway morphology—needs further validation in order to provide better understanding regarding which diagnostic questions it can be expected to answer. Internationally recognised guidelines for CBCT use in orthodontics are existent, and similar ones should be developed to provide clear indications about the appropriate use of CBCT for upper airway assessment, including a list of specific clinical questions justifying its prescription.

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“…Because of the susceptibility of tongue collapse in supine position, mandibular advancement devices (MAD) have been developed to target this anatomical structure. 113 …”

Section: Upper Airway Analysis On Cbct Scansmentioning

confidence: 99%

Section: Upper Airway Analysis On Cbct Scansmentioning

confidence: 99%

The use of CBCT in orthodontics with special focus on upper airway analysis in patients with sleep-disordered breathing

Savoldi,

Dagassan-Berndt,

Patcas

et al. 2024

Dentomaxillofacial Radiology

View full text Add to dashboard Cite

show abstract

“…Other recent literature reviews were given by, e.g., Faizal et al [ 191 ] and Ayodele et al [ 99 ]. Recent publications considering patient-specific mathematical modelling and simulation for clinical decision support include, e.g., [ 89 , 90 , 192 , 193 , 194 , 195 ]. Interestingly, many research questions raised by Quadrio et al [ 196 ] a decade ago regarding nasal airflow, such as the selection of turbulence models and boundary conditions, as well as the validity of assuming rigid walls, remain unresolved.…”

Section: Part Ii—overview Of Published Literature On In Vitro and In ...mentioning

confidence: 99%

Computational Rhinology: Unraveling Discrepancies between In Silico and In Vivo Nasal Airflow Assessments for Enhanced Clinical Decision Support

Johnsen

2024

Bioengineering

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Computational rhinology is a specialized branch of biomechanics leveraging engineering techniques for mathematical modelling and simulation to complement the medical field of rhinology. Computational rhinology has already contributed significantly to advancing our understanding of the nasal function, including airflow patterns, mucosal cooling, particle deposition, and drug delivery, and is foreseen as a crucial element in, e.g., the development of virtual surgery as a clinical, patient-specific decision support tool. The current paper delves into the field of computational rhinology from a nasal airflow perspective, highlighting the use of computational fluid dynamics to enhance diagnostics and treatment of breathing disorders. This paper consists of three distinct parts—an introduction to and review of the field of computational rhinology, a review of the published literature on in vitro and in silico studies of nasal airflow, and the presentation and analysis of previously unpublished high-fidelity CFD simulation data of in silico rhinomanometry. While the two first parts of this paper summarize the current status and challenges in the application of computational tools in rhinology, the last part addresses the gross disagreement commonly observed when comparing in silico and in vivo rhinomanometry results. It is concluded that this discrepancy cannot readily be explained by CFD model deficiencies caused by poor choice of turbulence model, insufficient spatial or temporal resolution, or neglecting transient effects. Hence, alternative explanations such as nasal cavity compliance or drag effects due to nasal hair should be investigated.

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“…Considering the recent advances in computational mechanics of upper airway (Pugachev et al. 2020 ; Caragiuli et al. 2021 ), patient-specific numerical models can be an interesting option for studying the influencing factors.…”

Section: Introductionmentioning

confidence: 99%

Potential of computational models in personalized treatment of obstructive sleep apnea: a patient-specific partial 3D finite element study

Ayyalasomayajula,

Moxness,

Skallerud

2023

Biomech Model Mechanobiol

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The upper airway experiences mechanical loads during breathing. Obstructive sleep apnea is a very common sleep disorder, in which the normal function of the airway is compromised, enabling its collapse. Its treatment remains unsatisfactory with variable efficacy in the case of many surgeries. Finite element models of the upper airway to simulate the effects of various anatomic and physiologic manipulations on its mechanics could be helpful in predicting surgical success. Partial 3D finite element models based on patient-specific CT-scans were undertaken in a pilot study of 5 OSA patients. Upper airway soft tissues including the soft palate, hard palate, tongue, and pharyngeal wall were segmented around the midsagittal plane up to a width of 2.5 cm in the lateral direction. Simulations of surgical interventions such as Uvulopalatopharyngoplasty (UPPP), maxillo-mandibular advancement (MMA), palatal implants, and tongue implants have been performed. Our results showed that maxillo-mandibular advancement (MMA) surgery of 1 cm improved the critical closing pressure by at least 212.2%. Following MMA, the best improvement was seen via uvulopalatopharyngoplasty (UPPP), with an improvement of at least 19.12%. Palatal and tongue implants also offered a certain degree of improvement. Further, we observed possible interacting mechanisms that suggested simultaneous implementation of UPPP and tongue stiffening; and palatal and tongue stiffening could be beneficial. Our results suggest that computational modeling is a useful tool for analyzing the influence of anatomic and physiological manipulations on upper airway mechanics. The goal of personalized treatment in the case of OSA could be achieved with the use of computational modeling.

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Application of patient‐specific simulation workflow for obstructive sleep apnea diagnosis and treatment with a mandibular advancement device

Cited by 8 publications

References 25 publications

The use of CBCT in orthodontics with special focus on upper airway analysis in patients with sleep-disordered breathing

The use of CBCT in orthodontics with special focus on upper airway analysis in patients with sleep-disordered breathing

Computational Rhinology: Unraveling Discrepancies between In Silico and In Vivo Nasal Airflow Assessments for Enhanced Clinical Decision Support

Potential of computational models in personalized treatment of obstructive sleep apnea: a patient-specific partial 3D finite element study

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