Dual Bite with Airway Compromise on Sleep Practice Evaluation

A 51-year-old male was referred by an airway and sleep practice for a full interpretation of CBCT with no specific clinical notes. During full-volume review, the radiologist identified a severely limited airway with a minimum cross-sectional area of 16.1 mm squared in the oropharyngeal region. At the same time, the condyles were inferiorly and anteriorly positioned while the patient was in maximum intercuspation, and the TMJs presented functional remodeling. The radiographic findings favored a dual bite, a condition in which the condyle positioning and occlusion change due to postural compensation for a small airway. The radiologist noted that dual bite is an orthopedically unstable position for the condyles and cannot be detected except on 3-D imaging with the patient in proper positioning. Any restorative or prosthetic work, or extractions, could allow the condyles to seat further into the fossa, facilitating a change in occlusion that would be difficult for the clinician to manage and potentially significant for the patient. This case highlights the broader effects that a compromised airway can have on the maxillofacial region beyond the airway itself.