Dental Sleep Medicine Insider November DSM Insider | Page 30

DOUGLAS CHENIN
CBCT & AIRWAY ANALYSIS:
A HOLISTIC APPROACH
CBCT imaging provides tre-
mendous value in treating
patients with Obstructive
Sleep Apnea. This value ex-
tends to both clinicians and to
the patient. As far as helping
us clinicians, CBCT imaging
allows us to see our patients
holistically. We can see how
multiple aspects of their cra-
niofacial anatomy, and this
may influence our combina-
tion treatment option recom-
mendations. It greatly serves
the patients by providing
them with deeper insight into
the nature of their problem
and how to go about getting
comprehensive care.
CBCT imaging allows us to
see a detailed visual of our
patients’ nasal passageways
and temporomandibular
joints, two anatomical re-
gions routinely compromised
in patients with sleep related
breathing disorders. Having
these visualizations allows us
to coordinate surgical care
with other professionals when
needed. Some questions that
we can ask and answer with
CBCT scans are:
1. Does this patient have
any head and neck, den-
tal/skeletal, sinus and/or
TMJ pathology?
A patient with severe chronic
nasal infection that completely
compromised nasal breathing.
Many patients with sleep
related breathing disorders
have difficulty breathing
through their nose and are
often mouth breathers. There
are multiple appliance de-
signs that allow us to help
foster and reestablish nasal
breathing. However, if we do
not know the full nature of
their nasal problems, we may
try to achieve something that
is not possible if there are
conditions like severe nasal
septum deviations, excessive
turbinate hypertrophy, or na-
sal and sinus pathology. CBCT
imaging allows us a detailed
inspection of these regions.
2. What surgical treatments are essential, recommend-
ed, possible or ruled out based on their 3D internal
anatomy?
A patient with Class II skele-
tal relationship whose airway is
constricted down to the level of
the hypopharynx at the base of
the tongue. UPPP surgery might
address some of the constriction
higher up but will not help allevi-
ate the constrictions present along
the entire length of the airway.