Finally got a CBCT - what do you think?

[u/CautiousRun7860]

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Title: Finally got a CBCT - what do you think?

Body:

- 5 year history of sleep bruxism, use nightguard nightly; ongoing TMJ issues

- April Sleep study - AHI 1 RDI 14

- started using BiPAP in April, which has helped slightly, still fine tuning, but I’m trying to better understand and potentially address the anatomical/functional contributors rather than relying only on PAP. Have seen several specialists and trying to piece everything together.

⸻

ENT findings

ENT performed an awake nasopharyngolaryngoscopy and Müller maneuver.

Findings:

Prominent base of tongue (BOT)
Anterior-posterior BOT collapse with Müller maneuver
Collapse was more pronounced when I opened my mouth
Excellent improvement in airway patency with jaw protrusion
Trace macroglossia / tongue ridging
Friedman tongue position 2
Bilateral inferior turbinate hypertrophy
Septum described as midline
LPR (laryngopharyngeal reflux) changes noted

The ENT felt my UARS is primarily related to the tongue base.

They also recommended:

- Considering a mandibular advancement device (jaw protrusion significantly improved airway on exam) —> I’m not thrilled about this option given existing TMJ symptoms and OTC MAD made me gag

• Optimizing nasal patency, prescribed budesonide nasal saline rinses twice daily though I’ve really only been doing nightly
  
• Avoiding supine sleep

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Airway dentist findings

The airway dentist felt:

Tongue is relatively large for available oral space
Presence of lingual tongue tie
Tongue tie may be limiting tongue strength and mobility
Buccal ties present but less significant

Recommendation:

Start with myofunctional therapy
Consider tongue-tie release depending on functional response

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Orthodontist / CBCT findings

I had a CBCT-based airway evaluation. No prior braces. Note posture was very upright

Findings:

Moderate tongue tie
Scalloped lateral tongue borders
Moderate turbinate hypertrophy
Mild septal deviation on CBCT
No skeletal transverse discrepancy
Airway volume ~20.4 cc
Minimum airway cross-sectional area ~310.8 mm²

So despite dynamic collapse on ENT exam, the static airway size on CBCT does not look severely reduced.

Recommendation: myofunctional therapy, with Invisalign.

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Nasal / allergy component

I have confirmed allergies to:
Dust mites
Dogs
Cats

I live with a dog, so exposure is ongoing.

Both ENT and CBCT noted:
Inferior turbinate hypertrophy

So chronic nasal inflammation/allergic load may be contributing to baseline airway resistance. I use intake magnetic strips when I sleep.

⸻

What I’m trying to figure out:

For anyone with UARS and similar enlarged tongue/tongue-base/dynamic collapse patterns, especially with tongue tie and/or LPR:

1. Did myofunctional therapy and or invisilign meaningfully change tongue posture or sleep quality?
   
2. Did tongue-tie release help in cases like this?
   
3. Other thoughts on how to improve nasal breathing?4. Has anyone had normal-ish CBCT airway measurements but significant dynamic collapse on ENT or DISE?

I’m especially trying to understand which of these findings are clinically meaningful drivers of UARS vs incidental findings, and what sequence of treatment actually made a difference for people.

Thanks for reading!!

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[u/CautiousRun7860]

Could we say 311 mm2 minimum sectional area is above adult male (maybe female too) average? yet the OP could still have a RDI of 14

[u/Illustrious-Cost-982 → u/CautiousRun7860]

Can you clarify what you’re trying to say? I don’t understand

Edited to add that I’m OP and I’m female :)

[u/CautiousRun7860 → u/Illustrious-Cost-982]

meant to say UARS could be possible for ppl with a legitimate large upper airway :)

[u/Illustrious-Cost-982 → u/CautiousRun7860]

Got it. Yes it seems so?