The Association Between Transverse Maxillary Deficiency and Septal Deviation in Adults with Obstructive Sleep Apnea

Abstract

ObjectivesRecent evidence suggests that environmental factors impact craniofacial development. Specifically, the height and width of the maxilla may impact the degree of septal deviation. We sought to determine the relationship between transverse maxillary deficiency and severity of septal deviation.MethodsA prospective cohort of adult sleep surgery patients were evaluated by standardized CT imaging. Primary outcomes evaluated the relationship of a narrow, high‐arched palate (the palatal height to width ratio) with the degree of septal deviation at the level of the 1st premolar and 1st molar. Secondary outcome evaluated the relationship of the palatal height‐to‐width ratio and nasal obstruction. Both adjusted and unadjusted linear regression were performed, including correction for multiple hypothesis testing.ResultsNinety‐three patients were included. On average, the cohort was middle aged (54.7 ± 12.7 years), obese (BMI 30.1 ± 4.5 kg/m2), predominantly male (74.2%), White (73.1%), and with severe obstructive sleep apnea (OSA) (AHI 30.0 ± 18.7 events/h). A moderate correlation was observed between both the relative and absolute inter‐premolar palatal height and the degree of septal deviation at the inter‐molar region. No significant correlation was observed between palatal dimensions and NOSE score.ConclusionThis study found that transverse maxillary deficiency is moderately associated with greater degree of septal deviation among a sample of OSA patients. This contributes to the concept that craniofacial development impacts the nasal airway, promoting a comprehensive evaluation of both endonasal and extranasal structures.Level of EvidenceIV Laryngoscope, 2023

Transverse Maxillary Deficiency Predicts Increased Upper Airway Collapsibility During Drug‐Induced Sleep Endoscopy

“…As highlighted by the letter, our paper included a detailed description of a step‐by‐step approach for obtaining each measure from DICOM files to ensure their reproducibility. This requirement was described in greater detail by another recent manuscript from our group that tested and confirmed inter‐rater reliability for these metrics 4 …”

“…This requirement was described in greater detail by another recent manuscript from our group that tested and confirmed inter-rater reliability for these metrics. 4 Regarding the question about the clinical significance of our findings, we presented observed differences in collapsibility per unit change in skeletal dimension (ie, β coefficients from regression models) after adjusting for age, sex, height, and body mass index for the expressed purpose of facilitating the readers' ability to translate our results into clinical practice. The β coefficients indicate that a 1 cmH 2 O increase in PhOP will be observed for each 4 mm reduction in IPMD, and that a 1 cmH 2 O increase in Pcrit A will be observed for each 4 mm reduction in IMD.…”