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Dive into the research topics where Walter Hochban is active.

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Featured researches published by Walter Hochban.


Plastic and Reconstructive Surgery | 1997

Surgical maxillofacial treatment of obstructive sleep apnea.

Walter Hochban; Regina Conradt; U. Brandenburg; Jörg Heitmann; J. H. Peter

&NA; Obstructive sleep apnea is the most common sleeprelated breathing disorder, with a surprisingly high prevalence. The treatment of choice is nasal continuous positive airway pressure (CPAP) ventilation during sleep, which has to be applied throughout the patients whole life. Because of various underlying pathomechanisms in patients with certain craniofacial disorders—narrow posterior airway space and maxillary‐mandibular deficiency— surgical therapy by craniofacial osteotomies seems possible. A series of 38 consecutive patients were treated by 10‐mm maxillomandibular advancement by retromolar sagittal split osteotomy and Le Fort I osteotomy, respectively. Obstructive sleep apnea syndrome was improved considerably in all patients; there was no significant difference compared to the results under nasal CPAP. In 37 of 38 patients, the postoperative apnea‐hypopnea index was reduced clearly to under 10 per hour, oxygen saturation rose, and sleep quality improved. This was achieved by maxillomandibular advancement of 10 mm without secondary refinements in all but 2 patients. In one patient, the apnea‐hypopnea index could only be reduced to 20 per hour, probably because of insufficient maxillary advancement. These results indicate that successful surgical treatment is possible in a high percentage of selected patients with certain craniofacial characteristics. In addition to cardiorespiratory polysomnography, there should be routine cephalometric evaluation of all patients. Maxillomandibular advancement should be offered as an alternative therapy to all patients with maxillary and/or mandibular deficiency or dolichofacial type in combination with narrow posterior airway space. (Plast. Reconstr. Surg. 99: 619, 1997.)


International Journal of Oral and Maxillofacial Surgery | 1996

Mandibular setback for surgical correction of mandibular hyperplasia — does it provoke sleep-related breathing disorders?

Walter Hochban; Ralph Schürmann; U. Brandenburg

The question has arisen as to whether mandibular setback may possibly cause sleep-related breathing disorders (SRBD). To evaluate the possible effects of mandibular setback on posterior airway space (PAS), 16 consecutive patients were examined prospectively. All patients underwent surgical mandibular setback using bilateral sagittal split osteotomy. Polysomnographic evaluation for SRBD was performed according to the Marburg graded diagnostic protocol before and after surgery. Cephalometric analysis was performed preoperatively, and 1 week, 3 months, and 1 year postoperatively, with particular attention to pharyngeal changes. PAS decreased considerably in all patients. Nevertheless, the preoperative PAS was enlarged in all patients with mandibular hyperplasia compared to normal subjects. Despite the pharyngeal narrowing, there was no evidence of postoperative SRBD in any of these patients. SRBD as a consequence of mandibular setback may be rare; nevertheless, the pharyngeal airway does decrease.


Journal of Cranio-maxillofacial Surgery | 1994

Morphology of the viscerocranium in obstructive sleep apnoea syndrome - cephalometric evaluation of 400 patients

Walter Hochban; U. Brandenburg

The aim of this study was the cephalometric evaluation of patients with obstructive sleep apnoea in order to see whether certain craniofacial characteristics exist. Additional to known skeletal facial parameters cephalometric analysis has been used to establish pharyngeal dimensions. Surprisingly, many patients with obstructive sleep apnoea (nearly 40%) showed certain craniofacial characteristics which apparently predispose to pharyngeal obstruction and to obstructive sleep apnoea. More than one third of 400 patients prove to have pharyngeal narrowing combined with more or less distinct maxillary and mandibular deficiency. Cephalometric evaluation helps to identify sleep apnoea patients, in whom maxillomandibular advancement surgery might be effective in the treatment of obstructive sleep apnoea. According to our results, an indication for surgical treatment by maxillomandibular advancement exists in patients with maxillary and especially mandibular deficiency combined with pharyngeal narrowing.


European Respiratory Journal | 1997

Long-term follow-up after surgical treatment of obstructive sleep apnoea by maxillomandibular advancement

Regina Conradt; Walter Hochban; U. Brandenburg; Jörg Heitmann; J. H. Peter

Obstructive sleep apnoea (OSA) is a common disorder with potentially serious consequences. If maxillary and mandibular deficiency, often in combination with a narrow posterior airway space is present, therapy of OSA by maxillomandibular osteotomy is possible. However, long-term follow-up of patients undergoing these procedures is lacking. We present the results of 15 OSA patients (1 female and 14 males), who underwent maxillomandibular advancement surgery with a follow-up of at least 2 yrs. Polysomnography was performed before surgery, after 6-12 weeks, and 1 and 2 yrs postoperatively. Mean apnoea/hypopnoea index (AHI) decreased from 51.4 events.h-1 before therapy to 5.0 events.h-1 6 weeks postoperatively, and was 8.5 events.h-1 after 2 yrs. Oxygen saturation significantly increased following surgery. After 2 yrs, the AHI was < 10 events.h-1 in 12 out of 15 subjects. No significant changes were found comparing the 6-12 weeks versus the 2 year follow-up data. The significant increase in stage 3/4 non-rapid eye movement (NREM) sleep and decrease in stage 1 NREM sleep, indicative of the restoration of normal physiological sleep structure, persisted in 14 of the 15 subjects 2 yrs postoperatively. Three patients, however, did not show satisfactory improvement 2 yrs postoperatively; two showed obstructive and one central respiratory events. This study demonstrates that maxillomandibular advancement is successful in a high percentage of patients carefully selected by cephalometric and polysomnographic investigation. Postoperative success has proved to be stable over a period of 2 yrs. Further preoperative evaluation seems necessary in patients with predominantly mixed or central apnoeas.


Journal of Sleep Research | 1998

Sleep fragmentation and daytime vigilance in patients with OSA treated by surgical maxillomandibular advancement compared to CPAP therapy

Regina Conradt; Walter Hochban; Jörg Heitmann; U. Brandenburg; Werner Cassel; T. Penzel; J. H. Peter

Impaired vigilance is a frequent daytime complaint of patients with obstructive sleep apnoea (OSA). To date, continuous positive airway pressure (CPAP) is a well established therapy for OSA. Nevertheless, in patients with certain craniofacial characteristics, maxillomandibular advancement osteotomy (MMO) is a promising surgical treatment. Twenty‐four male patients with OSA (pretreatment respiratory disturbance index (RDI) 59.3 SD±24.1 events/h) participated in this investigation. The mean age was 42.7±10.7 years and the mean body mass index was 26.7±2.9 kg/m2. According to cephalometric evaluation, all patients had a narrow posterior airway space, more or less due to severe maxillary and mandibular retrognathia. All patients except two were treated first with CPAP for at least 3 months and afterwards by MMO. Two patients only tolerated a CPAP trial for 2 nights. Polysomnographic investigation and daytime vigilance were assessed before therapy, with CPAP therapy and 3 months after surgical treatment. Patients’ reports of impaired daytime performance were confirmed by a pretreatment vigilance test using a 90‐min, four‐choice reaction‐time test. The test was repeated with effective CPAP therapy and postoperatively. Daytime vigilance was increased with CPAP and after surgical treatment in a similar manner. Respiratory and polysomnographic patterns clearly improved, both with CPAP and after surgery, and showed significant changes compared to the pretreatment investigation. The RDI decreased significantly, both with CPAP (5.3±6.0) and postoperatively (5.6±9.6 events/h). The percentages of non‐rapid eye movement Stage 1 (NREM 1) sleep showed a marked decrease (with CPAP 8.2±3.6% and after MMO 8.2±4.4% vs. 13.3±7.4% before treatment), whereas percentages of slow wave sleep increased significantly from 8.0±6.1% before therapy to 18.2±12.8 with CPAP and 14.4±7.3% after MMO. The number of awakenings per hour time in bed (TIB) was significantly reduced after surgery (2.8±1.3), compared to both preoperative investigation (baseline 4.2±2.0 and CPAP 3.4±1.5). Brief arousals per hour TIB were reduced to half with CPAP (19.3±20.0) and after MMO (19.7±13.6), compared to baseline (54.3±20.0). We conclude that the treatment of OSA by MMO in carefully selected cases has positive effects on sleep, respiration and daytime vigilance, which are comparable to CPAP therapy.


International Journal of Oral and Maxillofacial Surgery | 1994

Acoustic rhinometry: A new diagnostic procedure — Experimental and clinical experience

Martin Kunkel; Walter Hochban

The diagnostic value of transnasal acoustic reflection measurements (Rhinoklack) was investigated in an experimental and clinical study. Within the range of nasal and epipharyngeal dimensions, in vitro and in vivo measurements showed satisfactory reproducibility. A simple maneuver helps to identify the transition from the rigid nasal cavity to the movable epipharynx. The location and the amount of nasal obstruction can be verified and traced back to their morphologic correlative. The effect of decongestion on nasal volume was measured for normal mucosa (41% enlargement) and mucosa altered by scar formation after septoplasty and turbinoplasty (21% enlargement). After maxillomandibulary advancement of 10 mm for obstructive sleep apnea, the EV index representing epipharyngeal volume (EV) showed an average increase of 6 cm3.


Oral and Maxillofacial Surgery | 1997

The influence of maxillary osteotomy on nasal airway patency and geometry

Martin Kunkel; Walter Hochban

Maxillary surgical repositioning affects nasal airway size. This study recorded ansal airway changes by acoustic rhinometry in patients with maxillary surgical repositioning after Le Fort I osteotomies. These changes were compared to the amount of skeletal movement by means of preoperative and 6-week postoperative lateral cephalography. Vertical linear movement of the posterior maxilla showed a very close relationship to volume changes in the posterior nasal segment. Anterior nasal volume changes can not be considered as a pure function of the direction and amount of skeletal movement. The greatest amount of cranial displacement tolerated without impaired nasal patency in this study was 7 mm. Umstellungsosteotomien der Maxilla beeinflussen zwangsläufig auch die unmittelbar benachbarten nasalen Atemwege. In dieser Studie wurden Veränderungen der Nasenhöhle durch Oberkieververlagerungen nach Le Fort-I-Osteotomien anhand einer akustischer Rhinometrie aufgezeichnet. Das Ausmaß der skelettalen Verlagerung kephalometrisch bestimmter Referenzpunkte wurde mit reflexionsakustisch ermittelten Volumenveränderungen verglichen. Für die vertikale Verlagerung der posterioren Maxilla ergab sich eine signifikante Korrelation zur akustisch festgestellten Volumenveränderung der hinteren Nasenhaupthöhle. Die Veränderungen der vorderen Nasenhöhle lassen sich nicht unmittelbar mit dem Ausmaß der skelettale Verlagerung korrelieren. Ohne Behinderung der Nasenatmung wurden in dieser Studie Kranialverlagerungen des Nasenbodens bis zu 7 mm toleriert.


Respiration | 2000

Immediate intraoral adaptation of mandibular advancing appliances of thermoplastic material for the treatment of obstructive sleep apnea.

Bernd Schönhofer; Walter Hochban; H.J. Vieregge; H. Brünig; Dieter Köhler

Background: In the treatment of obstructive sleep apnea (OSA), mandibular advancing devices (MAD) are usually individually fabricated on plaster casts of both jaws from polymethyl-methacrylate. The potential disadvantages of these devices are (1) the costs and (2) the time required to construct the device. Objective: In this study, the efficacy and feasibility of a cheap MAD consisting of thermoplastic material (SnorBan®), which can be directly moulded intraorally, were evaluated. Methods: In a prospective study, the effect of an MAD consisting of thermoplastic material was investigated in 22 consecutive patients with OSA [respiratory disturbance index (RDI) 32.6 ± 18.4/h]. Polysomnographic sleep was recorded prior to treatment and after 3 months of treatment with the MAD. Results: Three of the 22 patients who did not tolerate the MAD were excluded from the analysis, whereas 11 patients were classified as responders. In the responder group, the mean RDI decreased from 27.6 ±7.3 to 7.3 ± 2.9 (p < 0.01), correspondingly the sleep quality and the Epworth Sleepiness Scale improved (p < 0.05). Eight patients proved to be non-responders without relevant changes for the measured parameters. Conclusions: In 50% (11 of 22) of the patients, the MAD improved the OSA to a clinically relevant degree. In contrast to the majority of established MAD, the MAD investigated is cheap and immediately adaptable and thus a feasible strategy to ‘screen’ the efficacy of this therapeutic principle. Thus the construction of unnecessary MAD is avoided.


Journal of Cranio-maxillofacial Surgery | 1989

Presurgical orthopaedic treatment using hard plates

Walter Hochban; Karl-Heinz Austermann

Our concept in the treatment of unilateral clefts of lip, alveolus and palate includes early maxillary orthopaedic treatment starting immediately after birth until the end of the first year of life and the surgical closure of the lip at three months and of the soft palate at twelve months. Hard palate and alveolus are closed after three years by secondary osteoplasty in the alveolar region. The appliance is made of hard acrylic resin and is adjusted monthly to allow for growth. It thus encourages passive orthopaedic guidance of maxillary growth. The local compatibility of the plate was excellent and the acceptance by the children created no problems until tooth eruption. Follow-up studies were conducted on twenty children treated in this way until three years of age. After the first year results show a good and harmonious arch alignment without any collapse of the alveolar segments. The cleft narrows and the steepness of the palatal slope flattens. This maxillary development is arrested after suspension of orthopaedic treatment, and a slight collapse of the alveolar segments is observed.


Journal of Cranio-maxillofacial Surgery | 1994

Acoustic rhinometry: rationale and perspectives

Martin Kunkel; Walter Hochban

Acoustic rhinopharyngometry provides a new, non-invasive access to upper airways geometry. In this experimental and clinical study the diagnostic value of acoustic rhinopharyngometry was investigated. In vitro measurements showed adequate accuracy, reliability and spatial resolution within the range of nasal and epipharyngeal dimensions. Clinical measurements confirmed reasonable reproducibility for the evaluation of nasal (NV) and epipharyngeal (EV) volume. Decongestion with xylometazoline resulted in a 36% enlargement of nasal volume on average. The alteration of pharyngeal soft tissues due to maxillomandibulary advancement of 10 mm correlated to an increase of the EV-index of 6 cm3. Acoustic rhinometry identifies location and amount of nasal obstruction and in addition allows differentiation between obstruction due to mucosal hypertrophy and that due to skeletochondral deformity. Changes in the epipharyngeal volume following maxillary and mandibular osteotomies can be estimated in comparison with the preoperative situation.

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G. Lalyko

University of Marburg

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T. Penzel

University of Marburg

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