미니스크류를 이용한 급속구개확장술이 폐쇄성 수면무호흡증이 있는 성인 환자의 상기도 호흡에 미치는 영향: 유체구조연계 분석법

학위논문 (박사)-- 서울대학교 대학원 치의학대학원 치의학과, 2017. 8. 백승학.The purpose of this study was to investigate the effects of miniscrew-assisted rapid palatal expansion (MARPE) on changes in airflow in the upper airway (UA) of an adult patient with obstructive sleep apnea syndrome (OSAS). Three-dimensional (3D) UA models of a young adult male patient with OSAS [age of 18 years and 7 months, body mass index (BMI), 25.0 kg/m2apnea and hypopnea index (AHI), 49.5 events/hourrespiratory disturbance index (RDI), 52.2 events/hourlowest O2 saturation rate (LSR), 85%] were fabricated using cone-beam computed tomography images taken before (T0) and after MARPE treatment (T1). The signs [age of 19 years and 1 month, BMI, 24.9 kg/m2AHI, 2.2 events/hourRDI, 20.2 events/hourLSR, 95%] and symptoms at the T1 stage significantly improved. A total of sixteen cross-sectional planes were set with the inter-plane distance of 10 mm along the upper airway: 7 planes for the nasal cavity and 9 planes for the pharynx. Using 3D computational fluid dynamics (3D-CFD) and fluid-structure interaction (FSI) analysis, changes in the cross-sectional area (CSA), velocity and pressure of airflow, displacements of nodes, and total resistance were investigated at maximum inspiration (MI), rest, and maximum expiration (ME). Compared to the T0 stage, the T1 stage exhibited significant increase in CSA at the most of parts of the nasal cavity and at the upper part of pharynx. Velocity of airflow was decreased primarily in the anterior part of the nasal cavity at MI and ME, and in the upper and middle parts of the pharynx at MI. However, the amounts of decrease were greater in the nasal cavity than the pharynx. Pressure of airflow was decreased mainly in the anterior parts of the nasal cavity and consistently in the whole pharynx. In terms of node displacement, the amount of displacement was insignificant at both T0 and T1 stages. In aspects of total resistance, there was significant decrease in the absolute values at MI (-55.1%), rest (-35.9%) and ME (-33.9 %) during T0-T1. Since MARPE improved airflow and reduced resistance in the UA, it might be an effective treatment modality for adult OSAS patients who have moderate to severe narrow basal arch and crowding and refuse to the oral appliance or MMA surgery.1. INTRODUCTION 1 2. REVIEW OF LITERATURE 3 3. MATERIALS AND METHODS 8 4. RESULTS 11 5. DISCUSSION 14 6. CONCLUSION 17Docto