University:
Boston University
Course:
SAR HP 151 | Introduction to Health Professions
Academic year:

2024
Views:

44

Pages:

16
Author:

gotejatsgrr7

MAXILLARY MORPHOLOGY OF PEDIATRIC OSA PATIENTS USING CBCT BACKGROUND • Pediatric obstructive sleep apnea (OSA) is characteristically different from adult OSA, not only in prevalence and etiology, but also in anatomical phenotype, in clinical presentation, and in sequelae. NIGHTTIME SYMPTOMS: Enuresis Sleep terrors Sleep walking NREM parasomnias B E H AV I O RA L C O N C E R N S : D i ffi c u l t y c o n c e n t r a t i n g Poor school perfo rmance Hyperactivity Depression Psychiatric problems D AY T I M E S Y M P T O M S : Morning headaches Excessive daytime sleepiness (EDS) Fa i l u r e t o t h r i v e DECREASED LEVELS OF GROWTH HORMONE BACKGROUND • The characteristic craniofacial morphology that predisposes children to experience sleep disordered breathing has been well studied using lateral cephalometrics, for sagittal and vertical analysis. • Analysis of phenotypes in the transverse dimension have been neglected due to: • inability to view on a 2D lateral ceph • limitations of panoramic films • inherent inaccuracies of a PA-ceph • CBCT scans enable clinicians to view the maxilla and surrounding regions more accurately and precisely in 3D SIGNIFICANCE • Contribution to science & current knowledge of the condition • Assistance to clinical professionals in screening, properly referring, thus diagnosing & treating OBJECTIVE • This study aims to use CBCT scans to analyze in 3D the maxillary dentoskeletal morphology in healthy children, as compared to children with diagnosed obstructive sleep apnea (OSA). HYPOTHESIS • Null Hypothesis (H0): There is no difference between the maxillary skeletal morphology of children with OSA as compared to children without OSA. • Alternative Hypothesis (H1): There is significant difference between the maxillary skeletal morphology of children with OSA as compared to children without OSA. MATERIALS & METHODS • Total n = 83 subjects with CBCT’s and PSGs • Males and females between the ages of 2 – 15 with no prior orthodontic treatment • Categorized into 2 groups: • (+)OSA diagnosis • (-)OSA diagnosis • Evaluation and analysis of CBCT images will be performed using Mimics v.21.0 (Materialise, Leuven, Belgium). Total n = 98 + OSA - OSA n = 35 n = 48 M F M F 23 12 34 14 DATA COLLECTION Land- Description mark 1,2 Second deciduous molar, or second permanent premolar measured at the alveolar crest at the most palatal aspect (L/R) 3,4 Second deciduous molar, or second permanent premolar measured at the alveolar crest at the most buccal aspect (L/R) 5,6 Second deciduous molar, or second permanent premolar measured at the central fossa (L/R) 7,8 Second deciduous molar, or second permanent premolar measured at the furcation (L/R) 9,10 Permanent or deciduous canine measured at the alveolar crest at the most palatal aspect (L/R) 11,12 Permanent or deciduous canine measured at the cusp tip (L/R) 13,14 Permanent or deciduous canine measured at the apex (L/R) 15,16 Greater palatine foramen (L/R) 17,18 Zygomatico-maxillary suture anterior (L/R) 19,20 Zygomatico-maxillary suture posterior superior (L/R) 21,22 Zygomatico-maxillary posterior inferior (L/R) 23 Nasofrontal suture anterior 24,25 Nasofrontal suture (L/R) 26,27 Pterygoid Process anterior (L/R) 28,29 Pterygoid Process posterior medial (L/R) 30,31 Pterygoid Process posterior lateral (L/R) 32 Vomer superior 33 Vomer inferior (L/R) DATA COLLECTION – PART 1 Line 1-2 3-4 5-6 7-8 9-10 1112 1314 1516 2627 Point 1 Second deciduous molar, or second permanent premolar measured at the alveolar crest at the most palatal aspect (R) Second deciduous molar, or second permanent premolar measured at the alveolar crest the most buccal aspect (R) Second deciduous molar, or second permanent premolar measured at the central fossa (R) Second deciduous molar, or second permanent premolar measured at the furcation (R) Permanent or deciduous canine measured at the alveolar crest at the most palatal aspect (R) Permanent or deciduous canine measured at the cusp tip (R) Point 2 Second deciduous molar, or second permanent premolar measured at the alveolar crest at the most palatal aspect (L) Second deciduous molar, or second permanent premolar measured at the alveolar crest the most buccal aspect (L) Second deciduous molar, or second permanent premolar measured at the central fossa (L) Second deciduous molar, or second permanent premolar measured at the furcation (L) Permanent or deciduous canine measured at the alveolar crest at the most palatal aspect (L) Permanent or deciduous canine measured at the cusp tip (L) Permanent or deciduous canine measured at the apex (R) Permanent or deciduous canine measured at the apex (L) Greater palatine foramen (R) Greater palatine foramen (L) Pterygoid process anterior (R) Pterygoid process anterior (L) DATA COLLECTION – PART 1 DATA COLLECTION – PART 2 Plane Zygomatico-maxillary Suture (Left) Zygomatico-maxillary Suture (Right) Nasofrontal Suture Point 1 Zygomatico-maxillary anterior (Left) Zygomatico-maxillary anterior (Right) Nasofrontal Anterior Point 2 Zygomatico-maxillary posterior superior (Left) Zygomatico-maxillary posterior superior (Right) Nasofrontal Left Point 3 Zygomatico-maxillary posterior inferior (Left) Zygomatico-maxillary posterior inferior (Right) Nasofrontal Right Pterygoid Process (Left) Pterygoid Process Anterior (Left) Pterygoid Process (Right) Pterygoid Process Anterior (Right) Vomer (Midway) Vomer Superior Pterygoid Process Posterior Medial (Left) Pterygoid Process Posterior Medial (Right) Vomer Inferior (Left) Pterygoid Process Posterior Lateral (Left) Pterygoid Process Posterior Lateral (Right) Vomer Inferior (Right) DATA COLLECTION – PART 2 RESULTS – PART 1 • Students t-test No OSA OSA Variables MD Mean Age SD Median IQR Mean SD Median SD P-Value IQR 6.86 2.35 6.77 3.63 6.94 2.38 7.11 3.62 -0.09 2.36 0.87 C or 3 Apex 29.30 2.72 29.22 3.64 28.20 4.70 29.12 5.66 1.10 3.67 0.18 C or 3 Cusp tip 30.10 2.96 29.29 4.20 29.25 4.94 29.71 6.25 0.85 3.80 0.34 C or 3 Palatal 23.43 2.55 23.16 3.58 22.89 3.25 22.88 4.82 0.54 2.86 0.40 E Alveolar 29.36 2.96 29.13 4.45 28.17 3.06 28.16 4.30 1.19 3.00 0.08 E Central Fossa 40.11 3.33 39.78 4.57 39.23 3.65 39.28 5.13 0.88 3.47 0.26 E Furcation 39.73 2.94 39.52 4.26 38.39 3.26 38.12 5.06 1.34 3.08 0.06 Greater Palatine 25.85 2.22 25.69 3.06 25.16 3.33 24.89 5.59 0.70 2.73 0.26 Maxillary Base 48.88 3.07 49.32 4.70 48.16 3.98 47.86 5.99 0.72 3.48 0.36 RESULTS – PART 1 • Logistic Regression Analysis Variables Odds Ratio 95% CI P-Value C or 3 Apex 0.916 0.804 1.04 0.19 C or 3 Cusp tip 0.933 0.820 1.06 0.29 C or 3 Palatal 0.927 0.782 1.10 0.39 E Alveolar 0.838 0.699 1.00 0.06 E Central Fossa 0.905 0.775 1.06 0.20 E Furcation 0.805 0.664 0.98 0.03 Greater Palatine 0.870 0.708 1.07 0.18 Maxillary Base 0.918 0.781 1.08 0.30 RESULTS – PART 2 • Pending CONCLUSION • Of the eight linear values measured, no measurement was found to have a statistically significant difference between positive and negative groups (p > 0.05). • Results are inconclusive as all parameters of the study have not been tested. According to the linear measurements analyzed so far, we have yet to determine a significant difference between the maxillary dentoskeletal morphology of children with OSA as compared to children without OSA. • Future studies look to increase landmarks and parameters to discover any associations

Maxillary Morphology of Pediatric Osa Patients Using CBCT

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