Korean J Orthod.  2017 Nov;47(6):353-364. 10.4041/kjod.2017.47.6.353.

Investigation of the effects of miniscrew-assisted rapid palatal expansion on airflow in the upper airway of an adult patient with obstructive sleep apnea syndrome using computational fluid-structure interaction analysis

Affiliations
  • 1Department of Orthodontics, School of Dentistry, Seoul National University, Seoul, Korea. drwhite@unitel.co.kr
  • 2Department of Mechanical Engineering, Soongsil University, Seoul, Korea.
  • 3Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea.
  • 4Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea.

Abstract


OBJECTIVE
The objective of this study was to investigate the effects of miniscrew-assisted rapid palatal expansion (MARPE) on changes in airflow in the upper airway (UA) of an adult patient with obstructive sleep apnea syndrome (OSAS) using computational fluid-structure interaction analysis.
METHODS
Three-dimensional UA models fabricated from cone beam computed tomography images obtained before (T0) and after (T1) MARPE in an adult patient with OSAS were used for computational fluid dynamics with fluid-structure interaction analysis. Seven and nine cross-sectional planes (interplane distance of 10 mm) in the nasal cavity (NC) and pharynx, respectively, were set along UA. Changes in the cross-sectional area and changes in airflow velocity and pressure, node displacement, and total resistance at maximum inspiration (MI), rest, and maximum expiration (ME) were investigated at each plane after MARPE.
RESULTS
The cross-sectional areas at most planes in NC and the upper half of the pharynx were significantly increased at T1. Moreover, airflow velocity decreased in the anterior NC at MI and ME and in the nasopharynx and oropharynx at MI. The decrease in velocity was greater in NC than in the pharynx. The airflow pressure in the anterior NC and entire pharynx exhibited a decrease at T1. The amount of node displacement in NC and the pharynx was insignificant at both T0 and T1. Absolute values for the total resistance at MI, rest, and ME were lower at T1 than at T0.
CONCLUSIONS
MARPE improves airflow and decreases resistance in UA; therefore, it may be an effective treatment modality for adult patients with moderate OSAS.

Keyword

Miniscrew-assisted rapid palatal expansion; Obstructive sleep apnea syndrome; Computational fluid dynamics; Fluid-structure interaction

MeSH Terms

Adult*
Cone-Beam Computed Tomography
Humans
Hydrodynamics
Nasal Cavity
Nasopharynx
Oropharynx
Pharynx
Sleep Apnea, Obstructive*

Figure

  • Figure 1 Three-dimensional models of the upper airway. T0 (A, green), T1 (B, yellow) and superimposition (C) of the models showing the locations of seven planes in the nasal cavity and nine planes in the pharynx. The superimposition was performed with the best-fit method using the anterior cranial base of T0 and T1 models, making the other structures invisible, then showing the upper airway only. Comparison of the cross sectional airway area between T0 (D and E) and T1 (F and G) at sections from ① to ⑦ in nasal cavity (D and F, from left to right) and from ① to ⑨ in Pharynx (E and G, from left to right).

  • Figure 2 Respiratory cycle used for fluid-structure interaction simulation to investigate the effects of miniscrew-assisted rapid palatal expansion on the upper airway airflow in an adult patient with obstructive sleep apnea syndrome. Total duration of one cycle, 5 seconds. Maximum inspiration at 1.080 seconds, rest at 1.730 seconds, and maximum expiration at 2.805 seconds.

  • Figure 3 Changes in airflow pressure in the nasal cavity and pharynx at maximum (Max.) inspiration, rest, and Max. expiration after miniscrew-assisted rapid palatal expansion (MARPE) in an adult patient with obstructive sleep apnea syndrome.

  • Figure 4 Changes in airflow velocity in the nasal cavity and pharynx at maximum (Max.) inspiration, rest, and Max. expiration after miniscrew-assisted rapid palatal expansion (MARPE) in an adult patient with obstructive sleep apnea syndrome.

  • Figure 5 Changes in node displacement in the soft tissue of the airway wall at maximum (Max.) inspiration, rest, and Max. expiration after miniscrew-assisted rapid palatal expansion (MARPE) in an adult patient with obstructive sleep apnea syndrome.


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