A computed tomographic evaluation of effect of mandibular advancement device at two different horizontal jaw positions in patients with obstructive sleep apnea.

STATEMENT OF PROBLEM: Studies pertaining to the objective assessments of the efficacy of mandibular advancement device in patients with obstructive sleep apnea are scarce.

PURPOSE: The purpose of this clinical study was to evaluate the effect of MAD at two different horizontal positions of mandible on upper airway dimensions through computed tomography.

MATERIAL AND

METHODS

Twenty-nine consenting participants satisfying predetermined inclusion and exclusion criteria were enrolled and an adjustable two-piece MAD was fabricated at 50% maximum mandibular protrusion and after 4 weeks was adjusted to 70% protrusion. CT scans were obtained at baseline, 4 weeks after delivering MAD with 50% mandibular protrusion, and then after 4 weeks with 70% mandibular protrusion. Cross sectional area with diameters (lateral and anteroposterior) of upper airway was measured at three specific anatomic levels (retropalatal-RP, retroglossal-RG, and epiglottal-EG). Data were analyzed using the Student t-test for parametric analysis.

RESULTS

Intragroup comparison revealed a statistically significant increase in lateral & anteroposterior dimensions as well as cross sectional area at all three anatomical levels at 4 weeks after MAD with 50% mandibular protrusion compared with baseline and 4 weeks after MAD with 70% mandibular protrusion compared with baseline. However, the difference between lateral and anteroposterior dimensions with MAD at 70% protrusion compared with MAD at 50% protrusion was not statistically significant. The difference between cross-sectional area was found to be statistically significant.

CONCLUSION

Mandibular advancement device at 70% mandibular protrusion is more effective compared with the device at 50% protrusion in relieving oropharyngeal obstruction seen in OSA.