Introduction\u00a0 <\/b>Obstructive Sleep Apnea Syn\u00addrome (OSAS) is a chronic sleep respiratory disturbances (DRS) re\u00adsult from a completed (apnea) or partial (hypopnea) upper airways obstruction, most often at the oro\u00adpharyngeal level, alternating with brief hyperventilation.<\/p>\n
Continuous Positive Airway Pres\u00adsure (CPAP) is actually considered the gold standard therapy for OSAS patients to reduces the symptomatology and the ap\u00adnea-hypopnea index (AHI), but it is not well tolerated by many pa\u00adtients for the encumbrance and the noise.<\/p>\n
Orthodontic treatment consists in the application of an intraoral Mandibular Advancement Device (MAD) with the aim of advancing jaw and tongue, having as final objective the opening of the pha\u00adryngeal air space, thus freeing the passage of air.<\/p>\n
Materials and methods\u00a0 <\/b>A 61-year-old man affected by severe (54.8 AHI, 82% nadir) OSAS came for an orthodontic evaluation after inferior turbinate, pharyngoplasty, uvuloplasty sur\u00adgery and drug induced sleep en\u00addoscopy (DISE) that evaluate a IV degree anterior-posterior collapse in the hypopharynx, II degree cir\u00adcular collapse in oropharynx and IV degree circular collapse in the nasopharynx.<\/p>\n
At the anamnesis and objective examination 21 Epworth Sleepi\u00adness Scale (ESS) score, 43.5 mm neck circumference, 8 mm of maximum protrusion and 6 mm of maximum retrusion (evaluated with George Gauge) and mandib\u00adular retrusion were evaluated. The airways volume was evaluated with a CBCT 12\u2019 FOV and from the cephalometric analysis was eval\u00aduated a second skeletal class which had confirm the mandibular retro-position.<\/p>\n
The initial polysomnography re\u00advealed a severe OSAS (54.8 AHI) with a positional component (57.1 supine AHI) and snoring index (SI) of 168.3 per hour. Oxygen aver\u00adage saturation was 94%, oxygen desaturation index (ODI) was 50.5 and nadir was 82%.<\/p>\n
The principal aim of the treatment was to improve the general health condition of the patient, reduce the AHI and the polysomnography parameters.<\/p>\n
Discussion and conclusions\u00a0 <\/b>Orthodontic treatment consisted in a Mandibular Advancement Device and vertical elastics (3\/16\u2019\u2019 56,7 g). The latest post-treatment polysomnography revealed a 1.6 AHI, 91% nadir and no episodes of oxygen desat\u00aduration lower than 90%.<\/p>\n
Otolaryngology surgery, orthodon\u00adtic evaluation and a corrected management of an OSAS adult patient improve the AHI score and oxygen saturation. It is necessary to select correctly the patient through the DISE evaluation. Or\u00adthodontic and multidisciplinary \u00a0 approach show a great outcome for a severe OSAS patient with no compliance to CPAP treatment.<\/p>\n
Clinical significance\u00a0 <\/b>Orthodontic evaluation permit to eval\u00aduate an adequate mandibular protru\u00adsion, absence of temporomandibular disorders, dental or periodontal prob\u00adlems. MAD treatment in a severe OSAS patient confirms, with an ade\u00adquate compliance, satisfactory results a valid alternative to CPAP use.<\/p>\n
A motivational interview with the patient shows an essential aspect to maintain the compliance to MAD use throughout life and this is the reason why annual checks are recommended.<\/p>\n
Per continuare la lettura gli abbonati possono scaricare l’allegato.<\/i><\/p>\n
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