학술논문
Mandibular advancement splint response is associated with the pterygomandibular raphe
ORIGINAL ARTICLE
ORIGINAL ARTICLE
Document Type
Academic Journal
Author
Source
SLEEP. April 2021, Vol. 44 Issue 4, p1l, 7 p.
Subject
Language
English
ISSN
0161-8105
Abstract
Introduction Mandibular advancement splint (MAS) treatment for obstructive sleep apnea (OSA) fixes the mandible in an anterior position during sleep with the aim to decrease airway collapsibility but is only [...]
Study Objectives: To investigate whether the presence of tendinous PMR could predict treatment outcome and how it affects lateral wall mechanical properties. Mandibular advancement increases the lateral dimensions of the nasopharyngeal airway via a direct connection from the airway to the ramus of the mandible. The anatomical structure in this region is the pterygomandibular raphe (PMR), but a tendinous component is not always present. Whether tendon presence influences treatment outcome is unknown. Methods: In total, 105 participants with obstructive sleep apnea completed detailed anatomical magnetic resonance imaging with and without mandibular advancement. The study design was case-control. Variables were compared between participants with and without the tendon present. Results: The amount of maximum mandibular advancement decreased when pterygomandibular tendon was present (4.0 [+ or -] 1.2 mm present versus 4.6 [+ or -] 1.4 mm absent, p = 0.04). PMR tendon-absent participants had a lower posttreatment apnea hypopnea index (16 [+ or -] 12 events/hour tendon present versus 9 [+ or -] 9 events/hour absent, p = 0.007) and were more likely to have complete response (63% versus 36%, p = 0.02). However, tendon-absent participants were more likely to not complete the study (x (2) (3) = 10.578, p = 0.014). Tendon-absent participants had a greater increase in midline anteroposterior airway diameter (1.6 [+ or -] 1.7 mm versus 0.6 [+ or -] 2.3 mm, p = 0.04). Conclusion: When PMR tendon is absent, treatment response and amount of maximum advancement improve, possibly at the expense of reduced splint tolerability. Tendon presence may help predict a group less likely to respond to mandibular advancement splint therapy. Key words: mandibular advancement; treatment outcome; tendon
Study Objectives: To investigate whether the presence of tendinous PMR could predict treatment outcome and how it affects lateral wall mechanical properties. Mandibular advancement increases the lateral dimensions of the nasopharyngeal airway via a direct connection from the airway to the ramus of the mandible. The anatomical structure in this region is the pterygomandibular raphe (PMR), but a tendinous component is not always present. Whether tendon presence influences treatment outcome is unknown. Methods: In total, 105 participants with obstructive sleep apnea completed detailed anatomical magnetic resonance imaging with and without mandibular advancement. The study design was case-control. Variables were compared between participants with and without the tendon present. Results: The amount of maximum mandibular advancement decreased when pterygomandibular tendon was present (4.0 [+ or -] 1.2 mm present versus 4.6 [+ or -] 1.4 mm absent, p = 0.04). PMR tendon-absent participants had a lower posttreatment apnea hypopnea index (16 [+ or -] 12 events/hour tendon present versus 9 [+ or -] 9 events/hour absent, p = 0.007) and were more likely to have complete response (63% versus 36%, p = 0.02). However, tendon-absent participants were more likely to not complete the study (x (2) (3) = 10.578, p = 0.014). Tendon-absent participants had a greater increase in midline anteroposterior airway diameter (1.6 [+ or -] 1.7 mm versus 0.6 [+ or -] 2.3 mm, p = 0.04). Conclusion: When PMR tendon is absent, treatment response and amount of maximum advancement improve, possibly at the expense of reduced splint tolerability. Tendon presence may help predict a group less likely to respond to mandibular advancement splint therapy. Key words: mandibular advancement; treatment outcome; tendon