Balakrishnan Jayan

Evaluation of upper airway dimensional changes and hyoid position following mandibular advancement in patients with skeletal class II malocclusion.

Background Class II skeletal malocclusion due to mandibular deficiency is considered a risk factor for sleep disorders due to oropharyngeal airway deficiencies. In view of the above, a prospective interventional study was undertaken to evaluate upper airway dimensional changes and position of hyoid bone by comparing pretreatment and posttreatment lateral cephalograms. The objective also included the establishment of the ratio of mandibular advancement to increase in airway dimensions. Patients and Methods Pretreatment and posttreatment lateral cephalograms of 20 adults (13 females and 7 males) with skeletal class II malocclusion treated by combined orthodontics and bilateral sagittal split ramus osteotomy was evaluated for changes in posterior airway space (PAS), superior airway space (SAS), minimum airway space (MAS), hyoid bone position (MP-H), effective mandibular length (Co-Gn), mandibular corpus length (Go-Pg), and pogonion position (N perpendicular-Pg). The cephalograms were manually traced by a single operator and the data analyzed using MINITAB 13.2 version software. Results There was a statistically highly significant (P = 0.0001) increase in PAS, SAS, MP-H, Co-Gn, and Go-Pg. The mean ratio of mandibular advancement to increase PAS, SAS, and MAS was 1:0.35, 1:0.34, and 1:0.24, respectively. Hyoid bone moved superiorly and in an anterior direction by 2.1 ± 2.8 mm and was found to be statistically highly significant (P = 0.0001). Conclusions The study showed an overall increase in airway dimension and improvement in hyoid position. Thus, the procedure may be considered beneficial in reducing upper airway collapsibility and preventing sleep disorders due to oropharyngeal airway deficiencies in skeletal class II malocclusion.

Stabilisation of cleft maxilla using modified technique during bi-jaw orthognathic surgical procedures with simultaneous use of two stage surgical splints

Maj S.S. Agarwal , Brig B. Jayan , Brig N.K. Sahoo , Maj Amrit Thapa d a Resident (Orthodontics), Dept of Dental Surg, Armed Forces Medical College, Pune 411040, India b Consultant (Orthodontics), Army Dental Centre (R&R), Delhi Cantt, India c Professor & Head, Dept of Dental Surg, Armed Forces Medical College, Pune 411040, India d Graded Specialist (Orthodontics), Command Military Dental Centre (Central Command), Lucknow, India

Evaluation of Therapeutic Efficacy of Adjustable Mandibular Advancement Device in the Management of Obstructive Sleep Apnea

Background: Medical Dental Sleep Appliance (MDSA) is an adjustable MAD recommended for treatment of snoring and OSA. There are very few studies on Indian population which evaluate the therapeutic efficacy of mandibular advancement devices in the management of OSA. Material and methods: A prospective clinical study was carried out. 20 Polysomnography diagnosed Obstructive Sleep Apnea patients fulfilling the inclusion and exclusion criteria were treated with MDSA and changes in pre and post treatment sleep parameters (AHI, ESS) were recorded. Results: Mean differences in Pre-treatment (T1 = 30.7 ± 5.0) and post-treatment (T2 = 17.2 ± 3.9) AHI values and ESS pre-treatment (T1 = 17.2 ± 0.6) and post-treatment (T2 = 10.9 ± 0.9) were highly statistically significant (p < 0.001). Clinically the maximum improvement was observed in mild and moderate OSA cases. Although significant clinical improvement was also observed in severe OSA cases, the post treatment AHI and ESS were still high. Conclusion: MDSA is a non invasive, low risk and cost-effective treatment option for patients suffering from mild and moderate obstructive sleep apnea and also in cases of severe OSA who are not comfortable with CPAP or not willing for surgery.

Effect of the personality traits of the patient on pain perception and attitude toward orthodontic treatment

Objective: The objective was to evaluate the relationship between personality traits, pain perception, and person′s attitude toward orthodontic treatment. Materials and Methods: The sample comprised of two groups: Group 1 consisted of 100 treated subjects (50 males, 50 females; average age, 16.07 ± 1.36 years), and Group 2 consisted of 100 untreated subjects (50 males, 50 females; average age, 16.07 ± 1.41 years). The instrument for data collection was a questionnaire that included an assessment of patients′ personality profiles, pain expectation for untreated subjects, pain experience for treated subjects, and attitude toward orthodontic treatment. Results: Gender and treatment status did not affect pain perception and attitude of a person toward orthodontic treatment. There was a strong relationship between pain perception and attitude with Pearson′s correlation of 0.367 and P ≤ 0.0001. With one unit increase in attitude there was 0.43 units increase in pain. Patients with high levels of trait neuroticism (P = 0.01) and low levels of trait conscientiousness (P = 0.02) experienced more pain. Patients with high levels of trait conscientiousness showed better attitude (P = 0.01). Conclusion: Personality traits, neuroticism, and conscientiousness have effect on pain perception and attitude of patients toward orthodontic treatment. Patients with better attitude experienced less pain and patients with less pain exhibited better attitude.

Cervical vertebral anomalies in patients with obstructive sleep apnea

Objective: The aim of this study was to find an association between the patients with obstructive sleep apnea (OSA) and with cervical vertebral anomalies and any further correlation between various anomalies with varying severities of OSA. Materials and Methods: The sample consisted lateral cephalograms of 70 subjects who were diagnosed with OSA and 70 other orthodontic patients who were selected as a control group. The lateral radiographs of both cases and controls were traced and findings were recorded. Results: In total, 21.42% of subjects in the OSA group and 8.57% in the control group were affected with cervical vertebrae anomalies. The statistical analysis reveals that the number of subjects affected with cervical vertebrae anomalies in OSA group is highly significant. A number of cases of fusion were higher than posterior arch deficiency in OSA group and equal in the control group. However, in both the groups, the number of cases with two vertebrae fusion was higher. Further, the higher number of two vertebrae fusion cases in OSA group was found to be statistically significant. The findings of one-way ANOVA for OSA cases reveals the number of cases affected with cervical vertebrae anomalies were statistically highly significant (P < 0.01) in severe cases of OSA. Conclusion: Patients of cervical vertebral anomalies may be at higher risk of developing OSA, and the possibility of the presence of cervical vertebral anomalies may increase with the increase in the severity of OSA. The most common vertebral anomaly was found to be two vertebral fusions.