Objective: To evaluate the effectiveness of mandibular advancement appliances (MAAs) for treatment of pediatric obstructive sleep apnea (OSA).

Methods: Several electronic databases (The Cochrane Database, EMBASE, Healthstar, MEDLINE, PubMed) were systematically searched, as well as a limited grey literature (Google Scholar) and manual searches. A health sciences librarian helped with the selection of Medical Subject Headings (MeSH), key words, and combinations of key words with truncations to account for any differences in controlled terminology in the different databases. Only studies that evaluated the effects of MAAs in children with OSA were pursued.

Results: Only 4 articles satisfied all inclusion criteria. Selected studies were retrospective except one study that was a quasi-randomized clinical trial. High risk of bias (Cochrane Risk of Bias assessment) was judged in all included studies. Based on the limited available evidence use of MAAs in a POSA population may result in improvements in Apnea Hypopnea Index (AHI) scores. However complete normalization of AHI scores was not demonstrated. Heterogeneity in study designs and collected information precluded meta-analysis.

Limitations: There are significant weaknesses in the existing evidence due primarily to absence of control groups, small sample sizes, lack of randomization and short-term results. Determination of AHI scores with MAAs still in the mouth should be avoided.

Conclusions: The current limited evidence may be suggestive that MAAs result in short-term improvements in AHI scores, but it is not possible to conclude that MMAs are effective to treat pediatric OSA. Medium- and long-term assessments are still required.

/pdf/mandibular-advancement-appliances-for-the-treatment-of-4mj2f6y0hl.pdf

Mandibular advancement appliances for the treatment of paediatric obstructive sleep apnea: a systematic review

Objectives. Our study aimed to highlight the effectiveness of palatal lift prosthesis in patients with velopharyngeal insufficiency with previous operated cleft palate.
 Methods. This study was done undertaken January 2008 to December of 2009 in the Phoniatic unit of Alnoor Specialist Hospital, Makkah, Saudi Arabia. Ten patients of ≥ 8 years to ≤ 10 years of age, who had previously undergone surgery for cleft palate, with or without cleft lip, with no other systemic illness and normal intelligent quotient level, were selected and managed by palatal lift prosthesis. All the study subjects were subjected to auditory perceptual speech evaluation for assessment of the degree of hypernasality, compensatory articulator mechanisms, glottal and pharyngeal articulation, audible nasal emission, facial grimace and overall intelligibility of speech. Data were analyzed using SPSS version 16. 
Results. The study included 10 subjects whose mean ± standard deviation of age was (8.9±0.9). On auditory speech perceptual evaluation after prosthesis application, significant improvement was found in glottal articulation 6 (85.7%), p=0.04, facial grimace 6 (85.7%) p=0.04, hyper nasality 10 (10%) p=0.008, and speech intelligibility 9 (90%) p=0.008. 
Conclusion. Young patients with repaired palatal cleft have significant improvement after application of palatal lift prosthesis.

/pdf/palatal-lifting-prosthesis-and-velopharyngeal-insufficiency-1gr69slgva.pdf

Palatal lifting prosthesis and velopharyngeal insufficiency: preliminary report.

Success in Maxillofacial Prosthetics depends on full cognizance of the principles that underlie facial harmony, anchorage and retention, weight bearing and leverage, durability, tissue compatibility and tolerance. The maxillofacial prosthodontist normally provides appliances to restore aesthetics and function to the patients who cannot be restored to normal appearances or functions by means of plastic reconstructions. The velopharynx is a dynamic anatomic structure which is essential for normal breathing, eating, and speaking. The soft palate acts as a separator between oral and nasal cavities. Impairment of velopharyngeal function can be caused by insufficiency or incompetency. This article describes in brief about velopharyngeal defects and their management.

Management of velopharyngeal defects: a review.

We aim to review the diagnostic role of magnetic resonance (MR) imaging in obstructive sleep apnea syndrome (OSAS). Basic background about sleep apnea, MR anatomy of the pharyngeal airway, and MR imaging sequences applied in obstructive sleep apnea are discussed. Static and dynamic MR imaging is used in the assessment of patients with OSAS. Magnetic resonance imaging can detect the level, degree, and cause of obstruction in the upper airway that guide the clinical diagnosis and treatment. Imaging is used for prediction of treatment outcome and monitoring and follow-up of patients with OSAS after therapy.

Diagnostic Role of Magnetic Resonance Imaging in Obstructive Sleep Apnea Syndrome.

Orofacial clefts (OFCs) are common and treatable birth defects. The etiologies of facial clefts include hereditary, environmental, and multifactorial causes. The role of dentistry in treating individuals with cleft and craniofacial anomalies is to provide comprehensive preventative and therapeutic oral health care. The diversity of surgical and complexity habilitating individuals with facial clefts often necessitates that the dentist work with a team of experts. The use of different services and interventions and their timing are critical to achieve optimal health outcomes in cleft patients. Management of patients from birth to adulthood will be presented and discussed with the main goal to provide the best care and improve the quality of their lives.

Management of Patients with Orofacial Clefts

PURPOSE The aim of this study was to assess the effect of a palatal lift prosthesis (PLP) on the speech intelligibility of cleft palate patients treated with pharyngeal flap surgery, the minimum duration required for improvement in nasality, and the sustenance of speech improvement after removing the appliance. MATERIALS AND METHODS Seven patients ranging between 16 and 26 years of age were recruited for this study. These subjects had velopharyngeal dysfunction secondary to a surgically corrected cleft palate, which failed to improve following pharyngeal flap surgery. A PLP was given to these patients and improvements in speech intelligibility were assessed using two speech examinations: perceptual analysis and nasometry. The nasal resonance, nasal air emission, and articulation were measured prior to the insertion of the prosthesis and at the end of every month for the next 3 months, following which the prosthesis was removed and the tests were repeated. RESULTS There was a statistically significant decrease in nasalance percentage at the end of the 3 months, and it was found that this improvement in speech persisted even after the removal of the prosthesis. CONCLUSIONS A PLP, when used for a minimum duration of 3 months, causes a significant decrease in nasal resonance, thereby improving speech intelligibility in patients who failed to see improvement following pharyngeal flap surgery for velopharyngeal incompetence.

Effect of a palatal lift prosthesis in individuals with velopharyngeal incompetence.

Prosthetic rehabilitation of extensive maxillectomy defects are exigent given the difficulties faced due to loss of palatal bone,teeth and surrounding supporting tissues which help in retention, support and stability of the prosthesis. An interim maxillary obturator is a prosthesis which is made after surgical resection of a portion or all of one or both maxilla where initial healing is completed. Frequently many or all teeth in the defect area are replaced by this prosthesis. It plays a vital role in preventing the facial disfigurement and irritation to the surgical site thereby enhancing the healing and restores the functional capabilities such as speech, mastication, deglutition etc. To gain better retention and stability, preservation of the unaffected regions is needed which can be achieved by proper surgical planning and designing of the prosthesis. This case series describes rehabilitation of three extensive maxillectomy defects with hollow open and closed interim obturators.

/pdf/rehabilitation-of-post-surgical-maxillectomy-defects-using-5519wiqujy.pdf

Rehabilitation of post surgical maxillectomy defects using interim obturators-a case series.

This preliminary study investigated the effect of a mandibular advancement device on upper airway collapsibility in seven patients with obstructive sleep apnea. Overnight polysomnography and dynamic magnetic resonance imaging were performed at the retropalatal and retroglossal levels, and the apnea-hypopnea Index(AHI), anteroposterior and lateral distances, and airway volumes were recorded. The tests were repeated following a 3-month period of wearing a customized mandibular advancement device. A significant reduction in AHI (from 31 events per hour to 18.2 events per hour) and improvement in airway dimension at both the retropalatal and retroglossal levels were recorded, suggesting a baseline record for future studies with a larger patient sample.

A preliminary report on the effect of a mandibular advancement device on obstructive sleep apnea using magnetic resonance imaging and polysomnography.

Mllerian agenesis is a congenital malformation in women. It is characterized by a failure of the Mllerian ducts to develop, which results in a missing uterus and variable malformations of the vagina. It is also the second most common cause of primary amenorrhea. This clinical report describes the fabrication of prosthesis, by a maxillofacial prosthodontist that is used in the non surgical management of Mllerian agenesis to aid in the dilation of a narrow vaginal opening.

https://print.ispub.com/api/0/ispub-article/9475

Prosthetic Vaginal Dilator- A Case Report

Aim: To compare the relationship between the crest of the residual alveolar ridge, central fossa of the teeth, tissue surface area, volumes in conventional mandibular dentures and dentures made by using the neutral zone concept. Materials and methods: Ten edentulous patients were selected, aged between 50 to 60 yrs, with an edentulous period of six months, and mandibular ridges showing clinically moderate to severe ridge resorption. For every patient, two sets of dentures were fabricated. First set by the conventional method and the second set by the neutral zone concept. Three studies to evaluate the aim were carried out. Results: It was found that neutral zone moved lingual to the crest of the ridge in the anterior region, remained constant in the premolar regions and moved buccal to the crest of the ridge in the molar regions in the dentures made by the neutral zone concept. Increased tissue surface area and reduction in volume of the denture were also a finding. Conclusion: Neutral zone always moves according to the periods of edentulism, tonicity of the perioral musculatures and tongue. Arrangement of the teeth in neutral zone, increasing the impression surface area of the denture and reduction in the volume of the denture, provides good retention, stability and in addition to that it also provides more comfort to the patients.

/pdf/comparative-study-of-mandibular-dentures-made-by-neutral-32xrwusbkf.pdf

Comparative Study Of Mandibular Dentures Made By Neutral Zone Concept With Conventional Mandibular Denture

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