Kazumi Okamoto

Mechanism of action and therapeutic indication of prosthetic mandibular advancement in obstructive sleep apnea syndrome.

Abstract Prosthetic mandibular advancement (PMA) was applied to nine patients with obstructive sleep apnea syndrome (OSAS) and its therapeutic usefulness, mechanism of action, and clinical indication were discussed based on polysomnographic findings and serial examination of upper airway before and during PMA treatment. Apnea hypopnea index significantly decreased during PMA treatment compared with the value before treatment (P < 0.01) and the rate of the treatment responder counted 78.1%. Cephalometric variables indicated forward and inferior advancement of mandible in our subjects. Magnetic resonance imaging of the upper airway during sleep revealed a marked improvement of velopharyngeal obstruction in most subjects. In addition, intraesophageal negative pressure during sleep decreased significantly. Our results confirmed the high therapeutic efficacy of PMA for OSAS and indicated forward advancement of the mandible and decrease of negative pressure loading on upper airway with PMA might suppress velopharyngeal collapse. Thus, PMA was regarded as one of the treatments of choice for OSAS occurring based on with velopharyngeal narrowing.

Clinical efficacy of prosthetic mandibular advancement on obstructive sleep apnea syndrome

In order to clarify the efficacy and indication of prosthetic mandibular advancement (PMA) on obstructive sleep apnea syndrome (OSAS), we made a comparison of both the polysomnographic findings and the upper airway configuration between before and during PMA on 19 OSAS patients. During PMA, there was a significant decreased apnea hypopnea index compared to before treatment. The changes in magnetic resonance imaging of the upper airway during sleep with PMA indicated that the treatment is regarded to be the first choice for OSAS patients with glossopharyngeal obstruction. In addition to that, the treatment might be considered for use in velopharyngeal obstruction.

A case of cystic lymphangioma. OK-432 local injection therapy and application of a chin-cap.

A 3-year-old boy was referred to our clinic with swelling of the neck, submandibular region and tongue. The patient had been previously treated in our clinic with local injection of bleomycin. We therefore resected the neck tumor and performed tongue reduction. After the operation, the patient was applied a chin-cap to manage progenia and open bite which were caused by congenital swelling of the tongue. Application of the chin-cap for 3 years brought about cure of the progenia and open bite. At the age of 7 years and 6 months, a huge cystic lymphangioma appeared in the parapharyngeal space. MRI was very effective in allowing us to estimate the characteristics of this cystic lymphangioma of the parapharyngeal space. Fortunately, OK-432 local injection therapy was effective for the lymphangioma, and no recurrence has been noted for 2 years and 3 months.