Palatal implant surgery effectiveness in treatment of obstructive sleep apnea: A numerical method with 3D patient-specific geometries

Collapse of the soft palate in the upper airway contributes to obstructive sleeping apnea (OSA). In this study, we investigate the influence of the adhesion from the tongue on the soft palate global response. This is achieved using a cohesive zone finite element approach. A traction-separation law is determined to describe the adhesion effect from the surface tension of the lining liquid between the soft palate and the tongue. According to pull-off experimental tests of human lining liquid from the oral surface of the soft palate, the corresponding cohesive properties, including the critical normal traction stress and the failure separation displacement, are obtained. The 3D patient-specific soft palate geometry is accounted for, based on one specific patient's computed tomography (CT) images. The calculation results show that influence of the adhesion from the tongue surface on the global response of the soft palate depends on the length ratio between the cohesive length and the soft palate length. When the length of the cohesive zone is smaller than half of the soft palate length, the adhesion's influence is negligible. When the adhesion length is larger than 70 percent of soft palate length, the adhesion force contributes to preventing the soft palate from collapsing towards to the pharynx wall, i.e. the closing pressure is more negative than in the no adhesion case. These results may provide useful information to the clinical treatment of OSA patients.

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“…The detailed description for the geometry modeling has been presented in our previous work Liu et al (2018).…”

Section: D Patient-specific Geometrymentioning

confidence: 99%

3D patient-specific numerical modeling of the soft palate considering adhesion from the tongue

Liu

Prot

Skallerud

2018

Journal of Biomechanics

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“…Numerical simulations on the other hand can often produce reliable outcomes with limited resources and time Mielczarek and Uzia lko-Mydlikowska (2012). Numerical simulations of upper airway fall into three categories: computational fluid dynamics (CFD) based Aasgrav, Johnsen, Simonsen, and Müller (2016); Sung, Jeong, Yu, Hwang, and Pae (2006); M. Zhao, Barber, Cistulli, Sutherland, and Rosengarten (2013a), finite element modeling (FEM) Henrik Strand Moxness, Wülker, Helge Skallerud, and Nordgård (2018); Huang, White, and Malhotra (2007); Lee, Choi, Lee, Ahn, and Noh (2018); H. Liu, Moxness, Prot, and Skallerud (2018), and fluid structure interaction (FSI) Y. ; M. Zhao, Barber, Cistulli, Sutherland, and Rosengarten (2013b); with each method having its own advantages and complications. CFD simulations analyze the airflow in both healthy and diseased human airway, where the airflow can be laminar, transitional, or turbulent.…”

Section: Introductionmentioning

confidence: 99%

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

Ayyalasomayajula,

Moxeness,

Skallerud

2023

Preprint

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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 3-D finite element models based on patient-specific CT-scans are generated. The pharyngeal wall, the soft palate, the tongue, and their interactions are aimed at. Anatomic and physiologic operations are then conducted on the generated models to reflect commonly employed surgical techniques. Our results showed that maxillo-mandibular advancement(MAD) surgery of just 1 cm improved the critical closing pressure by atleast 212.2%. Following MAD, 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 which 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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“…The results showed a significant increase in airflow velocity at the nostrils for patients with nasal obstruction as compared to the control group. The effectiveness of palatal implant surgery in treatment of OSA was evaluated by Liu et al 17 on the basis of patient-specific finite element models.…”

Section: Introductionmentioning

confidence: 99%

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

Pugachev

Arnold

Burgmann

et al. 2020

Numer Methods Biomed Eng

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A computational fluid dynamics simulation workflow was developed to analyze the upper airway of patients with obstructive sleep apnea, which is a potentially serious sleep‐related breathing disorder. A single characteristic parameter was introduced to assess the severity of sleep apnea on the basis of the numerical results. Additionally, a fluid‐structure interaction simulation was applied to study in detail the behavior of compliant pharyngeal walls. An experimental setup was designed to validate the patient‐specific upper airway modeling. The suitability of the characteristic parameter was demonstrated in a retrospective analysis of radiological and clinical data of 58 patients as well as a prospective analysis of 22 patients. The simulation workflow was successfully used as part of an ongoing clinical investigation to predict the outcome of the obstructive sleep apnea treatment with a mandibular advancement device. The simulation results provided essential information about the critical region in the pharynx for the selection of an appropriate treatment and readily demonstrated the effect of mandibular protrusion on the air flow in the upper airway.

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Palatal implant surgery effectiveness in treatment of obstructive sleep apnea: A numerical method with 3D patient-specific geometries

Cited by 10 publications

References 40 publications

3D patient-specific numerical modeling of the soft palate considering adhesion from the tongue

3D patient-specific numerical modeling of the soft palate considering adhesion from the tongue

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

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

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