Investigation of the effects of miniscrew-assisted rapid palatal expansion on airflow in the upper airway of an adult patient with obstructive sleep apnea syndrome using computational fluid-structure interaction analysis

Abstract

ObjectiveThe objective of this study was to investigate the effects of miniscrew-assisted rapid palatal expansion (MARPE) on changes in airflow in the upper airway (UA) of an adult patient with obstructive sleep apnea syndrome (OSAS) using computational fluid-structure interaction analysis.MethodsThree-dimensional UA models fabricated from cone beam computed tomography images obtained before (T0) and after (T1) MARPE in an adult patient with OSAS were used for computational fluid dynamics with fluid-structure interaction analysis. Seven and nine cross-sectional planes (interplane distance of 10 mm) in the nasal cavity (NC) and pharynx, respectively, were set along UA. Changes in the cross-sectional area and changes in airflow velocity and pressure, node displacement, and total resistance at maximum inspiration (MI), rest, and maximum expiration (ME) were investigated at each plane after MARPE.ResultsThe cross-sectional areas at most planes in NC and the upper half of the pharynx were significantly increased at T1. Moreover, airflow velocity decreased in the anterior NC at MI and ME and in the nasopharynx and oropharynx at MI. The decrease in velocity was greater in NC than in the pharynx. The airflow pressure in the anterior NC and entire pharynx exhibited a decrease at T1. The amount of node displacement in NC and the pharynx was insignificant at both T0 and T1. Absolute values for the total resistance at MI, rest, and ME were lower at T1 than at T0.ConclusionsMARPE improves airflow and decreases resistance in UA; therefore, it may be an effective treatment modality for adult patients with moderate OSAS.

MARPE for the treatment and cure of OSAS: Aruba experience

“…The results of initial air flow and minimum area as shown in Table 2 also supports the fact that definitely usage of MARPE has improved the condition of OSAS which are in corroboration of earlier findings 24 , Showing that usage of MARPE improves airflow and decreases resistance in Upper Airway.…”

Decreased maxillary sinus volume is a potential predictor of obstructive sleep apnea

“…A CFD study of a patient who underwent miniscrewassisted rapid palatal expansion showed a significant increase in the cross-sectional area of the nasal airway and an improvement in pharyngeal airflow. 30 In addition, a systematic review and meta-analysis of maxillary expansion in adult OSA confirmed that maxillary expansion improved the AHI and lowest oxygen saturation. 31 The ideal way to measure nasal airflow is still controversial, but volumetric analysis of nasal airway based on segmentation of CT images may have limitations in evaluating nasal airway function.…”

Uso da expansão rápida palatal assistida por mini-implantes (MARPE) em tratamentos ortopédicos maxilares – revisão de literatura e relato de caso

“…Através dela são observados menores efeitos adversos dentoalveolares como: deslocamento dentário, inclinações dentárias, recessões gengivais, deiscência óssea, reabsorções dentárias e o efeito no processo alveolar é insignificante quando comparado a disjuntores convencionais. Também possui a vantagem de ocasionar menor risco de complicações, quando comparado a um tratamento de disjunção cirúrgica (3,14,16,17,20,26,27,28,29). (22) o disjuntor MARPE deve ser usado de forma criteriosa em pacientes que apresentam pouca espessura de osso alveolar vestibular e crista alveolar baixa na região de pré-molares.…”

“…São observados efeitos benéficos à respiração e à qualidade do sono após tratamento com MARPE (17,18,21). Além de não se observar recidivas, demonstrando estabilidade a longo prazo (16,17,20,22). A paciente não apresentou recidivas posteriormente à disjunção e nem um ano e quatro meses após o acompanhamento.…”

“…Cunha et al (20) realizaram disjunção com MARPE em uma paciente de vinte e quatro anos, a qual apresentou estabilidade de expansão até o período de acompanhamento, que foi de três anos. Os autores concluíram que o disjuntor MARPE é eficaz para correção de discrepâncias transversais em pacientes adultos, pois proporciona expansão maxilar nos níveis suturais e diminui os efeitos colaterais dentoalveolares.…”