Since Fujita first described uvulopalatopharyngoplasty(UPPP)in 1981,UPPP and its modified procedures have been widely used to treat obstructive sleep apnea and hyponea syndrome(OSAHS).However,despite of its wide application,the success rates was uncertain,ranging from 20% to 80%,with patients of varing Friedman stages.It is well known that the principle of UPPP is to remove the redundant tissue of palate,elongated uvula and hypertrophic tonsils in order to widen the anteroposterior space at the level of palate.But recently,surgeons have found that not only the collapse of soft palate but also the collapse of lateral wall at the palate level can contribute to the obstruction of upper airway at the level of palate.As a result,many surgeries which can widen the lateral velopharyneal space have sprung up in these years.This review focuses on the development of techniques that emphasize the enlargement of lateral velopharyneal space in patients with OSAHS.
Humans ; Larynx ; Palate ; anatomy & histology ; Palate, Soft ; Pharynx ; anatomy & histology ; Sleep Apnea, Obstructive ; therapy ; Uvula

OBJECTIVE: To discuss the soft palate, hard palate and mandibule for the pathogenesis and clinical treatment of patients who have obstructive sleep apnea hypopnea syndrome. METHOD: There were 52 patients with OSAHS diagnosed by the PSG and 32 cases of normal healthy volunteers in our hospital. All objects were given 128 slice spiral CT scan of the upper airway. We measured the related indexes of the soft palate, hard palate and mandible, then analysed statistical differences between them and did Pearson correlation analysis with apnea hypoventilation index (AHI), average blood oxygen saturation (MSaO2) in PSG. RESULT: Compared with the control group, the soft palate length [(37.93 ± 5.20)mm VS (33.52 ± 4.25)mm] and the distance between mandible with cervical vertebra [(75.00 ± 7.10)mm VS (69.93 ± 5.58)mm] increased significantly, but the distance of trailing edge of hard palate to inferior margin of slope significantly reduced [(42.57 ± 4.52)mm VS (45.80 ± 2.94)mm, P < 0.01] in patients with OSAHS. Each measurement associated with AHI and MSaO2 had no significant correlation (P > 0.05). CONCLUSION The soft palate, hard palate and mandibular are some of the important risk factors of OSAHS, and they also have reference value for the choice of clinical treatment operation. Preoperative CT examination can offer help in the treatment of OSAHS.
Case-Control Studies ; Humans ; Mandible ; anatomy & histology ; Oximetry ; Palate, Hard ; anatomy & histology ; Palate, Soft ; anatomy & histology ; Sleep Apnea, Obstructive ; diagnosis ; Tomography, Spiral Computed

There are little information on prevalence of obstructive sleep apnea syndrome (OSAS) and clinical features in the young military population. The purpose of this study was to estimate the prevalence of snoring and high risk of OSAS in young male soldiers in Korea and to identify the risk factors of OSAS. A total of 665 participants (aged 20-23 yr) who visited the Armed Forces Ildong Hospital for regular physical examination were enrolled. All participants completed the Berlin Questionnaire and underwent a physical examination. The participants with high risk for OSAS completed portable sleep monitoring. The prevalence of snoring and high risk of OSAS in young male soldiers in Korea was 13.5% and 8.1%, respectively. The prevalence of high arched palate, tongue indentation, long uvula, large tonsil and retrognathia was significantly higher in the high risk OSAS group. High arched palate, long uvula or low lying soft palate, tonsil size III or IV, Epworth Sleepiness Scale score > 10 and obesity (BMI > 27 kg/m2) were found to independently predict OSAS. For early identification and treatment of young soldiers with OSAS in a military environment, a precise screening by questionnaire and physical examination is needed.
Asian Continental Ancestry Group ; Body Mass Index ; Humans ; Logistic Models ; Male ; *Military Personnel ; Odds Ratio ; Palate/anatomy & histology ; Palatine Tonsil/anatomy & histology ; Polysomnography ; Prevalence ; Questionnaires ; Republic of Korea ; Retrognathia/physiopathology ; Risk Factors ; Sleep Apnea, Obstructive/*epidemiology ; Snoring/epidemiology ; Uvula/anatomy & histology ; Young Adult

INTRODUCTIONAccurate localisation of the greater palatine foramen (GPF) is imperative while negotiating the greater palatine canal for blocking the maxillary nerve within the pterygopalatine fossa. The aim of this study was to define the position of the foramen relative to readily identifiable intraoral reference points in order to help clinicians judge the position of the GPF in a consistently reliable manner.

METHODSThe GPF was studied in 100 dried, adult, unsexed skulls from the state of Maharashtra in western India. Measurements were made using a vernier caliper.

RESULTSThe mean distances of the GPF from the midline maxillary suture, incisive fossa, posterior palatal border and pterygoid hamulus were 14.49 mm, 35.50 mm, 3.40 mm and 11.78 mm, respectively. The foramen was opposite the third maxillary molar in 73.38% of skulls, and the direction in which the foramen opened into the oral cavity was found to be most frequently anteromedial (49.49%). In one skull, the greater and lesser palatine foramina were bilaterally absent. Except for the invariably present incisive canals, there were no accessory palatal foramina, which might have permitted passage of the greater palatine neurovascular bundle in lieu of the absent GPF. To the best of our knowledge, this is the first study of such a non-syndromic presentation.

CONCLUSIONThe GPF is most frequently palatal to the third maxillary molar. For an edentulous patient, the foramen may be located 14-15 mm from the mid-palatal raphe or about 12 mm anterior to the palpable pterygoid hamulus.

Anesthesia ; methods ; Cadaver ; Humans ; India ; Maxilla ; anatomy & histology ; innervation ; Maxillary Nerve ; pathology ; Molar ; anatomy & histology ; Palate, Hard ; abnormalities ; anatomy & histology ; innervation ; Reference Values ; Skull ; anatomy & histology

AIMThe purpose of this study was to conduct quantitative research on bone height and bone mineral density of palatal implant sites for implantation, and to provide reference sites for safe and stable palatal implants.

METHODOLOGYThree-dimensional reformatting images were reconstructed by cone beam computed tomography (CBCT) in 34 patients, aged 18 to 35 years, using EZ Implant software. Bone height was measured at 20 sites of interest on the palate. Bone mineral density was measured at the 10 sites with the highest implantation rate, classified using K-mean cluster analysis based on bone height and bone mineral density.

RESULTSAccording to the cluster analysis, 10 sites were classified into three clusters. Significant differences in bone height and bone mineral density were detected between these three clusters (P<0.05). The greatest bone height was obtained in cluster 2, followed by cluster 1 and cluster 3. The highest bone mineral density was found in cluster 3, followed by cluster 1 and cluster 2.

CONCLUSIONCBCT plays an important role in pre-surgical treatment planning. CBCT is helpful in identifying safe and stable implantation sites for palatal anchorage.

Adolescent ; Adult ; Bone Density ; Cluster Analysis ; Cone-Beam Computed Tomography ; Dental Implants ; Female ; Humans ; Male ; Orthodontic Anchorage Procedures ; instrumentation ; Palate ; anatomy & histology ; diagnostic imaging ; Young Adult

OBJECTIVETo observe and survey the location of Xiaguan (ST 7), "Die'e" and Quanliao (SI 18) on the surface, and the needling depth and direction from the 3 points to sphenopalatine ganglion.

METHODSFifteen corpses (30 sides) of adult male were fixed by 10% formalin. The lateral areas of face were dissected from the surface to the deep on the 3 acupoints: the electric drill with the kirschner wire punctured towards the sphenopalatine ganglion and extended to the contralateral areas according to different directions of puncturing sphenopalatine ganglion from the 3 acupoints. The corresponding puncturing points of the 3 acupoints were measured by the coordinate location method.

RESULTS(1) Surface location: the distance between Quanliao (SI 18) and "Die'e" was 21 mm and the distance between Xiaguan (ST 7) and "Die'e" was 17 mm; (2) Inserting depth of each point to sphenopalatine ganglion: the depths of Xiaguan (ST 7), "Die'e" and Quanliao (SI 18) were 49.9 mm, 46.9 mm and 46.6 mm, respectively; (3) The coordinate location of the corresponding puncturing points: the puncturing direction of Xiaguan (ST 7) was anterointernal upper corresponding to the area of connecting center between contralateral Taiyang (EX-HN 5) and Tongziliao (GB 1), the distance between the corresponding inserting point of Xiaguan (ST 7) and Sizhukong (TE 23) was 17.6 mm; the puncturing direction of "Die'e" point was posterointernal upper, and the horizontal distance from the corresponding puncture point to the zygomatic arch was 33 mm and the vertical distance from the corresponding puncture point to the eyes' outer canthus was 42 mm; the puncturing direction of Quanliao (SI 18) was posteriointernal upper and the distance between the corresponding inserting point and the area of contralateral parietal tuber, the distance between the corresponding inserting point of Quanliao (SI 18) and the connecting line of bilateral external acoustic pore was 28 mm, the distance between the corresponding inserting point of Quan-liao (SI 18) and the medial line of the head was 62 mm.

CONCLUSIONUnderstanding the surface location, inserting depths and the general puncturing directions of the 3 points can provide basis for puncturing the sphenopalatine ganglion in clinical practice.

Acupuncture Points ; Adult ; Cadaver ; Electroacupuncture ; methods ; Face ; innervation ; Ganglia, Parasympathetic ; anatomy & histology ; physiology ; Humans ; Male ; Palate ; innervation ; Sphenoid Sinus ; innervation

OBJECTIVE: To inquiry the variety difference of upper airway caliber OSAHS sufferer and normal person in quiet respiration. METHOD: Twenty OSAHS sufferer who were viewed by PSG and 16 normal adults who hagve no chief complaint of sleeping disease were selected. The curves of the subjects in a respiratory cycle were recorded by respiratory monitoring system in PSG, while the morphological changes in the pharynx of all subjects were observed by fiberscope in a calm respiratory cycle, and then both of the two processes simultaneously were recorded on the same computer. According to the different stages of respiratory cycle by analyzing respiratory curve the video had been edited into pictures about the various anatomical areas in the upper airway, the cross section area and the dimension of palate and lingua and root of the tongue region upper airway whereas studied by the image tools in computer, and the changes of areas and dimensions at palate, and lingua and root of the tongue region upper airway were calculated. RESULT: It was found that there wasps a morphological change of the upper airway with the respiratory movement in the both groups. The upper airway caliber decrease with inspiration begin and reach the most narrowing at the end of inspiration, then upper airway caliber enlarges with the expiration begin and reach the most widening at the end of expiration. No matter the normal group or the OSAHS group has the obvious changes in the palate and lingua region on the diameter, the cross section area and the dimension in respiration. The changes in the palate and lingua region on the diameter, the cross section area and the dimension of OSAHS group were greater than normal group. No matter OSAHS group or normal group on the diameter and cross section area change in the palate was obviously more than the tongue area and the root of tongue area. The changes of OSAHS group on the dimension in the palate were greater than the tongue area and the root of tongue area. CONCLUSION There are periodically changes of upper airway during respiration cycle in normal adults and OSAHS patients. The effects of respiration on upper airway caliber of OSAHS patients are more obviously than normal adults, and the increasing effects in OSAHS patients is one of OSAHS etiology.
Adult ; Case-Control Studies ; Humans ; Male ; Middle Aged ; Palate ; anatomy & histology ; pathology ; Palate, Soft ; anatomy & histology ; pathology ; Pharynx ; anatomy & histology ; pathology ; Respiration ; Respiratory System ; Sleep Apnea, Obstructive ; pathology ; physiopathology ; Tongue ; anatomy & histology ; pathology

Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Body Weight ; Humans ; Laryngeal Muscles ; anatomy & histology ; Magnetic Resonance Imaging ; Middle Aged ; Palate, Soft ; anatomy & histology ; Pharynx ; anatomy & histology ; Sleep Apnea, Obstructive ; pathology ; Tongue ; anatomy & histology ; Young Adult

OBJECTIVETo describe the morphology of upper airway in non-apnea males aged seventy years or over.

METHODSThirty-one non-apnea males aged 70 years or over [diagnosed by whole-night polysomnography (PSG), apnea and hypopnea index (AHI) < 10 per hour] had been taken magnetic resonance imaging (MRI) scanning.

RESULTSThe narrowest point of upper airway was at velopharynx. The mean and the minimum section areas were (190.9 +/- 67.1) mm(2) and (112.1 +/- 47.7) mm(2), respectively. Each sagittal/transverse ratio was between 0.22 and 0.89. It showed an ellipse-like cross-section of upper airway, while velopharynx was the most "slender" segment (sagittal/transverse-caliber was 0.22 - 0.71). The min/max section area of upper airway was between 0.38 and 0.62. It demonstrated that each airway segment was a "cone-like" form, while the velopharynx was the steepest segment.

CONCLUSIONSIn the non-apnea elderly males aged seventy years or over, the velopharynx was most likely to collapse.

Aged ; Aged, 80 and over ; Humans ; Magnetic Resonance Imaging ; Male ; Palate, Soft ; anatomy & histology ; Pharynx ; anatomy & histology ; Polysomnography ; Sleep Apnea, Obstructive ; Surveys and Questionnaires ; Tongue ; anatomy & histology

OBJECTIVE: To provide anatomic data of pterygopalatine fossa(PPF) for endoscopic PPF surgery. METHOD: Fifteen wet adult skull specimen fixed in 10% formaldehyde were studies. From center the skulls were sawed, the middle and inferior turbinate were resected, the anterior and posterior ethmoid sinuses were resected. Then after punch out perpendicular part of palatine bone and posterior wall of maxillary,the pterygopalatine fossa were showed and some related measurements were made. RESULT: This pathway can lead to a good view of pterygopalatine fossa. The main soft structures in PPF were maxillary artery and nerve with their branches. The diameter of artery branches was smaller than 3 mm. CONCLUSION The endoscopic PPF surgery is safe and practical from the anatomic data.
Adult ; Endoscopy ; Ethmoid Sinus ; anatomy & histology ; Humans ; Maxilla ; anatomy & histology ; Maxillary Artery ; anatomy & histology ; Maxillary Sinus ; anatomy & histology ; surgery ; Nasal Cavity ; surgery ; Palate, Hard ; anatomy & histology ; Pterygopalatine Fossa ; anatomy & histology ; surgery