A method of studying adaptive changes of the oropharynx to variation in mandibular position in patients with obstructive sleep apnoea

The aim of this study was to develop a method of studying the effects of mandibular advancement on oropharyngeal airway dimensions in the sagittal plane in conscious, supine patients. Six white, dentate, male patients with proven obstructive sleep apnoea had sagittal fluoroscopic recordings taken in the resting supine position. Images were recorded at four frames per second as the mandible was advanced with the teeth in contact to maximum protrusion and then opened. Software in the fluoroscopic imaging system permitted measurement of the change in mandibular position together with oropharyngeal airway dimensions expressed as the narrowest dimension observable in the post-palatal and post-lingual sites. Plotting of airway dimensions during mandibular advancement enabled estimation of the degree of protrusion associated with maximal airway benefits. Progressive mandibular advancement produced variable adaptive changes in the post-palatal and post-lingual regions of the oropharynx. The amount of airway opening appeared to be related to the horizontal and vertical relationships of the face and to the dimensions of the soft palate. The changes in post-palatal and post-lingual airway dimensions were not always identical, despite the observation that both tongue and soft palate were seen to move in unison, with close contact being maintained between the two structures. Jaw opening resulted in synchronous posterior movement of both tongue and soft palate, with consequent narrowing of oropharyngeal airspace. Fluoroscopy is a simple method of assessing upper airway changes with mandibular advancement in the conscious patient. The technique should facilitate the selection of subjects for whom mandibular advancement would seem advantageous. The nature of the adaptive response is dependent on individual structural variation. It is suggested that, where artificial mandibular advancement with dental devices is considered beneficial, jaw opening should be kept to a minimum.