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Facial profile shape, malocclusion and palatal morphology in Malay obstructive sleep apnea patients

Banabilh SM, Samsudin AR, Suzina AH, Dinsuhaimi S

Angle Orthod, 2010 Jan;80(1):37-42.
PMID: 19852637 DOI: 10.2319/011509-26.1

To test the null hypothesis that there is no difference in facial profile shape, malocclusion class, or palatal morphology in Malay adults with and without obstructive sleep apnea (OSA).
Dental arch morphology in south-east Asian adults with obstructive sleep apnoea: geometric morphometrics

Banabilh SM, Suzina AH, Dinsuhaimi S, Samsudin AR, Singh GD

J Oral Rehabil, 2009 Mar;36(3):184-92.
PMID: 19207445 DOI: 10.1111/j.1365-2842.2008.01915.x

The association between dental arch morphology and the aetiology of obstructive sleep apnoea (OSA) is not clear. To compare dental arch morphology in 108 Asian adults with and without ''OSA, overnight'' hospital polysomnography was performed, and sleep reports were obtained for all subjects. Standardized digital photographs were also taken of the subjects' upper and lower study models. Using 25 homologous landmarks, mean OSA and control dental arch configurations were computed, and subjected to finite-element morphometry (FEM), t-tests and principal components analysis (PCA). Mean upper and lower OSA dental arch morphologies were statistically different from respective Control upper and lower arch morphologies (P < 0.05). FEM of the upper arch indicated that the mean OSA configuration was 7-11% narrower in the transverse plane in the incisor and canine regions when compared with the control configuration, and inter-landmark analysis (ILA) confirmed this finding. FEM for the lower arch indicated that the mean OSA configuration was 10-11% narrower in the antero-posterior plane in the pre-molar and molar regions, and confirmed by ILA. Using PCA, significant differences were also found between the two groups in the lower arch using the first two eigenvalues, which accounted for 90% of the total shape change (P < 0.001). Supporting their role as aetiological factors, size and shape differences in dental arch morphology are found in patients with OSA.
Prevalence of snoring and craniofacial features in Malaysian children from hospital-based medical clinic population

Banabilh SM, Asha'ari ZA, Hamid SS

Sleep Breath, 2008 Aug;12(3):269-74.
PMID: 17978839 DOI: 10.1007/s11325-007-0154-6

Snoring is considered as the most common clinical symptom of obstructive sleep apnea-hypopnea syndrome. However, many snoring studies were done in western population, and data from around Asia is scarce. Therefore, the purposes of this study were to determine the prevalence of snoring among Malaysian children from hospital-based medical clinic population setting and to compare the craniofacial features of children with and without snoring using cephalometric analysis. A cross-sectional study among children aged 7-15 years were carried out in Hospital Kuala Terengganu. Sleep behavior questionnaire (Berlin questionnaire) was given to 500 children. The respondents were divided into snoring and non-snoring groups. Thirty children from each group were randomly selected to undergo a cephalometric X-ray. For each lateral cephalometric radiograph, 17 parameters consisting bony, soft tissue, and angular measurements were recorded using computer software VixWin2000. Independent t test was used to analyze the data. The results indicated that the whole questionnaire respondents were 317 (46 snoring and 271 non-snoring), hence, the prevalence of snoring in our survey population was 14.51%. The cephalometric X-ray showed that the snoring children manifested a significant different craniofacial features, such as narrow airway at the level of the soft palate and oropharynx (p < 0.05), more inferiorly positioned hyoid bone (p < 0.05), longer vertical airway length from posterior nasal spine to the base of epiglottis (p < 0.05), more protruding maxilla, and anterior-posterior discrepancy of maxilla and mandible (p < 0.05). In conclusion, our snorer children exhibit significant craniofacial differences compared to non-snorer groups.

Study site: ACC at Hospital Kuala Terengganu, MalaysiaThe ACC is a daycare center consisting of
various specialty clinics such as Pediatrics, Orthopedics,
Otorhinolaryngology, Dental, Oral-maxillofacial, General
Surgery, General Medical, Ophthalmology, Psychiatry, and
Obstetrics and Gynecology clinics.
Cranial base and airway morphology in adult malays with obstructive sleep apnoea

Banabilh SM, Suzina AH, Dinsuhaimi S, Singh GD

Aust Orthod J, 2007 Nov;23(2):89-95.
PMID: 18200785

Obstructive sleep apnoea (OSA) has been described as a public health problem comparable to smoking in its impacts upon society.
Facial soft tissue features assessed with finite element analysis

Banabilh SM, Rajion ZA, Samsudin AR, Singh GD

Int J Orthod Milwaukee, 2006;17(4):17-20.
PMID: 17256439

Facial soft tissues are a major determinant of treatment choice. When Class I and Class II malocclusions were compared using finite-element analysis, morphologic differences were localized and quantified. This study highlights the importance of determining the timing, magnitude and direction offacial growth prior to treatment to achieve stable results.
Dental arch shape and size in Malay schoolchildren with Class II malocclusion

Banabilh SM, Rajion ZA, Samsudin R, Singh GD

Aust Orthod J, 2006 Nov;22(2):99-103.
PMID: 17203572

To quantify and localise differences in Class I and Class II dental arches in Malay schoolchildren.
Assessment of 3-D nasal airway morphology in Southeast Asian adults with obstructive sleep apnea using acoustic rhinometry

Banabilh SM, Suzina AH, Mohamad H, Dinsuhaimi S, Samsudin AR, Singh GD

Clin Oral Investig, 2010 Oct;14(5):491-8.
PMID: 19806371 DOI: 10.1007/s00784-009-0342-9

The aim of the present study is to investigate nasal airway morphology in Asian adults with and without obstructive sleep apnea (OSA) using acoustic rhinometry (AR), principal components analysis (PCA), and 3-D finite-element analysis (FEA). One hundred eight adult Malays aged 18-65 years (mean ± SD, 33.2 ± 13.31) underwent clinical examination and limited channel polysomnography, providing 54 patients with OSA and 54 non-OSA controls. The mean minimal cross section area 1 (MCA1) and the mean minimal cross sectional area 2 (MCA2) were obtained from AR for all subjects and subjected to t tests. The OSA and control nasal airways were reconstructed in 3-D and subjected to PCA and FEA. The mean MCA1 and MCA2 using AR were found to be significantly smaller in the OSA group than in the control group (p < 0.001). Comparing the 3-D OSA and control nasal airways using PCA, the first two eigenvalues accounted for 94% of the total shape change, and statistical differences were found (p < 0.05). Similarly, comparing the nasal airways using FEA, the 3-D mean OSA nasal airway was significantly narrower in the OSA group compared to the control group. Specifically, decreases in size of approx. 10-22% were found in the nasal valve/head of inferior turbinate area. In conclusion, differences in nasal airway morphology are present when comparing patients with OSA to controls. These differences need to be recognized as they can improve our understanding of the etiological basis of obstructive sleep apnea and facilitate its subsequent management.
Craniofacial obesity in patients with obstructive sleep apnea

Banabilh SM, Suzina AH, Dinsuhaimi S, Samsudin AR, Singh GD

Sleep Breath, 2009 Mar;13(1):19-24.
PMID: 18763003 DOI: 10.1007/s11325-008-0211-9

INTRODUCTION: Obstructive sleep apnea (OSA) and obesity are serious, widespread public health issues.
OBJECTIVE: To localize and quantify geometric morphometric differences in facial soft tissue morphology in adults with and without OSA.
MATERIALS AND METHODS: Eighty adult Malays, consisting of 40 patients with OSA and 40 non-OSA controls, were studied. Both groups were evaluated by the attending physician and through ambulatory sleep studies. 3-D stereophotogrammetry was used to capture facial soft tissues of both groups. The 3-D mean OSA and control facial configurations were computed and subjected to principal components analysis (PCA) and finite-element morphometry (FEM).
RESULTS: The body mass index was significantly greater for the OSA group (32.3 kg/m(2) compared to 24.8 kg/m(2), p < 0.001). The neck circumference was greater for the OSA group (42.7 cm compared to 37.1 cm, p < 0.001). Using PCA, significant differences were found in facial shape between the two groups using the first two principal components, which accounted for 50% of the total shape change (p < 0.05). Using FEM, these differences were localized in the bucco-submandibular regions of the face predominantly, indicating an increase in volume of 7-22% (p < 0.05) for the OSA group.
CONCLUSION: Craniofacial obesity in the bucco-submandibular regions is associated with OSA and may provide valuable screening information for the identification of patients with undiagnosed OSA.