Skip to main content

Advertisement

SpringerLink
Log in

Comparison of anterior mandible anatomical characteristics between obstructive sleep apnea patients and healthy individuals: a combined cone beam computed tomography and polysomnographic study

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

This study aims to evaluate the morphology of the genial tubercle (GT) and lingual foramen (LF) between obstructive sleep apnea (OSA) and non-OSA patients for considerations of mandibular advancement surgery.

Methods

Cone beam CT records of 198 patients were retrospectively collected and analyzed. Five variables were measured for genial tubercle; anterior mandible thickness (AMT), the distance from the lower incisors to the superior border of the genial tubercle, the distance from the inferior border of the genial tubercle to inferior border of the mandible, the height of GT, and genial tubercle width. Lingual foramen were classified according to the genial tubercle. The frequencies, distances of lingual foramen to alveolar crest, lower border of mandible (LVDL) and diameter of LF were also measured.

Results

Significant differences was found for genial tubercle width, anterior mandible thickness, and the distance of lower mandibular border to the midline lingual foramina between OSA and non-OSA patients (p < 0.05). AMT gets thicker and GT gets narrower in OSA patients (p < 0.05). A linear regression analysis on the apnea hypopnea index with measured anatomical variables showed the LVDL (R = − 0.355*), body mass index (R = 0.254), and age (R = 0.33) showed a statistically significant association (p < 0.05). None of the other variables reached formal significance.

Conclusion

LVDL is linearly associated with sleep apnea severity. The variable dimensions and anatomy of genial tubercle as well as lingual foramen for OSA patients suggest the need of 3D preoperative radiological evaluation before genioglossus advancement surgery. Cone beam CT can be a powerful low radiation dose tool both for evaluating the anatomy of the upper airway and mandibular structures at the same time for OSA patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Salles C, Terse-Ramos R, Souza-Machado A, Cruz AA (2013) Obstructive sleep apnea and asthma. J Bras Pneumol 39(5):604–612

    Article  Google Scholar 

  2. Ogna A, Forni Ogna V, Mihalache A, Pruijm M, Halabi G, Phan O, Cornette F, Bassi I, Haba Rubio J, Burnier M, Heinzer R (2015) Obstructive sleep apnea severity and overnight body fluid shift before and after hemodialysis. Clin J Am Soc Nephrol 10(6):1002–1010

    Article  Google Scholar 

  3. Drakatos P, Karkoulias K, Giannitsas K, Kalogeropoulou C, Papapanagiotou N, Lykouras D, Sampsonas F, Petsas T, Perimenis P, Spiropoulos K (2016) Computed tomography cephalometric and upper airway measurements in patients with OSA and erectile dysfunction. Sleep Breath 20(2):769–776

    Article  Google Scholar 

  4. White DP, Younes MK (2012) Obstructive sleep apnea. Compr Physiol 2(4):2541–2594

    PubMed  Google Scholar 

  5. Hudgel DW (1992) Mechanisms of obstructive sleep apnea. Chest 101(2):541–549

    Article  CAS  Google Scholar 

  6. Oz U, Orhan K, Aksoy S, Ciftci F, Özdoğanoğlu T, Rasmussen F (2016) Association between pterygoid hamulus length and apnea-hypopnea index in patients with obstructive sleep apnea: a combined three-dimensional cone-beam computed tomography and polysomnographic study. Oral Surg Oral Med Oral Pathol Oral Radiol 121(3):330–339

    Article  Google Scholar 

  7. Strollo PJ Jr, Soose RJ, Maurer JT, de Vries N, Cornelius J, Froymovich O, Hanson RD, Padhya TA, Steward DL, Gillespie MB, Woodson BT, Van de Heyning PH, Goetting MG, Vanderveken OM, Feldman N, Knaack L, Strohl KP, STAR Trial Group (2014) Upper-airway stimulation for obstructive sleep apnea. N Engl J Med 370(2):139–149

    Article  CAS  Google Scholar 

  8. Kolsuz ME, Orhan K, Bilecenoglu B, Sakul BU, Ozturk A (2015) Evaluation of genial tubercle anatomy using cone-beam computed tomography. J Oral Sci 57(2):151–156

    Article  CAS  Google Scholar 

  9. Dharia SM, Brown LK, Unruh ML (2013) Recognition and treatment of obstructive sleep apnea. Semin Dial 26(3):273–277

    Article  Google Scholar 

  10. Barbick MB, Dolwick MF (2009) Genial tubercle advancement for obstructive sleep apnea syndrome: a modification of design. J Oral Maxillofac Surg 67(8):1767–1770

    Article  Google Scholar 

  11. Makris N, Stamatakis H, Syriopoulos K, Tsiklakis K, van der Stelt PF (2010) Evaluation of the visibility and the course of the mandibular incisive canal and the lingual foramen using cone-beam computed tomography. Clin Oral Implants Res 21(7):766–771

    Article  Google Scholar 

  12. von Arx T, Matter D, Buser D, Bornstein MM (2011) Evaluation of location and dimensions of lingual foramina using limited cone-beam computed tomography. J Oral Maxillofac Surg 69(11):2777–2785

    Article  Google Scholar 

  13. Sheikhi M, Mosavat F, Ahmadi A (2012) Assessing the anatomical variations of lingual foramen and its bony canals with CONE BEAM CT taken from 102 patients in Isfahan. Dent Res J (Isfahan) 9(Suppl 1):S45–S51

    Google Scholar 

  14. Jafari B, Mohsenin V (2010) Polysomnography. Clin Chest Med 31(2):287–297

    Article  Google Scholar 

  15. American Thoracic Society. Indications and standards for cardiopulmonary sleep studie (1989) Medical section of the American Lung Association. Am Rev Respir Dis 139:559–568

    Article  Google Scholar 

  16. Demiralp KO, Bayrak S, Orhan M, Alan A, Kursun Cakmak ES, Orhan K (2018) Anatomical characteristics of the lingual foramen in ancient skulls: a cone-beam computed tomography study in an Anatolian population. Folia Morphol (Warsz) 77(3):514–520

    Article  CAS  Google Scholar 

  17. Chang PC, Liang K, Lim J, Chung MC, Chien LY (2013) A comparison of the thresholding strategies of micro-CT for periodontal bone loss: a pilot study. Dentomaxillofac Radiol 42:66925194

    Article  Google Scholar 

  18. Neelapu BC, Kharbanda OP, Sardana HK, Balachandran R, Sardana V, Kapoor P, Gupta A, Vasamsetti S (2017) Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: a systematic review and meta-analysis of cephalometric studies. Sleep Med Rev 31:79–90

    Article  Google Scholar 

  19. Sands SA, Eckert DJ, Jordan AS, Edwards BA, Owens RL, Butler JP, Schwab RJ, Loring SH, Malhotra A, White DP, Wellman A (2014) Enhanced upper-airway muscle responsiveness is a distinct feature of overweight/obese individuals without sleep apnea. Am J Respir Crit Care Med 190(8):930–937

    Article  Google Scholar 

  20. Motoyama EK, Finder JD (2011) Respiratory physiology in ınfants and children. In: Davis PJ, Cladis FP, Motoyama EK (eds) Smith’s anesthesia for ınfants and children, 8th edn. Elsevier Mosby, Philadelphia, p 40

    Google Scholar 

  21. Agarwal S, Gaurav I, Agarwal R, Ahluwalia KS (2013) Determination of genial tubercle position and dimensions using cone-beam computerized tomography. Indian J Med Spec 4:29–33

    Article  Google Scholar 

  22. Yin SK, Yi HL, Lu WY, Guan J, Wu HM, Cao ZY, Yu DZ, Huang YY, Wu CG (2007) Anatomic and spiral computed tomographic study of the genial tubercles for genioglossus advancement. Otolaryngol Head Neck Surg 136(4):632–637

    Article  Google Scholar 

  23. Chang ET, Kwon YD, Jung J, Capasso R, Riley R, Liu SC, Camacho M (2019) Genial tubercle position and genioglossus advancement in obstructive sleep apnea (OSA) treatment: a systematic review. Maxillofac Plast Reconstr Surg 41:34

    Article  Google Scholar 

  24. Silverstein K, Costello BJ, Giannakpoulos H, Hendler B (2000) Genioglossus muscle attachments: an anatomic analysis and the implications for genioglossus advancement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 90(6):686–688

    Article  CAS  Google Scholar 

  25. Vanderbeek C, Liu YF, Reichert Z, Thakker J, Collett T, Inman JC (2019) Effect of mandible and maxilla osteotomies on velar, oropharyngeal, and hypopharyngeal diameter. J Oral Maxillofac Surg 77(2):398–404

    Article  Google Scholar 

  26. Prinsell JR (1999) Maxillomandibular advancement surgery in a site specific treatment approach for obstructive sleep apnea in 50 consecutive patients. Chest 116:1519–1529

    Article  CAS  Google Scholar 

  27. Kim CH, Loree N, Han PS, Ostby ET, Kwon DI, Inman JC (2019) Mandibular muscle attachments in genial advancement surgery for obstructive sleep apnea. Laryngoscope

  28. Wang YC, Liao YF, Li HY, Chen YR (2012) Genial tubercle position and dimensions by cone-beam computerized tomography in a Taiwanese sample. Oral Surg Oral Med Oral Pathol Oral Radiol 113:e46–e50

    Article  Google Scholar 

  29. Tepper G, Hofschneider UB, Gahleitner A, Ulm C (2001) Computed tomographic diagnosis and localization of bone canals in the mandibular interforaminal region for prevention of bleeding complications during implant surgery. Int J Oral Maxillofac Implants 16(1):68–72

    CAS  PubMed  Google Scholar 

  30. Gahleitner A, Hofschneider U, Tepper G, Pretterklieber M, Schick S, Zauza K, Watzek G (2001) Lingual vascular canals of the mandible: evaluation with dental CT. Radiology 220(1):186–189

    Article  CAS  Google Scholar 

  31. Liang X, Jacobs R, Lambrichts I, Vandewalle G, van Oostveldt D, Schepers E, Adriaensens P, Gelan J (2005) Microanatomical and histological assessment of the content of superior genial spinal foramen and its bony canal. Dentomaxillofac Radiol 34(6):326–336

    Article  Google Scholar 

  32. Sekerci AE, Sisman Y, Payveren MA (2014) Evaluation of location and dimensions of mandibular lingual foramina using cone-beam computed tomography. Surg Radiol Anat 36(9):857–864

    Article  Google Scholar 

  33. Lang TF (2011) The bone-muscle relationship in men and women. J Osteopor 2011:702735

    Article  Google Scholar 

  34. Frost HM (2000) Muscle, bone, and the Utah paradigm: a 1999 overview. Med Sci Sports Exerc 32(5):911–917

    Article  CAS  Google Scholar 

  35. Mahns DA, Ivanusic JJ, Sahai V, Rowe MJ (2006) An intact peripheral nerve preparation for monitoring the activity of single, periosteal afferent nerve fibres. J Neurosci Methods 156:140–144

    Article  Google Scholar 

  36. Fan W, Bouwense SA, Crawford R, Xiao Y (2010) Structural and cellular features in metaphyseal and diaphyseal periosteum of osteoporotic rats. J Mol Histol 41:51–60

    Article  CAS  Google Scholar 

  37. Elefteriou F, Campbell P, Ma Y (2014) Control of bone remodeling by the peripheral sympathetic nervous system. Calcif Tissue Int 94(1):140–151

    Article  CAS  Google Scholar 

  38. Grassi G, Facchini A, Trevano FQ, Dell’Oro R, Arenare F, Tana F, Bolla G, Monzani A, Robuschi M, Mancia G (2005) Obstructive sleep apnea-dependent and -independent adrenergic activation in obesity. Hypertension 46:321–325

    Article  CAS  Google Scholar 

  39. McArdle N, Hillman D, Beilin L, Watts G (2007) Metabolic risk factors for vascular disease in obstructive sleep apnea: a matched controlled study. Am J Respir Crit Care Med 175:190–195

    Article  CAS  Google Scholar 

  40. Holty C, Guilleminault C (2010) Surgical options for the treatment of obstructive sleep apnea. Med Clin N Am 94:479–515

    Article  Google Scholar 

  41. Passeri LA, Choi JG, Kaban LB, Lahey ET 3rd (2016) Morbidity and mortality rates after maxillomandibular advancement for treatment of obstructive sleep apnea. J Oral Maxillofac Surg 74:2033–2043

    Article  Google Scholar 

Download references

Acknowledgements

The preliminary result of this study is presented at the 3rd International Congress of Oral Diagnosis and Maxillofacial Radiology Society, 25–28 April 2019, Antalya, Turkey.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Near East University, Nicosia, Cyprus

    Mujgan Firincioglulari & Secil Aksoy

  2. Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey

    Kaan Orhan

  3. Department of Orthodontics, Faculty of Dentistry, Near East University, Nicosia, Cyprus

    Ulas Oz

  4. Department of Allergy, Sleep and Respiratory Diseases and Cyprus Sleep Center, Faculty of Medicine, Near East University, Nicosia, Cyprus

    Finn Rasmussen

Authors
  1. Mujgan Firincioglulari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Secil Aksoy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kaan Orhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ulas Oz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Finn Rasmussen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MF, SA and FR. The first draft of the manuscript was written by MF, UO and KO and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mujgan Firincioglulari.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Faculty of Medicine, Ethical Com. (IRB number: 2018/63) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Patients or their legal delegates gave their informed consent prior to radiography and the consent forms were reviewed and approved by the institutional review board of the faculty.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Firincioglulari, M., Aksoy, S., Orhan, K. et al. Comparison of anterior mandible anatomical characteristics between obstructive sleep apnea patients and healthy individuals: a combined cone beam computed tomography and polysomnographic study. Eur Arch Otorhinolaryngol 277, 1427–1436 (2020). https://doi.org/10.1007/s00405-020-05805-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-020-05805-2

Keywords

Search

Navigation