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To assess the craniofacial morphology in children with sleep-disordered breathing (SDB) using nonradiation and readily accessible photogrammetry technique.Included children aged 3-18 years with SDB-related symptoms from April 2019 to February 2020 in a tertiary center. All participants underwent craniofacial photogrammetry and overnight polysomnography (PSG). Participants were stratified into 2 groups (obstructive sleep apnea [OSA] group: apnea-hypopnea index [AHI] ≥ 1 and non-OSA group: AHI1). Craniofacial photogrammetry was performed to derive variables of craniofacial features in standardized frontal and profile views. The 2 groups were propensity score matched based on age, sex, and body mass index (BMI) percentiles. Associations between craniofacial feature variables and OSA (AHI ≥1) likelihood were examined using logistic regression test. intraclass correlation coefficient (ICC) was used to evaluate the intrarater and interrater reliability.In total, 58 children were enrolled for the analysis after matching. All 3 variables representing the mandibular plane angle in the profile view were increased in the OSA group (mego-tn: 34.85 ± 5.99 vs 31.65 ± 5.96°, odds ratio [OR]: 1.10, 95% CI:1.02 to 1.18, P = .01; tn-gogn: 28.65 ± 6.38 vs 25.91 ± 5.38°, OR: 1.08, 95% CI:1.02 to 1.15, P = .012; and gome-tsup: 26.71 ± 6.13 vs 22.20 ± 5.89°, OR: 1.13, 95% CI:1.04 to 1.23, P = .003).Craniofacial photogrammetry revealed increased mandibular inclination in children with OSA. A steep mandibular plane with craniofacial photogrammetry is considered a potential predictor of pediatric OSA. Further investigation with a large sample size is required to clarify the validity of photogrammetry in evaluating pediatric OSA.

IMPORTANCE: Early intervention using cone-beam computed tomography (CBCT) and adenotonsillectomy for children with obstructive sleep apnea (OSA) may prevent impaired growth, adverse cardiovascular consequences, learning deficits, and poor quality of life. OBJECTIVE: To assess changes in CBCT airway measurements and polysomnography (PSG) parameters that occur after adenotonsillectomy in children with OSA and to determine whether CBCT changes are correlated with apnea-hypopnea index (AHI) reduction. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study was conducted at a tertiary medical center from 2013 to 2016. Children aged 7 to 13 years with PSG-confirmed OSA (ie, AHI ≥1) were recruited. Data analysis was performed from March to July 2021. EXPOSURES: All participants underwent CBCT and PSG before and after adenotonsillectomy. MAIN OUTCOMES AND MEASURES: Changes in PSG and CBCT parameters after adenotonsillectomy were analyzed. RESULTS: A total of 49 children (mean [SD] age, 9.5 [1.8] years; 34 boys [69.4%]) were recruited. Eighteen participants (36.7%) had obesity. After adenotonsillectomy, AHI significantly decreased from 11.4 to 1.2 events per hour (mean difference, −10.24 events per hour; 95% CI, −13.84 to −6.64 events per hour). The following CBCT parameters significantly increased: total airway volume (from 11 265 to 15 161 mm(3); mean difference, 3896.6 mm(3); 95% CI, 2788.0 to 5005.2 mm(3)), nasopharyngeal volume (from 2366 to 3826 mm(3); mean difference, 1459.7 mm(3); 95% CI, 1122.9 to 1796.5 mm(3)), minimal nasopharyngeal airway area (from 128 to 191 mm(2); mean difference, 63.1 mm(2); 95% CI, 47.4 to 78.8 mm(2)), mean nasopharyngeal airway area (from 144 to 231 mm(2); mean difference, 86.8 mm(2); 95% CI, 67.0 to 106.5 mm(2)), oropharyngeal volume (from 8898 to 11 335 mm(3); mean difference, 2436.9 mm(3); 95% CI, 1477.0 to 3396.8 mm(3)), minimal oropharyngeal airway area (from 82 to 158 mm(2); mean difference, 76.2 mm(2); 95% CI, 57.0 to 95.4 mm(2)), and mean oropharyngeal airway area (from 182 to 234 mm(2); mean difference, 52.5 mm(2); 95% CI, 33.6 to 71.4 mm(2)). Among all parameters, only body mass index percentile showed large effect size between the group with residual OSA (postoperative AHI ≥1) and the group with resolved disease, with the residual OSA group having a higher body mass index percentile (87.8 vs 61.4; mean difference, 26.33; 95% CI, 10.00 to 42.66). A quantile regression model revealed that total airway volume and minimal oropharyngeal airway area were significantly correlated with reductions in AHI. CONCLUSIONS AND RELEVANCE: These findings suggest that in children undergoing adenotonsillectomy, improvements in total airway volume and oropharyngeal minimal airway area were correlated with reduction of AHI. Future studies are needed to assess whether CBCT has a role in the evaluation of children with OSA who are being considered for adenotonsillectomy.

Masticatory muscle thickness provides objective measurements of the oral motor function, which may change in patients with oral myofascial pain. In this study, we aimed to establish a reliable ultrasound (US) protocol for imaging the superficial and deep masticatory muscles and to identify the potential influencers of the measurements. Forty-eight healthy participants without orofacial pain were enrolled. The intra-and inter-rater reliabilities of US measurements for masseter, temporalis, and lateral pterygoid muscles were assessed. Intraclass correlation coefficients for all muscles were greater than 0.6. The generalised estimating equation was used to analyse the impact of age, gender, laterality, and body mass index on the measurements, whereby age and body mass index were likely to be associated with an increase in masticatory muscle thickness. The thickness tended to be lesser in females. Laterality seemed to exert minimal influence on masticatory muscle thickness. Our study shows acceptable reliability of US in the evaluation of superficial and deep masticatory muscle thickness. Future studies are warranted to validate the usefulness of US imaging in patients with oral myofascial pain syndrome.

OBJECTIVE Cone-beam computed tomography (CBCT) offers three-dimensional structures in assessing upper airway of patients. This study aims to compare the cone-beam computerized tomography scan measurements between children with obstructive sleep apnea (OSA) and primary snoring. STUDY DESIGN Case-control study. METHODS This prospective study was conducted in a tertiary referral center. Thirty-six children with moderate-to-severe OSA (with apnea-hypopnea index [AHI] > 5 events/hour) and 36 age-, gender-, and obesity-matched children with primary snoring (AHI

Dynamic magnetic resonance imaging (MRI) allows real-time characterization of upper airway collapse in sleeping subjects with obstructive sleep apnea (OSA). The aim of our study was to use sleep MRI to compare differences in upper airway collapse sites between BMI-matched subjects with mild OSA and severe OSA. This is a prospective, nested case–control study using dynamic sleep MRI to compare 15 severe OSA subjects (AHI >40) and 15 mild OSA (AHI

Objectives Using sleep MRI, we aimed to identify static craniofacial measurements and dynamic upper airway collapse patterns associated with severe obstructive sleep apnoea (OSA) during natural sleep in age and BMI-matched patients. Design Nested case–control study. Setting Sleep MRI images (3.0 Tesla scanner) and synchronised acoustic recording were used to observe patterns of dynamic airway collapse in subjects with mild and severe OSA. Midsagittal images were also used for static craniofacial measurements. Participants Fifteen male subjects with severe OSA (mean AHI 70.3 ± 23 events/h) were matched by age and BMI to 15 subjects with mild OSA (mean AHI 7.8 ± 1.4 events/h). Subjects were selected from a consecutive sleep MRI study cohort. Main outcome measures Static craniofacial measurements selected a priori included measurements that represent maxillomandibular relationships and airway morphology. Axial, sagittal and coronal views of the airway were rated for dynamic collapse at retropalatal, retroglossal and lateral pharyngeal wall regions by blinded reviewers. Bivariate analysis was used to correlate measures associated with severity of OSA using AHI. Statistical significance was set at P

OBJECTIVE The aim of this study was to analyse morphological changes in the upper airways in patients with anterior open bite treated with temporary anchorage devices for intrusion of upper posterior teeth. MATERIALS AND METHODS Twelve nonobese (body mass index

Background/PurposeCone-beam computed tomography (CBCT) can provide valuable data for root canal systems of human teeth in vivo. This study used CBCT to evaluate the number of roots and canals of 300 mandibular first premolars in 150 northern Taiwanese patients.MethodsThe root canal systems of 300 mandibular first premolars in 150 northern Taiwanese patients with bilateral premolars were analyzed by CBCT.ResultsOf the 300 mandibular first premolars, 197 (65.7%) had one root with one canal (1R1C), 49 (16.3%) had one root with two canals (1R2C), 51 (17.0%) had two roots with one canal in each root (2R2C), and three (1.0%) had three roots with one canal in each root (3R3C). Statistical analyses showed that women had a significantly higher incidence of 1R1C mandibular first premolars (71.4%) than men (58.8%, p = 0.031), and men had a significantly higher incidence of 2R2C mandibular first premolars (27.2%) than women (8.5%, p

Background Cephalometric radiography has been used for orthodontic and surgical treatment planning and assessment, and for quantifying mandibular growth. However, it remains unclear how head positioning errors and the level of examiner experience affect the reliability of such morphometric measurements. The current study aimed to bridge the gap by determining the intra-, inter-rater, and inter-session reliability of measurements of mandibular morphology with random head positioning errors as measured by a junior and a senior dentist. Methods Cone-beam computed tomography data of twelve mandibles were obtained with each rotated randomly away from the neutral position within the range of +3 and −3° along each of the anatomical axes to simulate six imaging trials. A synthetic cephalogram for each trial was obtained via a digitally reconstructed radiography (DRR) technique and eleven landmarks for twelve morphological parameters on the cephalogram were identified manually six times by a junior and a senior dentist. The procedure was repeated on another day within 5 days. Test–retest reliability was assessed in terms of an intra-class correlation coefficient (ICC) using a two-way mixed-effects model. Results Good to very good intra-rater (senior: ICC > 0.92; junior: ICC > 0.78), inter-rater (ICC > 0.70 for most parameters) and inter-session reliability (senior: ICC > 0.84; junior: ICC > 0.62) were found. Bland & Altman plots of inter-rater comparisons show that there were systematical biases between the examiners on most parameters, except for the distance between Gonion and Pogonion. Conclusions The current results suggest that good to very good intra-rater, inter-rater and inter-session reliability can be achieved for most parameters with randomized head positioning errors; higher inter-session reliability can be achieved by more experienced examiners; and that long-term monitoring of mandibular growth based on cephalographic measurements should be made by the same more experienced examiner. The current DRR-based approach can be used to evaluate individual factors that affect the morphological measurements.

Progressive narrowing of the upper airway increases airflow resistance and can produce snoring sounds and apnea/hypopnea events associated with sleep-disordered breathing due to airway collapse. Recent studies have shown that acoustic properties during snoring can be altered with anatomic changes at the site of obstruction. To evaluate the instantaneous association between acoustic features of snoring and the anatomic sites of obstruction, a novel method was developed and applied in nine patients to extract the snoring sounds during sleep while performing dynamic magnetic resonance imaging (MRI). The degree of airway narrowing during the snoring events was then quantified by the collapse index (ratio of airway diameter preceding and during the events) and correlated with the synchronized acoustic features. A total of 201 snoring events (102 pure retropalatal and 99 combined retropalatal and retroglossal events) were recorded, and the collapse index as well as the soft tissue vibration time were significantly different between pure retropalatal (collapse index, 24 ± 11%; vibration time, 0.2 ± 0.3 s) and combined (retropalatal and retroglossal) snores (collapse index, 13 ± 7% [P ≤ 0.0001]; vibration time, 1.2 ± 0.7 s [P ≤ 0.0001]). The synchronized dynamic MRI and acoustic recordings successfully characterized the sites of obstruction and established the dynamic relationship between the anatomic site of obstruction and snoring acoustics.

Obstructive sleep apnea syndrome (OSAS) is caused by multi-level upper airway obstruction. Anatomic changes at the sites of obstruction may modify the physical or acoustic properties of snores. The surgical success of OSA depends upon precise localization of obstructed levels. We present a case of OSAS who received simultaneous dynamic MRI and snore acoustic recordings. The synchronized image and acoustic information successfully characterize the sites of temporal obstruction during sleep-disordered breathing events.

This study investigated whether the presence of tooth wear in young adults can help to discriminate patients with sleep bruxism (SB) from control subjects.The tooth wear clinical scores and frequency of sleep masseter electromyographic activity of 130 subjects (26.6 +/- 0.5 years) were compared in this case-control study. Tooth wear scores (collected during clinical examination) for the incisors, canines, and molars were pooled or analyzed separately for statistics. Sleep bruxers (SBrs) were divided into two subgroups according to moderate to high (M-H-SBr; n = 59) and low (L-SBr; n = 48) frequency of masseter muscle contractions. Control subjects (n = 23) had no history of tooth grinding. The sensitivity and specificity of tooth wear versus SB diagnosis, as well as positive and negative predictive values (PPV and NPV), were calculated. One-way analysis of variance and the Mann-Whitey U test were used to compare groups.Both SBr subgroups showed significantly higher tooth wear scores than the control group for both pooled and separated scores (P.001). No difference was observed between M-H-SBr and L-SBr frequency groups (P = .14). The pooled sum of tooth wear scores discriminates SBrs from controls (sensitivity = 94%, specificity = 87%). The tooth wear PPV for SB detection was modest (26% to 71%) but the NPV to exclude controls was high (94% to 99%).Although the presence of tooth wear discriminates SBrs with a current history of tooth grinding from nonbruxers in young adults, its diagnostic value is modest. Moreover, tooth wear does not help to discriminate the severity of SB. Caution is therefore mandatory for clinicians using tooth wear as an outcome for SB diagnosis.

Objective To assess the effects of epigallocatechin-3-gallate (EGCG) on oncostatin M (OSM)–induced CCL2 synthesis and the associated signaling pathways in human osteoblastic cells. The therapeutic effect of EGCG on collagen-induced arthritis (CIA) in rats was also studied. Methods CCL2 and c-Fos messenger RNA expression was analyzed by Northern blotting. The modulating effects of EGCG on the activation of Raf-1, Akt, and phosphatidylinositol 3-kinase (PI 3-kinase) were examined by coimmunoprecipitation, Western blotting, and PI 3-kinase activity assay. Interactions between c-Fos and CCL2 promoter were evaluated by electrophoretic mobility shift assay (EMSA) and chromatin immunoprecipitation (ChIP) assay. The effect of EGCG on CIA in rats was examined clinically and immunohistochemically. Results EGCG inhibited OSM-stimulated CCL2 expression in primary human osteoblasts and MG-63 cells. In MG-63 cells, EGCG alleviated the OSM-induced phosphorylation of Raf-1 at Ser338 but restored the dephosphorylation of Raf-1 at Ser259. EGCG increased the activity of PI 3-kinase, the level of phosphorylated Akt (Ser473), and binding between Raf-1 and active Akt. EMSA and ChIP assay revealed that EGCG attenuated activator protein 1 (AP-1)–CCL2 promoter interaction, possibly by reducing c-Fos synthesis. Codistribution of CD68+ macrophages and CCL2+ osteoblasts in osteolytic areas was obvious in the CIA model. Administration of EGCG markedly diminished the severity of CIA, macrophage infiltration, and the amount of CCL2-synthesizing osteoblasts. Conclusion By stimulating PI 3-kinase activity, EGCG promoted Akt/Raf-1 crosstalk, resulting in decreased AP-1 binding to CCL2 promoter, and finally reduced CCL2 production in osteoblasts. EGCG alleviated the severity of CIA, probably by suppressing CCL2 synthesis in osteoblasts to diminish macrophage infiltration. Our data support the therapeutic potential of EGCG on arthritis.

To compare the results of 3 methods of recognizing internal derangements with a clicking sound on condylar movement: 2 function-based methods (clinical examination and condylar movement recording) and 1 anatomy-based method (magnetic resonance imaging [MRI]).For the recognition of an anterior or posterior disc displacement with reduction and of hypermobility within the temporomandibular joint (TMJ), 42 participants underwent a clinical examination, an opto-electronic movement recording, and an MRI scan. The examinations were executed in a single-blind design, with different experienced examiners for each technique. In addition, for 10 randomly chosen participants, the condylar movement recordings and the MRI scans were carried out twice. Without the examiners' knowledge, these second recordings were added to the other data.Intraobserver reliability for the recognition of internal derangements was excellent for condylar movement recording (kappa = 0.86) and fair to good for MRI (kappa = 0.73). Intermethod agreement was fair to good (kappa = 0.59) between the 2 function-based techniques. However, intermethod agreement between the anatomy-based MRI technique and either of the 2 function-based techniques was poor (for condylar movement recording, kappa = 0.15; and for clinical examination, kappa = 0.12).There is a great discrepancy between the diagnoses for internal derangements based upon anatomical TMJ characteristics and those based on functional TMJ characteristics. For a function-based diagnosis, there is probably no need for the sophisticated technique of condylar movement recording, since that method shows fair to good agreement with a carefully performed clinical examination.

Temporomandibular joint (TMJ) discs displaced simultaneously, dorsoventrally, and mediolaterally are assumed to be rotated. However, a pilot study performed with individualized oblique-axial scans on supposedly rotated discs did not show disc rotation consistently. The aim of this study was the quantitative evaluation of disc rotation on a larger sample size, assessing the mediolateral disc geometry and position by the use of a reference system determined by the condylar long axis.Eighty-five TMJs from 50 subjects were analyzed. One series of sagittal and 1 of 14 individualized oblique-axial magnetic resonance (MR) scans were taken for each joint. The dorsoventral disc position was diagnosed by means of the sagittal scans. The mediolateral disc width and position were then measured on every oblique-axial scan. The width and midline was computed for each disc and its deviation from the perpendicular to the condylar long axis was calculated. Finally, a statistical analysis was performed to study whether the disc width and the direction of the disc midline varied between discs normally positioned and anteriorly displaced.The disc width varied significantly more within the anteriorly displaced discs than within the normal ones. The midline of the anteriorly displaced discs deviated more from the perpendicular to the condylar long axis than that of normally positioned discs and was mostly in a lateral direction. The disc midline also deviated more in the ventral than in the dorsal part of the disc.Most anteriorly displaced discs were laterally displaced and showed a larger width variation than normally positioned discs. This fact seems to indicate disc deformation.