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Yey Özkeskin SZ, Ersan N, Öztürk Muhtar M, Cansiz E, Ramazanoğlu M. Evaluation of Minimum Axial Airway Area and Airway Volume in Orthognathic Surgery Patients: A Retrospective Study. J Craniofac Surg 2024:00001665-990000000-01811. [PMID: 39141820 DOI: 10.1097/scs.0000000000010533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 07/11/2024] [Indexed: 08/16/2024] Open
Abstract
The aim of this study was to compare preoperative and postoperative linear, planar, and volumetric measurements in the pharyngeal airway in orthognathic surgery patients. Preoperative and postoperative cone beam computed tomography (CBCT) images of 60 patients, who underwent maxillary advancement with mandibular setback (Group I, n=25) and bimaxillary advancement (Group II, n=35), were compared. The airway was divided into 3 regions as nasopharynx, oropharynx, and hypopharynx. Linear and planar measurements were made on the reference sections of each region. The minimum axial airway area, the volume of 3 regions, and total airway volume were also measured. Regarding the linear, planar, and volumetric measurements, while there was a statistically significant increase in the measurements for all three regions in Group II, in Group I only the measurements in the nasopharyngeal region demonstrated a statistically significant increase postoperatively (P<0.05). There was an increase in minimum axial airway areas in both groups; however, it was only statistically significant in Group II (P<0.05). There was a statistically significant increase in total airway volumes in both groups (P<0.05). A positive and good correlation was found between the percent increase in the minimum axial area and the percent increase in the total volume (P<0.05). While bimaxillary advancement surgery results in a significant increase in the pharyngeal airway, mandibular setback with maxillary advancement caused an increase in the total airway. Changes that may occur in the airway should be considered while planning orthognathic surgery.
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Affiliation(s)
| | - Nilüfer Ersan
- Department of Dentomaxillofacial Radiology, Yeditepe University Faculty of Dentistry, Istanbul, Turkiye
| | - Merve Öztürk Muhtar
- Department of Oral and Maxillofacial Surgery, Istanbul University Faculty of Dentistry, Istanbul, Turkiye
| | - Erol Cansiz
- Department of Oral and Maxillofacial Surgery, Istanbul University Faculty of Medicine, Istanbul, Turkiye
| | - Mustafa Ramazanoğlu
- Department of Oral and Maxillofacial Surgery, Istanbul University Faculty of Dentistry, Istanbul, Turkiye
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Shah S, Block-Wheeler N, Liu K, Weintraub MR, Williams WB. The Association of Body Mass Index and Early Outcomes Following Orthognathic Surgery. J Oral Maxillofac Surg 2024; 82:782-791. [PMID: 38643964 DOI: 10.1016/j.joms.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND The existing data on the link between body mass index (BMI), operative characteristics, and surgical outcomes across orthognathic surgery are limited. PURPOSE The purpose was to measure the association between BMI and early postoperative outcomes in orthognathic surgery. STUDY DESIGN, SETTING, AND SAMPLE This is a retrospective cohort study of patients (n = 118) aged > 14 years undergoing bimaxillary orthognathic surgery between 2015 and 2018 by a single surgeon within the Kaiser Permanente Northern California-integrated healthcare system. Patients undergoing unilateral or additional procedures, history of prior orthognathic surgery, or pre-existing pain conditions were excluded. PREDICTOR VARIABLE The predictor variable was BMI measured as a continuous (kg/m2) and categorical variable (underweight/normal, overweight, obese). MAIN OUTCOME VARIABLE(S) The primary outcome variables were additional postoperative antibiotics, increased postoperative visits, wound dehiscence, and wound infection. The secondary outcome variables were total operative and anesthesia time. COVARIATES The demographic covariates included age, sex, and race/ethnicity. The clinical covariates included history of obstructive sleep apnea, Mallampati score, tobacco use, American Society of Anesthesia classification, thyromental distance, history of difficult intubation, and Angle's classification. ANALYSES Bivariate and multivariate analyses were performed to measure the associations between BMI and the primary and secondary outcomes. Multivariable logistic regression analyses were used to measure associations between BMI and the postoperative outcomes. Statistical significance was defined as P < .05. RESULTS The study sample was composed of 118 subjects with a mean age of 26.91 years (standard deviation 9.43). Forty-seven percent (n = 55) were male, and the mean BMI was 25.13 (standard deviation 5.19). BMI category was significantly associated with age, with increasing age associated with higher BMI category (P = .02). According to the bivariate and multivariable logistic regression analyses, controlling for age, race/ethnicity, BMI, and total operative time, increased total operative time was associated with additional postoperative antibiotics (odds ratio = 1.03, 95% confidence interval: 1.01, 1.05), and increased postoperative appointments (odds ratio = 1.02, 95% confidence interval: 1.01, 1.04). No significant association between BMI and other clinical or operative characteristics was seen aside from American Society of Anesthesia classification. CONCLUSION AND RELEVANCE Elevated BMI was not associated with worsened operative characteristics or postoperative outcomes. This supports the suitability of orthognathic surgery in a BMI-diverse population.
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Affiliation(s)
- Swapnil Shah
- Medical Student, Creighton University School of Medicine, Omaha, NE; Resident, Department of Head and Neck Surgery, Kaiser Permanente, Northern California, Oakland, CA.
| | - Nikolas Block-Wheeler
- Resident, Department of Head and Neck Surgery, Kaiser Permanente, Northern California, Oakland, CA
| | - Kalena Liu
- Resident, Department of Head and Neck Surgery, Kaiser Permanente, Northern California, Oakland, CA; Medical Student, City University of New York School of Medicine, New York, NY
| | - Miranda Ritterman Weintraub
- Research Manager, Department of Graduate Medical Education, Kaiser Permanente, Northern California, Oakland, CA
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Magnus A, Agneta M, Anders M, Jahan A, Ola S, Martin U. Effects of orthognathic surgery on respiratory function during sleep: A prospective longitudinal study. Orthod Craniofac Res 2024. [PMID: 38940200 DOI: 10.1111/ocr.12828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Abstract
When treating patients with orthognathic surgery, there might be a risk of obstructive sleep apnoea (OSA) due to soft tissue changes in the upper airways, especially in patients treated with isolated mandibular setback or mandibular setback in combination with maxillary advancement. In the present study, we assessed respiratory function during sleep with home cardiorespiratory polygraphy in 62 patients who had not been previously been diagnosed with OSA at three times: prior to orthognathic surgery for aesthetic and functional indications, and then 3 months and 1 year after surgery. We evaluated surgical displacement based on measurements in three dimensions using pre- and post-operative computed tomography. There were only minor changes in the respiratory parameters such as the apnoea-hypopnoea index (AHI), the apnoea-hypopnoea index in the supine position (AHIsup), the oxygen saturation index (ODI) and the snore index. There was no significant correlation between surgical displacement and the AHI, AHIsup and ODI. There was a weak but significant correlation between vertical displacement of the anterior mandible and the snore index. Within the limitations of the present study, the risk for iatrogenic obstruction of the upper airways seems to be low in patients without OSA treated with orthognathic surgery.
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Affiliation(s)
- Ahl Magnus
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Oral and Maxillofacial Surgery, The Institute for Postgraduate Dental Education, Jönköping, Sweden
| | - Marcusson Agneta
- Maxillofacial Unit, Linköping University Hospital, Linköping, Sweden
| | - Magnusson Anders
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Centre for Oral Health, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Abtahi Jahan
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Maxillofacial Unit, Linköping University Hospital, Linköping, Sweden
| | - Sunnergren Ola
- Ear, Nose & Throat Clinic, Region Jönköping County, Jönköping, Sweden
| | - Ulander Martin
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
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Honglertnapakul Y, Peanchitlertkajorn S, Likitkulthanaporn A, Saengfai NN, Chaweewannakorn C, Boonpratham S. Impacts of mandibular setback with or without maxillary advancement for class III skeletal correction on sleep-related respiratory parameters: A systematic review and meta-analysis. Orthod Craniofac Res 2024. [PMID: 38661057 DOI: 10.1111/ocr.12798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 04/26/2024]
Abstract
A systematic review and meta-analysis was conducted to evaluate the impacts of mandibular setback with or without maxillary advancement for class III skeletal correction on respiratory parameters measured by polysomnography (PSG) and to compare these respiratory parameters between these procedures for class III skeletal correction. Six electronic databases were searched up to June 2023. Studies comparing PSG parameters before and after orthognathic surgery for skeletal class III patients were selected for further analysis. The outcomes of interest were apnoea-hypopnea index (AHI), respiratory disturbance index (RDI), the lowest oxygen saturation (lowest SpO2), the average oxygen saturation (mean SpO2), and the 3% oxygen desaturation index (3% ODI). Data extraction, methodological quality assessment, risk of bias assessment, meta-analysis, and subgroup analysis were performed. Sixteen studies with a total of 476 patients who underwent orthognathic surgery for class III skeletal correction were included for meta-analysis. The risk of bias level was moderate for most studies. All PSG parameters before and after orthognathic surgery were not significantly different. The different surgical procedures also did not significantly affect post-operative PSG parameters. 5.8% of patients developed post-operative obstructive sleep apnoea (OSA). Most of them underwent a large distance of mandibular setback. There is a moderate level of evidence that mandibular setback with or without maxillary advancement for class III skeletal correction does not pre-dispose young and healthy patients to obstructive sleep apnoea when evaluated in the short term after surgery. However, post-operatively developed OSA was found in several isolated cases that underwent a large amount of mandibular setback with or without maxillary advancement.
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Affiliation(s)
| | | | | | | | | | - Supatchai Boonpratham
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, Nakhon Pathom, Thailand
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Wei Z, Jiang H, Wang S, Wang Z, Qu B, Hu M. Influencing factors for the development of obstructive sleep apnea after orthognathic surgery in skeletal class III patients: A systematic review. J Craniomaxillofac Surg 2024; 52:503-513. [PMID: 38383249 DOI: 10.1016/j.jcms.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 12/22/2023] [Accepted: 02/02/2024] [Indexed: 02/23/2024] Open
Abstract
This systematic review aimed to investigate the factors that may contribute to the development of OSA after orthognathic surgery in patients with skeletal class III. Electronic searches of PubMed, Embase, Web of Science, and Cochrane databases were conducted up to December 10, 2022. In total, 277 studies were retrieved and screened according to the inclusion and exclusion criteria, and 14 were finally selected. All studies were of medium quality (moderate risk of bias). The occurrence of OSA after orthognathic surgery in patients with class III skeletal relationships depends on surgical factors and patient self-factors. Surgical factors include surgery type, amount of maxillary and mandibular movement, and the patient's postoperative swelling. Patient self-factors include weight, age, gender, and hypertrophy of the soft palate, tonsils, and tongue. According to information in the 14 selected articles, the incidences of OSA after Le Fort I impaction and BSSO setback, BSSO setback, and Le Fort I advancement and BSSO setback were 19.2%, 8.57%, and 0.7%, respectively, mostly accompanied with greater amounts of mandibular recession. However, no clear evidence exists to confirm that orthognathic surgery is a causative factor for postoperative sleep breathing disorders in patients with mandibular prognathism. The wider upper airway in patients with class III skeletal might be the reason for the rare occurrence of OSA after surgery. In addition, obesity and advanced age may lead to sleep apnea after orthognathic surgery. Obese patients should be advised to lose weight preoperatively.
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Affiliation(s)
- Ziqing Wei
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, China
| | - Huan Jiang
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, China.
| | - Shaotai Wang
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, China
| | - Zheqing Wang
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, China
| | - Bo Qu
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, China
| | - Min Hu
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, China; Key Laboratory of Pathobiology, Ministry of Education, Jilin University, Changchun, China.
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Costa ALF, Castilho Fardim KA, de Almeida BM, Gomes JPP, Braz-Silva PH, Dieguez FL, Cardoso CDAB, Araki AT, de Castro Lopes SLP. Eccentric movements of temporomandibular joint and upper airway volume: Three-dimensional segmentation using cone beam computed tomography. Cranio 2024; 42:10-17. [PMID: 33719936 DOI: 10.1080/08869634.2021.1894860] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of the present investigation was to assess whether possible changes in the dynamic movements of the TMJ might cause a greater variation between the volumes of the upper airways in open- and closed-mouth positions. METHODS CBCT scans of 92 subjects were used to assess the TMJ bilaterally. All scans were acquired in closed (CM) and maximum mouth opening (MMO) positions. The difference in the volume of the oropharyngeal cavity obtained by subtracting the CM volume from the MMO volume (delta volume or volume variation) was calculated. The resulting volume was analyzed by Mann-Whitney test for variation in rotation. RESULTS A significant difference was found (p-value = 0.0188) on the right side regarding changes in the rotational movement of the condyle (Mann-Whitney test). CONCLUSION This study showed a relationship between degree of abnormal or limited rotation and variation in the upper airway volume on one side.
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Affiliation(s)
| | - Karolina Aparecida Castilho Fardim
- Department of Diagnosis and Surgery, São José dos Campos Dental School, São Paulo State University (UNESP), São José dos Campos, SP, Brazil
| | - Bruna Maciel de Almeida
- Department of Diagnosis and Surgery, São José dos Campos Dental School, São Paulo State University (UNESP), São José dos Campos, SP, Brazil
| | - João Pedro Perez Gomes
- Department of Stomatology, School of Dentistry, University of São Paulo, Sao Paulo, Brazil
| | | | - Flávia Limberg Dieguez
- Postgraduate Program in Dentistry, Cruzeiro do Sul University (UNICSUL), São Paulo, SP, Brazil
| | | | - Angela Toshie Araki
- Postgraduate Program in Dentistry, Cruzeiro do Sul University (UNICSUL), São Paulo, SP, Brazil
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Ceylan Eser N, Arslan C, Altuğ AT. Validation of a Finite Element Model for Clinical and Virtual Evaluation of the Changes in Airway Dimensions Following Class III Bimaxillary Orthognathic Surgery. J Maxillofac Oral Surg 2023; 22:217-225. [PMID: 36703662 PMCID: PMC9871107 DOI: 10.1007/s12663-022-01781-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/05/2022] [Indexed: 01/29/2023] Open
Abstract
Introduction The aim of this study was to evaluate pharyngeal airway changes in adult skeletal Class III cases whose bimaxillary surgical treatments were planned with different amounts of maxillary and mandibular movement using lateral cephalometric radiographs and finite element analysis (FEA). Our null hypothesis was that bimaxillary orthognathic surgery in which maxillary forward movement (MF) is greater than mandibular backward movement (MB) will result in more expansion of the pharyngeal airway. Materials and Methods A total of 31 individuals (11 females, 20 males) with class III skeletal deformity were included in the study. Patients who underwent bimaxillary orthognathic surgery with greater maxillary advancement (MF > MB) were categorized in Group 1 (n = 15), and those with greater mandibular set-back (MB > MF) as Group 2 (n = 16). Changes in airway dimensions were evaluated from lateral cephalometric radiographs. In addition, FEA modeling was used to determine pharyngeal airway changes with 5 different MF/MB combinations performed in skeletal class III bimaxillary surgeries. Results Nasopharyngeal and oropharyngeal airway dimensions increased in direct proportion to the amount of MF. Hypopharyngeal volume decreased compared to preoperative value in direct proportion to the decrease in MB. According to the FEA models, total pharyngeal airway volume decreased when MF was less than or equal to MB, was nearly unchanged when MF was 2 mm greater than MB, and increased when MF was 4 mm greater than MB. The results of FEA and lateral cephalometric analysis were compatible. Conclusion Our results supported the null hypothesis. We concluded that when possible, planning slightly more maxillary advancement than mandibular set-back will not have an adverse impact on the airway. Although the skeletal deformity only causes forward displacement of the mandible, dividing the skeletal correction between the maxilla and mandible may be considered to avoid the risk to patients' quality of life in terms of respiratory function.
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Affiliation(s)
| | - Can Arslan
- Department of Orthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
- Yeditepe Üniversitesi Diş Hastanesi, Bağdat Caddesi, Istanbul, 34728 Turkey
| | - Ayşe Tuba Altuğ
- Department of Orthodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey
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Maxillomandibular Advancement and Upper Airway Stimulation for Treatment of Obstructive Sleep Apnea: A Systematic Review. J Clin Med 2022; 11:jcm11226782. [PMID: 36431259 PMCID: PMC9697253 DOI: 10.3390/jcm11226782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
This systematic review aimed to comparatively evaluate the efficacy and safety of maxillomandibular advancement (MMA) and upper airway stimulation (UAS) in obstructive sleep apnea (OSA) treatment. A MEDLINE and Embase database search of articles on MMA and/or UAS for OSA was conducted. Twenty-one MMA studies and nine UAS studies were included. All the MMA studies demonstrated a reduction in apnea hypopnea index (AHI) postoperatively, and success rates ranged from 41.1% to 100%. Ten MMA studies reported pre- and postoperative Epworth sleepiness scale (ESS), and all but one study demonstrated a reduction in ESS. In the UAS studies, all but one demonstrated a reduction in AHI, and success rates ranged from 26.7% to 77.8%. In the eight UAS studies reporting pre- and postoperative ESS, an ESS reduction was demonstrated. No studies reported any deaths related to MMA or UAS. The most common postoperative complications after MMA and UAS were facial paresthesia in the mandibular area and discomfort due to electrical stimulation, respectively. This systematic review suggests that both MMA and UAS are effective and generally safe therapies for OSA. However, due to the limitations of the included studies, there is no evidence yet to directly compare these two procedures in OSA treatment.
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Madhan S, Holte MB, Diaconu A, Thorn JJ, Ingerslev J, Nascimento GG, Cornelis M, Pinholt EM, Cattaneo PM. Pharyngeal airway changes five years after bimaxillary surgery - A retrospective study. J Craniomaxillofac Surg 2022; 50:848-857. [PMID: 36473761 DOI: 10.1016/j.jcms.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/31/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to retrospectively evaluate pharyngeal airway (PA) changes after bimaxillary surgery (BMS). Preoperative, immediate- and 5-year postoperative cone-beam computed tomography images of subjects who underwent BMS were assessed. The primary outcome variable was the PA volume. The secondary outcome variables were the retropalatal and oropharyngeal volumes, cross-sectional area, minimal hydraulic diameter, soft tissue, skeletal movements and sleep-disordered breathing (SDB). A total of 50 patients were included, 33 female and 17 male, with a mean age of 26.5 years. A significant increase in the PA volume was seen immediately after surgery (40%), and this increase was still present at 5-year follow-up (34%) (P < 0.001). A linear mixed model regression analysis revealed that a mandibular advancement of ≥5 mm (P = 0.025) and every 1-mm upward movement of epiglottis (P = 0.016) was associated with a volume increase of the oropharyngeal compartment. Moreover, ≥5-mm upward movement of hyoid bone (P = 0.034) and every 1-mm increase in minimal hydraulic diameter (P < 0.001) correlated with an increase of the PA volume. A total of 30 subjects reported improvement in the SDB at 5-year follow-up. This study demonstrated that BMS led to an increase in PA dimensions in non-OSA patients, and these changes were still present at 5-year follow-up. BMS seemed to induce clinical improvement in SDB.
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Affiliation(s)
- Sivaranjani Madhan
- Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark; Section of Orthodontics, Section of Orofacial Pain and Joint Function, Department of Dentistry and Oral Health, Faculty of Health, Aarhus University, Vennelyst Boulevard 9, 8000, Aarhus, Denmark.
| | - Michael Boelstoft Holte
- Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark.
| | - Alexandru Diaconu
- Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark.
| | - Jens Jørgen Thorn
- Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark.
| | - Janne Ingerslev
- Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark.
| | - Gustavo G Nascimento
- Section for Periodontology, Department of Dentistry and Oral Health, Faculty of Health, Aarhus University, Vennelyst Boulevard 9, 8000, Aarhus, Denmark.
| | - Marie Cornelis
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 720 Swanston St, Carlton, 3053, Victoria, Australia.
| | - Else Marie Pinholt
- Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark.
| | - Paolo M Cattaneo
- Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark; Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 720 Swanston St, Carlton, 3053, Victoria, Australia.
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Three-Dimensional Evaluation of Upper Airway Changes After Bimaxillary Surgery of Skeletal Class 3 Patients. J Craniofac Surg 2022; 34:996-1000. [PMID: 36084226 DOI: 10.1097/scs.0000000000008988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/30/2022] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to evaluate the 3-dimensional changes in upper airway space of class 3 patients after surgery with sleep-related breathing disturbance. This is a retrospective cohort study included 25 patients who had undergone bimaxillary orthognathic surgery with maxillary advancement and mandibular setback for skeletal class 3 deformity. The changes in minimum axial area, nasopharyngeal and oropharyngeal airway volume were determined by cone-beam computed tomography images, as well as the sleep parameters by polysomnography preoperatively and postoperatively. The impacts of mandibular setback and maxillary advancement amounts on the airway structures were evaluated and compared with other parameters. The results show that pharyngeal volume measurement means were found to be significantly increased postoperatively (P<0.05). No significant difference was observed in the mean values of minimum axial area and sleep parameters after the operation (P>0.05). A positive relationship was determined between the oropharyngeal volume and minimum axial area changes at a rate of 60% (r: 0.600). No relationship was revealed between airway volume changes and polysomnographic parameters. An increase in the total airway volume and no postoperative sleep-related disturbance symptoms were observed in the patients treated by maxillary advancement and mandibular setback surgery.
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Khaghaninejad MS, Khojastehpour L, Danesteh H, Changizi M, Ahrari F. Changes in the pharyngeal airway after different orthognathic procedures for correction of class III dysplasia. Maxillofac Plast Reconstr Surg 2022; 44:23. [PMID: 35678935 PMCID: PMC9184694 DOI: 10.1186/s40902-022-00352-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/24/2022] [Indexed: 12/02/2022] Open
Abstract
Objective This study was conducted to compare changes in pharyngeal airway after different orthognathic procedures in subjects with class III deformity. Methods The study included CBCT scans of 48 skeletal class III patients (29 females and 19 males, mean age 23.50 years) who underwent orthognathic surgery in conjunction with orthodontic treatment. The participants were divided into three groups of 16, as follows: Group 1, mandibular setback surgery; group 2, combined mandibular setback and maxillary advancement surgery; and group 3, maxillary advancement surgery. CBCT images were taken 1 day before surgery (T0), 1 day (T1), and 6 months (T2) later. The dimensions of the velopharynx, oropharynx, and hypopharynx were measured in CBCT images. Results In all groups, there was a significant decrease in airway variables immediately after surgery, with a significant reversal 6 months later (P < 0.05). In subjects who underwent maxillary advancement, the airway dimensions were significantly greater at T2 than the T0 time point (P < 0.05), whereas in the mandibular setback and bimaxillary surgery groups, the T2 values were lower than the baseline examination (P < 0.05). The alterations in airway variables were significantly different between the study groups (P < 0.05). Conclusions The mandibular setback procedure caused the greatest reduction in the pharyngeal airway, followed by the bimaxillary surgery and maxillary advancement groups, with the latter exhibiting an actual increase in the pharyngeal airway dimensions. It is recommended to prefer a two-jaw operation instead of a mandibular setback alone for correction of the prognathic mandible in subjects with predisposing factors to the development of sleep-disordered breathing.
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Affiliation(s)
- Mohammad Saleh Khaghaninejad
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Khojastehpour
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Danesteh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Changizi
- Oral and Maxillofacial Surgery Resident, Department of Oral and Maxillofacial Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Ahrari
- Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
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Tsai MS, Chen HC, Liu SYC, Lee LA, Lin CY, Chang GH, Tsai YT, Lee YC, Hsu CM, Li HY. Holistic care for obstructive sleep apnea (OSA) with an emphasis on restoring nasal breathing: A review and perspective. J Chin Med Assoc 2022; 85:672-678. [PMID: 35507064 DOI: 10.1097/jcma.0000000000000737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by partial or complete airway blockage during sleep. Nocturnal nasal obstruction usually leads to mouth breathing while sleeping, which worsens sleep apnea by aggravating tongue base and lateral pharyngeal wall collapse. The pathogenesis of OSA is multifactorial, and the precipitating factors vary significantly among individuals. Although continuous positive airway pressure (CPAP) is considered the first-line therapy for OSA, its adherence rate remains a challenge. Oral appliances are more suitable for simple snorers or patients with mild OSA. Maxillomandibular advancement (MMA) is highly effective for treating those with mandibular retrognathia and moderate-to-severe OSA. Intrapharyngeal surgeries yield favorable outcomes in patients with large tonsils and low tongue resting position (Friedman Stage I); however, their efficacy declines with time. Each therapy has its own strength and weakness; thus, the principle of multimodality treatment should be adopted. Nasal surgery plays an indispensable role in the holistic care for OSA. In addition to alleviating nasal congestion, nasal surgery significantly reduces snoring intensity and daytime sleepiness, which improves the quality of life of patients with OSA. Although it significantly reduces the respiratory disturbance index, its effect on the apnea-hypopnea index remains controversial. A combination of nasal surgery and multilevel pharyngeal surgery may result in better prognosis. Nasal surgery can significantly reduce the therapeutic pressure and improve the CPAP compliance of patients undergoing CPAP therapy. In conclusion, multimodality treatment and holistic care for OSA should involve nasal surgery for optimizing treatment outcomes.
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Affiliation(s)
- Ming-Shao Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
- Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
| | - Hung-Chin Chen
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Stanley Yung-Chuan Liu
- Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Li-Ang Lee
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Cheng-Yu Lin
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
- Department of Environmental and Occupational Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
- Sleep Medicine Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Geng-He Chang
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
- Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
| | - Yao-Te Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yi-Chan Lee
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
- Department of Otolaryngology-Head and Neck Surgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan, ROC
| | - Cheng-Ming Hsu
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Hsueh-Yu Li
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
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Application of computational fluid dynamics for the analysis of postoperative airway changes in oral cancer patients. J Vis (Tokyo) 2022. [DOI: 10.1007/s12650-022-00835-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Three-dimensional morphologic evaluation of the changes in the pharyngeal airway and hyoid bone after bimaxillary surgery in patients with skeletal Class III malocclusion with facial asymmetry: A preliminary study. Am J Orthod Dentofacial Orthop 2022; 162:42-50. [DOI: 10.1016/j.ajodo.2021.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 11/24/2022]
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Hassing GJ, The V, Shaheen E, Politis C, de Llano-Pérula MC. Long-term three-dimensional effects of orthognathic surgery on the pharyngeal airways: a prospective study in 128 healthy patients. Clin Oral Investig 2021; 26:3131-3139. [PMID: 34826028 DOI: 10.1007/s00784-021-04295-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/11/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate volumetric and circumferential pharyngeal airway space (PAS) changes and stability over time as evaluated with cone beam computed tomography (CBCT) before and after orthognathic surgery 2 years postoperatively. MATERIALS AND METHODS One hundred twenty-eight patients underwent bimaxillary orthognathic surgery at the Department of Maxillofacial Surgery of University Hospitals, Leuven, Belgium, were recruited prospectively. Patients were divided into 4 groups based on the amount of mandibular advancement in 5 mm increments (< 0 mm, 0-5 mm, 5-10 mm, or > 10 mm). CBCT data was acquired preoperatively and 1-6 weeks, 6 months, 1 year, and 2 years postoperatively. Patients with a history of maxillofacial trauma or surgery, obstructive sleep apnoea syndrome, or craniofacial anomalies were excluded. Nasopharyngeal, oropharyngeal, and hypopharyngeal PAS volumes and constriction surface areas (mCSA) were measured and compared between each time point with a paired t-test. RESULTS The largest significant increase in oropharyngeal volume and mCSA were observed in the 5-10 mm (+ 13.3-21.7%, + 51.3-83.0%)) and > 10 mm (+ 23.3-44.6%, + 92.3-130.0%) mandibular advancement groups. This increase only remained stable 2 years postoperatively in the > 10 mm group. In other mandibular advancement groups, short-term oropharyngeal volume and mCSA increases were noticed, which returned to baseline levels 6 months to 1 year postoperatively. CONCLUSION Bimaxillary advancement osteotomy significantly increases oropharyngeal volume and mCSA, which remains stable between 6 months to 1 year postoperatively. CLINICAL RELEVANCE Long-term stable volumetric and mCSA enlargements were found with > 10 mm mandibular advancements over a period of 2 years. Return towards baseline levels was observed in the other mandibular advancement groups.
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Affiliation(s)
- Gert-Jan Hassing
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Vincent The
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Eman Shaheen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Oral and Facial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Oral and Facial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Maria Cadenas de Llano-Pérula
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium.
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Rocha TL, Lima L, Pinzan A, Sant'ana E, Nogueira RLM, Bronfman CN, Janson G. Three-dimensional pharyngeal airway space changes after bimaxillary advancement. Dental Press J Orthod 2021; 26:e2119364. [PMID: 34669826 PMCID: PMC8529957 DOI: 10.1590/2177-6709.26.5.e2119364.oar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 08/19/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The probability of improvement in the upper airway space (UAS) with orthognathic surgery should be considered during the surgical-orthodontic treatment decision, providing not only an esthetic, but also a functional benefit for the patient. OBJECTIVE The purpose of this study was to evaluate the 3D changes in the upper airway space after maxillomandibular advancement surgery (MMA). METHODS A retrospective analysis of 56 patients, 21 male and 35 female, with a mean age of 35.8 ± 10.7 years, who underwent MMA was performed. Pre- and postoperative cone-beam computed tomography scans (CBCT) were obtained for each patient, and the changes in the UAS were compared using Dolphin Imaging 11.7 software. Two parameters of the pharyngeal airway space (PAS) were measured: airway volume (AV) and minimum axial area (MAA). Paired t-test was used to compare the data between T0 and T1, at 5% significance level. RESULTS There was a statistically significant increase in the UAS. Bimaxillary advancement surgery increased the AV and the MAA, on average, by 73.6 ± 74.75% and 113.5 ± 123.87%, respectively. CONCLUSION MMA surgery tends to cause significant increase in the UAS; however, this increase is largely variable.
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Affiliation(s)
- Thaís Lima Rocha
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Ortodontia (Bauru/SP, Brazil)
| | - Ludmila Lima
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Ortodontia (Bauru/SP, Brazil)
| | - Arnaldo Pinzan
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Ortodontia (Bauru/SP, Brazil)
| | - Eduardo Sant'ana
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Estomatologia (Bauru/SP, Brazil)
| | - Renato Luiz Maia Nogueira
- Universidade Federal do Ceará, Faculdade de Odontologia, Departamento de Cirurgia Oral (Fortaleza/CE, Brazil)
| | - Caroline Nemetz Bronfman
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Ortodontia (Bauru/SP, Brazil)
| | - Guilherme Janson
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Ortodontia (Bauru/SP, Brazil)
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Kang NE, Lee DH, In Seo J, Lee JK, Song SI. Postoperative changes in the pharyngeal airway space through computed tomography evaluation after mandibular setback surgery in skeletal class III patients: 1-year follow-up. Maxillofac Plast Reconstr Surg 2021; 43:31. [PMID: 34448114 PMCID: PMC8390598 DOI: 10.1186/s40902-021-00319-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background This study evaluated the pharyngeal airway space changes up to 1 year after bilateral sagittal split osteotomy mandibular setback surgery and bimaxillary surgery with maxillary posterior impaction through three-dimensional computed tomography analysis. Methods A total of 37 patients diagnosed with skeletal class III malocclusion underwent bilateral sagittal split osteotomy setback surgery only (group 1, n = 23) or bimaxillary surgery with posterior impaction (group 2, n = 14). Cone-beam computed tomography scans were taken before surgery (T0), 2 months after surgery (T1), 6 months after surgery (T2), and 1 year after surgery (T3). The nasopharynx (Nph), oropharynx (Oph), hypopharynx (Hph) volume, and anteroposterior distance were measured through the InVivo Dental Application version 5. Results In group 1, Oph AP, Oph volume, Hph volume, and whole pharynx volume were significantly decreased after the surgery (T1) and maintained. In group 2, Oph volume and whole pharynx volume were decreased (T2) and relapsed at 1 year postoperatively (T3). Conclusion In class III malocclusion patients, mandibular setback surgery only showed a greater reduction in pharyngeal airway than bimaxillary surgery at 1 year postoperatively, and bimaxillary surgery was more stable in terms of airway. Therefore, it is important to evaluate the airway before surgery and include it in the surgical plan.
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Affiliation(s)
- No Eul Kang
- Department of Oral and Maxillofacial Surgery, Institute of Oral Health Science, Ajou University School of Medicine, 164, Worldcup-ro, Yengto-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Dae Hun Lee
- Department of Oral and Maxillofacial Surgery, Institute of Oral Health Science, Ajou University School of Medicine, 164, Worldcup-ro, Yengto-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Ja In Seo
- Department of Oral and Maxillofacial Surgery, Institute of Oral Health Science, Ajou University School of Medicine, 164, Worldcup-ro, Yengto-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Jeong Keun Lee
- Department of Oral and Maxillofacial Surgery, Institute of Oral Health Science, Ajou University School of Medicine, 164, Worldcup-ro, Yengto-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Seung Il Song
- Department of Oral and Maxillofacial Surgery, Institute of Oral Health Science, Ajou University School of Medicine, 164, Worldcup-ro, Yengto-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea.
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Iwai K, Ueda H, Nagasaki T, Medina CC, Matsumura Y, Tanimoto K. Multislice computed tomography assessment of airway patency changes in the supine position following mandibular setback surgery for mandibular prognathism: A prospective 1-year follow-up study. APOS TRENDS IN ORTHODONTICS 2021. [DOI: 10.25259/apos_169_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives:
The purpose of this study was to perform a three-dimensional analysis on the pharyngeal airway of supine patients who have undergone mandibular setback surgery, using multislice computed tomography (MSCT). We also measured the respiratory disturbance index pre- and post-surgery, using a portable sleep monitor.
Materials and Methods:
The subjects included two males and nine females who were diagnosed with mandibular prognathism at Hiroshima University Hospital and were scheduled to undergo the bilateral sagittal split osteotomy. Using a CT scanner, baseline MSCT images were obtained from the subjects before surgery for morphological analysis, and then the two further scans were obtained after mandibular setback surgery. All patients were provided with at-hoeme sleep monitor to use it both at baseline and approximately 1 year after surgery.
Results:
Middle and epiglottis pharyngeal space and cross-sectional area were significantly decreased immediately after setback surgery, but did not change further over the 1-year period. Mandibular setback was not associated with the development of sleep breathing disorder (SBD) during the 1-year follow-up period.
Conclusion:
We found no evidence that the reduction in the pharyngeal airway space immediately after mandibular setback surgery recovered significantly during the follow-up period, although mandibular setback was not associated with development of SBD.
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Affiliation(s)
- Koji Iwai
- Department of Orthodontics and Craniofacial Developmental Biology, Hiroshima University, Hiroshima, Japan,
| | - Hiroshi Ueda
- Department of Orthodontics and Craniofacial Developmental Biology, Hiroshima University, Hiroshima, Japan,
| | - Toshikazu Nagasaki
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan,
| | - Cynthia Concepcion Medina
- Department of Orthodontics and Craniofacial Developmental Biology, Hiroshima University, Hiroshima, Japan,
| | - Yu Matsumura
- Department of Orthodontics and Craniofacial Developmental Biology, Hiroshima University, Hiroshima, Japan,
| | - Kotaro Tanimoto
- Department of Orthodontics and Craniofacial Developmental Biology, Hiroshima University, Hiroshima, Japan,
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The Effect of Orthognathic Surgery on the Hyoid Bone Position in Skeletal Class III Patients: An Evaluation Using Cephalometric Analysis. World J Plast Surg 2021. [DOI: 10.52547/wjps.10.2.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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20
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Bin LR, Filho LI, Yamashita AL, de Souza Pinto GN, Mendes RA, Ramos AL, Dos Santos Previdelli IT, Iwaki LCV. How does bimaxillary orthognathic surgery change dimensions of maxillary sinuses and pharyngeal airway space? Angle Orthod 2021; 90:715-722. [PMID: 33378484 DOI: 10.2319/120919-782.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/01/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To assess changes in the maxillary sinus (MS) and pharyngeal airway space (PAS) after bimaxillary orthognathic surgery using cone-beam computed tomography (CBCT). MATERIALS AND METHODS The CBCT scans of 48 patients were divided into two groups: group 1: maxillary advancement and mandibular setback (n = 24); group 2: maxillomandibular advancement (n = 24). The CBCTs were acquired 1 to 2 months preoperatively and 6 to 8 months postoperatively. A kappa test was used to determine intra- and interexaminer agreement. Area, volume, and linear measurements of MSs and PASs obtained before and after surgery were compared using a mixed model (P < .05). RESULTS All variables of the MS showed significant postsurgical reductions in both groups, except the MS length, which showed a significant increase in group 2. Volume and minimum axial area of PAS showed statistically significant postsurgical increases in both groups (P < .05). CONCLUSIONS Despite the reduction in the MS and the increase in the PAS, results indicated that the airway was not negatively affected after maxillomandibular advancement and maxillary advancement with mandibular setback.
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Computational Fluid Dynamic Analysis of the Pharyngeal Airway after Bimaxillary Orthognathic Surgery in Patients with Mandibular Prognathism. Processes (Basel) 2021. [DOI: 10.3390/pr9010152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study aimed to analyze pharyngeal airflow characteristics and their relationship with the skeletal movement of the maxilla and mandible after bimaxillary orthognathic surgery in patients with skeletal class III (mandibular prognathism) malocclusion. Cone-beam computed tomography (CBCT) was conducted before surgery (T0), immediately after surgery (T1), and at least six months after surgery (T2). Digital imaging and communications in medicine files were transferred to InVivo (Anatomage) software to measure the skeletal changes after surgery. The changes in the maxillary and mandibular position, tongue position, and hyoid bone position were analyzed. Patient-specific models were reconstructed using 3D-Doctor software. The models after converting to the stereolithography (STL) file for Ansys integrated computer engineering and manufacturing code for computational fluid dynamics (ICEM CFD), commercial software were used for calculating the geometry, pressure drop and adjusted pressure coefficient value. The total volume of the upper airway including nasal cavity was reduced by 23% immediately after surgery and recovered to 92.2% of the initial volume six months after surgery. The airflow computation analysis showed a decrease in the pressure drop values immediately after surgery and six months after surgery. The adjusted pressure coefficients were slightly different but the change was statistically insignificant. The airflow characteristics computed using the computational fluid dynamics were correlated to the surgical changes. The surgical changes can affect the aerodynamics of the pharyngeal airway. In clinical practice, this knowledge is useful for developing a suitable orthognathic surgery treatment plan.
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Rückschloß T, Ristow O, Jung A, Roser C, Pilz M, Engel M, Hoffmann J, Seeberger R. The relationship between bimaxillary orthognathic surgery and the extent of posterior airway space in class II and III patients – A retrospective three-dimensional cohort analysis. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2021. [DOI: 10.1016/j.ajoms.2020.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Safi M, Amiri A, Nasrabadi N, Khosravi S. Comparing Outcomes of Airway Changes and Risk of Sleep Apnea after Bimaxillary Orthognathic Surgery and Mandibular Setback Surgery in Patients with Skeletal Class III Malocclusion: A Systematic Review and Meta-Analysis. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2021. [DOI: 10.1590/pboci.2021.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Velopharyngeal Space Assessment in Patients Undergoing Le Fort 1 Maxillary Advancement. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3232. [PMID: 33299700 PMCID: PMC7722571 DOI: 10.1097/gox.0000000000003232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/07/2020] [Indexed: 12/04/2022]
Abstract
Background: The effects of maxillary advancement on velopharyngeal anatomy have primarily been studied using lateral cephalometric radiographs. However, with recent advances in orthognathic surgery, there is an increased need for more detailed and precise imaging such as computerized tomographic (CT) scan reconstructions, to help in surgical planning and to measure outcomes. The purpose of this study was to compare the pre- and post-operative velopharyngeal anatomic configuration modifications as measured on CT scans. Methods: This is a retrospective cohort study of 44 patients with and without cleft palate who were treated with maxillary advancement. The pre- and post-operative CT scans were compared with respect to pre-established landmarks. Linear distances, cross-sectional areas, and volumes were measured using 3-dimensional CT scan reconstructions. Results: For the linear distances measured, a statistically significant difference was found when comparing the pre- and post-operative measures of the narrowest part of the nasopharynx and the narrowest part of the retropalatal airway space (P = 0.001 and 0.026, respectively). Retropalatal cross-sectional areas, nasopharyngeal cross-sectional areas, and the volumetric assessment of the nasopharyngeal space showed no statistically significant differences when comparing pre- and post-operative scans (P < 0.05). Mean changes in the measures did not differ over time (pre- and post-operative) depending on whether there was a prior history of cleft palate repair. Conclusions: Although structural modifications of the pharyngeal space are inherent to maxillary advancement, its surface area and volume do not significantly change. The use of 3-dimensional reconstruction using CT scans should be the first choice for evaluation of the upper airway.
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A Modified Cosmetic Genioplasty Can Affect Airway Space Positively in Skeletal Class II Patients: Studying Alterations of Hyoid Bone Position and Posterior Airway Space. Aesthetic Plast Surg 2020; 44:1639-1655. [PMID: 32472313 DOI: 10.1007/s00266-020-01790-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Improving the posterior airway space is one of the most important functions of genioplasty. Studies have shown that the posterior airway space (PAS) can play an important role in the evaluation of obstructive sleep apnea syndrome (OSAS). The purpose of this study is to evaluate the airway safety of our modified technology by observing the impact on PAS in skeletal Class II patients without OSAS. METHODS We have modified a cosmetic genioplasty, which can guarantee the continuity of the lower edge of the bilateral mandible by rotating the chin segment clockwise. Fourteen patients submitted to our modified cosmetic genioplasty alone were included in the study. The facial convexity angle and the ratio of the face were measured by analyzing photographs. The position of the hyoid bone and the width of the PAS were measured by analyzing lateral cephalograms. The volume and the cross-sectional area (CSA) of the PAS were measured using 3D reconstruction. The Wilcoxon signed-rank test and paired samples t test were used to assess the significance of differences of the data (p < 0.05). RESULTS Soft tissue measurements were statistically different (p = 0.001) and achieved satisfactory results. The position of the hyoid bone moved up (LX: p = 0.004; LML: p = 0.056) and forward (LY: p = 0.001; LCV3: p = 0.016). The increase in the CSA had statistical significance (p < 0.005). There were significant statistical differences in the total airway volume and hypopharynx (p = 0.001), except in the oropharynx (p = 0.096). CONCLUSIONS Our modified genioplasty not only achieved better cosmetic results by ensuring the continuity of the lower edge of the bilateral mandible but also exerted a significant positive impact on the posterior airway space for patients with skeletal class II, thus helping reduce the prevalence of OSAS. We hence suggest performing this modified cosmetic genioplasty on the skeletal class II patients with/without OSAS if necessary. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Kim SH, Choi SK. Changes in the hyoid bone, tongue, and oropharyngeal airway space after mandibular setback surgery evaluated by cone-beam computed tomography. Maxillofac Plast Reconstr Surg 2020; 42:27. [PMID: 32821741 PMCID: PMC7423819 DOI: 10.1186/s40902-020-00271-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Mandibular setback surgery can change the position of the mandible which improves occlusion and facial profile. Surgical movement of the mandible affects the base of the tongue, hyoid bone, and associated tissues, resulting in changes in the pharyngeal airway space. The aim of this study was to analyze the 3-dimensional (3D) changes in the hyoid bone and tongue positions and oropharyngeal airway space after mandibular setback surgery. Methods A total of 30 pairs of cone-beam computed tomography (CBCT) images taken before and 1 month after surgery were analyzed by measuring changes in the hyoid bone and tongue positions and oropharyngeal airway space. The CBCT images were reoriented using InVivo 5.3 software (Anatomage, San Jose, USA) and landmarks were assigned to establish coordinates in a three-dimensional plane. The mean age of the patients was 21.7 years and the mean amount of mandibular setback was 5.94 mm measured from the B-point. Results The hyoid bone showed significant posterior and inferior displacement (P < 0.001, P < 0.001, respectively). Significant superior and posterior movements of the tongue were observed (P < 0.05, P < 0.05, respectively). Regarding the velopharyngeal and glossopharyngeal spaces, there were significant reductions in the volume and minimal cross-sectional area (P < 0.001). The anteroposterior and transverse widths of the minimal cross-sectional area were decreased (P < 0.001, P < 0.001, respectively). In addition, the amount of mandibular setback positively correlated with the amount of posterior and inferior movement of the hyoid bone (P < 0.05, P < 0.05, respectively). Conclusion There were significant changes in the hyoid bone, tongue, and airway space after mandibular setback surgery.
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Affiliation(s)
- Seon-Hye Kim
- Department of Orthodontics, School of Dentistry, Wonkwang University, Iksan, Korea
| | - Sung-Kwon Choi
- College of dentistry, Graduate School of Wonkwang University, Iksan, Korea
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Yang H, Jung YE, Kwon I, Lee JY, Hwang S. Airway changes and prevalence of obstructive sleep apnoea after bimaxillary orthognathic surgery with large mandibular setback. Int J Oral Maxillofac Surg 2020; 49:342-349. [DOI: 10.1016/j.ijom.2019.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/19/2019] [Accepted: 07/23/2019] [Indexed: 11/25/2022]
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Hong SN, Kim HG, Han SY, Ji JY, Kim MK, Han DH, Won TB, Kim DY, Kim HJ. Indications for and Outcomes of Expansion Sphincter Pharyngoplasty to Treat Lateral Pharyngeal Collapse in Patients With Obstructive Sleep Apnea. JAMA Otolaryngol Head Neck Surg 2020; 145:405-412. [PMID: 30844019 DOI: 10.1001/jamaoto.2019.0006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance The lateral pharyngeal wall is recognized as an important site of upper airway collapse during sleep in patients with obstructive sleep apnea (OSA), and expansion sphincter pharyngoplasty (ESP) may have promising clinical utility in patients with OSA and lateral pharyngeal wall collapse. Objectives To evaluate the therapeutic outcomes of ESP in conjunction with other surgical procedures and to investigate indications for ESP in patients with OSA. Design, Setting, and Participants Cohort study of 63 patients with OSA diagnosed with lateral pharyngeal collapse under drug-induced sleep endoscopy who underwent ESP combined with tonsillectomy, uvuloplasty, or nasal surgery at Seoul National University Hospital in Seoul, Korea, between March 1, 2015, and December 1, 2016. Main Outcomes and Measures The primary outcome measure was the change in the apnea-hypopnea index (AHI) after surgery (AHI represents the number of apnea-hypopnea events per hour). Other outcome measures were differences in the surgical response rates, lowest oxygen saturation, subjective visual analog scale scores for snoring and apnea, and Epworth Sleepiness Scale score. Results Fifty of the 63 patients (79%) were male; the mean age was 42.1 (range, 20-54) years, and the mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 27.6 (range, 19.0-32.1). Expansion sphincter pharyngoplasty was performed in patients with OSA with an AHI greater than 15 events per hour, more than 75% retropalatal circumferential narrowing when awake, and narrowed oropharynx due to bulky soft tissue around the lateral pharyngeal wall. In 42 of the 63 patients (67%), ESP was objectively successful in correcting lateral pharyngeal collapse; there was a significant reduction in mean AHI from 35.5 to 17.3 (mean difference, 18.1; 95% CI, 16.3-20.0) and improvement of the lowest mean (SD) oxygen saturation measurement from 78.2% (21.3%) to 86.4% (10.6%) (mean difference, 8.60%; 95% CI, 6.60%-10.60%) 6 months after the operation. The rate of postoperative complications, including pain and bleeding, was minimal after ESP, and a few patients reported an abnormal sensation around the soft palate and swallowing difficulty after ESP. Conclusions and Relevance Expansion sphincter pharyngoplasty appears to be a promising surgical technique to reduce lateral pharyngeal collapse in patients with moderate or severe OSA. Clinical data suggest that both severe palatal circumferential narrowing and bulky lateral pharyngeal tissue are favorable surgical indications for ESP in patients with OSA.
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Affiliation(s)
- Seung-No Hong
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Otorhinolaryngology, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung Gu Kim
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Yoon Han
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Yeon Ji
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Kyung Kim
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Doo Hee Han
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-Bin Won
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Young Kim
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jik Kim
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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An JH, Park SB, Choi YK, Lee SH, Kim KB, Kim YI. Cone-Beam Computed Tomography Evaluation of Pharyngeal Airway Space Changes After Bimaxillary Orthognathic Surgery in Patients With Class III Skeletal Deformities: A 6-Year Follow-Up Study. J Oral Maxillofac Surg 2019; 77:2534-2544. [DOI: 10.1016/j.joms.2019.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 10/26/2022]
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Vonk PE, Rotteveel PJ, Ravesloot MJL, Ho JPTF, de Lange J, de Vries N. The influence of position dependency on surgical success in patients with obstructive sleep apnea undergoing maxillomandibular advancement. J Clin Sleep Med 2019; 16:73-80. [PMID: 31957656 DOI: 10.5664/jcsm.8126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES (1) To evaluate surgical success in patients with obstructive sleep apnea undergoing maxillomandibular advancement (MMA) stratifying for the reduction of both the total apnea-hypopnea index (AHI) and the AHI in the supine and nonsupine position; (2) to evaluate the influence of position dependency on surgical outcome; and (3) to analyze the prevalence of residual position-dependent obstructive sleep apnea (OSA) in nonresponders after MMA. METHODS A single-center retrospective study including a consecutive series of patients with OSA undergoing MMA between August 2011 and February 2019. RESULTS In total, 57 patients were included. The overall surgical success was 52.6%. No significant difference in surgical success between nonpositional patients (NPP) and positional patients (PP) with OSA was found. Surgical success of the supine AHI was not significantly different between NPP and PP, but surgical success of the nonsupine AHI was significantly greater in NPP than in PP. Of the 17 preoperative NPP, 13 of them moved to being PP with less severe OSA postoperatively. In total, 21 out of 27 nonresponders (77.8%) were PP postoperatively. CONCLUSIONS No significant difference in surgical success between NPP and PP undergoing MMA was found. However, the improvement of total and nonsupine AHI in NPP was significantly greater compared to PP. In nonresponders, a postoperative shift from severe OSA in NPP to less severe OSA in PP was found, caused by a greater reduction of the nonsupine AHI than the supine AHI postoperatively. In patients with residual OSA in the supine position after MMA, additional treatment with positional therapy can be indicated.
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Affiliation(s)
- Patty E Vonk
- Department of Otorhinolaryngology - Head and Neck Surgery, OLVG, Amsterdam, the Netherlands
| | - Perry J Rotteveel
- Department of Otorhinolaryngology - Head and Neck Surgery, OLVG, Amsterdam, the Netherlands
| | - Madeline J L Ravesloot
- Department of Otorhinolaryngology - Head and Neck Surgery, OLVG, Amsterdam, the Netherlands.,Department of Otorhinolaryngology, Medical Centre Jan van Goyen, Amsterdam, the Netherlands
| | - Jean-Pierre T F Ho
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC/ACTA, Amsterdam, the Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC/ACTA, Amsterdam, the Netherlands
| | - Nico de Vries
- Department of Otorhinolaryngology - Head and Neck Surgery, OLVG, Amsterdam, the Netherlands.,Department of Oral Kinesiology, ACTA, MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands.,Faculty of Medicine and Health Sciences, Department of Otorhinolaryngology, Head and Neck Surgery Antwerp University Hospital, Antwerp, Belgium
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Riekert M, Kreppel M, Schier R, Zöller JE, Rempel V, Schick VC. Postoperative complications after bimaxillary orthognathic surgery: A retrospective study with focus on postoperative ventilation strategies and posterior airway space (PAS). J Craniomaxillofac Surg 2019; 47:1848-1854. [PMID: 31810851 DOI: 10.1016/j.jcms.2019.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/29/2019] [Accepted: 11/18/2019] [Indexed: 02/08/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate the impact of extubation time on postoperative complications in patients undergoing bimaxillary orthognathic surgery. We therefore retrospectively compared the effect of early extubating (EE) in the operating room versus delayed extubating (LE) on the intensive care unit (ICU) regarding postoperative complications and length of ICU/hospital stay (LOICUS/LOHS). Furthermore, we analyzed the influence of the PAS change on postoperative complications. METHODS The clinical data of 117 patients were retrospective analyzed regarding postoperative complications using Clavian-Dindo Classification. Volumetric calculations of the pre- and postoperative PAS were conducted using ITK-SNAP software. The Fisher's exact test was performed to evaluate the significance of differences between categorical variables. Continuous variables were analyzed using the Mann-Whitney U-Test or the Kruskal-Wallis one-way analysis of variance. Regression analysis was used estimating predictors for postoperative complications. RESULTS EE led to significant shortening of LOICUS (p < 0.001) and LOHS (p = 0.023). In total, we recorded 38 complications (minor n = 30; major n = 8) within the hospital stay. Complication rates were without significant differences with respect to the postoperative ventilation strategy. Large changes in PAS volume led to an increase in the major complication rates (p = 0.031). Increase or decrease of PAS was independent from postoperative complication rates (p = 1.000). Higher body mass index (p = 0.04) and a higher ASA PS score (p = 0.016) were associated with increased major complication rates. CONCLUSION Early extubation after surgery is a safe procedure and is associated with a reduced LOICUS and LOHS. Complications seem to occur more frequently in marked changes of the PAS and should be considered in perioperative risk stratification.
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Affiliation(s)
- Maximilian Riekert
- Department of Oral and Craniomaxillofacial and Plastic Surgery, (Head: Prof. Dr. Dr. Joachim E. Zöller), University Hospital of Cologne, Germany.
| | - Matthias Kreppel
- Department of Oral and Craniomaxillofacial and Plastic Surgery, (Head: Prof. Dr. Dr. Joachim E. Zöller), University Hospital of Cologne, Germany
| | - Robert Schier
- Department of Anaesthesiology and Intensive Care Medicine, (Head: Prof. Dr. Bernd W. Böttiger), University Hospital of Cologne, Germany
| | - Joachim E Zöller
- Department of Oral and Craniomaxillofacial and Plastic Surgery, (Head: Prof. Dr. Dr. Joachim E. Zöller), University Hospital of Cologne, Germany
| | - Vadim Rempel
- Department of Oral and Craniomaxillofacial and Plastic Surgery, (Head: Prof. Dr. Dr. Joachim E. Zöller), University Hospital of Cologne, Germany
| | - Volker C Schick
- Department of Anaesthesiology and Intensive Care Medicine, (Head: Prof. Dr. Bernd W. Böttiger), University Hospital of Cologne, Germany
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Lee K, Hwang SJ. Change of the upper airway after mandibular setback surgery in patients with mandibular prognathism and anterior open bite. Maxillofac Plast Reconstr Surg 2019; 41:51. [PMID: 31824889 PMCID: PMC6877677 DOI: 10.1186/s40902-019-0230-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/23/2019] [Indexed: 11/10/2022] Open
Abstract
Purpose It has been reported before that the amount of pharyngeal airway space (PAS) significantly decreases following mandibular setback (MS) surgery in patients with mandibular prognathism (MP). Further, MP patients with an anterior open-bite (AOB) presentation may show a larger decrease in PAS compared with those without AOB. However, studies on postoperative PAS changes in MP patients with AOB remain rare. This study sought to evaluate changes in PAS and hyoid bone positioning following MS surgery in MP patients with and without AOB. Patients and methods Twenty patients who underwent two jaw surgery involving MS movement were included. Patients were divided into a non-AOB group (n = 10; overbite > 2 mm) and an AOB group (n = 10; overbite < - 4 mm). Three-dimensional changes in PAS and hyoid bone positioning were compared and statistically evaluated pre- and postoperatively using computed tomography (CT). Results The mean magnitude of MS was 6.0 ± 2.8 mm and 5.6 ± 3.2 mm in the non-AOB group and AOB group, respectively. The oropharyngeal volume and upper hypopharyngeal volume were significantly reduced after surgery in both the groups (p = 0.006 and p = 0.003), while the retroglossal cross-sectional area was significantly reduced only in the AOB group (p = 0.028). Although the AOB group showed a larger decrease in PAS, the difference was not statistically significant between the groups. The position of the hyoid bone showed significant posterior and inferior displacement only in the AOB group, while the vertical displacement of the hyoid bone showed a statistically significant difference between the two groups. Conclusion PAS was significantly decreased after MS in both the groups, while only the AOB group presented a statistically significant reduction in the retroglossal cross-sectional area. Vertical displacement of the hyoid bone showed a statistically significant difference between the groups, while the PAS change was not. Surgeons should be aware of potential postoperative airway problems that may arise when performing MS surgeries.
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Affiliation(s)
- Kyungjin Lee
- 1Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Soon Jung Hwang
- HSJ Dental Clinic for Oral and Maxillofacial Surgery, Wannam Building 2,3F, 349 Gangnam-daero, Seocho-gu, Seoul, 06626 Republic of Korea
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Gurani SF, Cattaneo PM, Rafaelsen SR, Pedersen MR, Thorn JJ, Pinholt EM. The effect of altered head and tongue posture on upper airway volume based on a validated upper airway analysis-An MRI pilot study. Orthod Craniofac Res 2019; 23:102-109. [PMID: 31550076 DOI: 10.1111/ocr.12348] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine the influence of altered head or tongue posture on upper airway (UA) volumes using MRI imaging based on a new objective and validated UA evaluation protocol. SETTING AND SAMPLE POPULATION One supine CBCT and five sagittal MRI scans were obtained from ten subjects in different head and tongue positions: (a) supine neutral head position (NHP) with the tongue in a natural resting position with the tip of the tongue in contact with the lingual aspect of the lower incisors (TRP); (b) head extension with TRP; (c) head flexion with TRP; (d) NHP with the tip of the tongue in contact with the posterior edge of the hard palate (THP); and (e) NHP with the tip of the tongue in contact with the floor of the mouth in contact with the caruncula sublingualis. MATERIAL AND METHODS Based on a validated CBCT UA analysis, the retropalatal, oropharyngeal and the corresponding total volumes were measured from each MRI scan. Wilcoxon signed-rank test was applied to determine the statistically significant difference in mean volume between the baseline head and tongue posture (NHP with TRP) and the other postures. RESULTS Five females and five males with a mean age of 46.5 ± 13.7 years volunteered for this pilot study. UA volumes, particularly the oropharyngeal volume, increased significantly with head extension and NHP with THP and decreased significantly with head flexion. CONCLUSION Altered head and tongue posture proved to affect UA volumes, thus representing confounding variables during three-dimensional radiographic image acquisition.
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Affiliation(s)
- Sirwan Fernandez Gurani
- Department of Oral & Maxillofacial Surgery, Hospital of South West Denmark, University Hospital of Southern Denmark, Esbjerg, Denmark.,Faculty of Health Sciences, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Paolo Maria Cattaneo
- Faculty of Health Sciences, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Section of Orthodontics, Department of Dentistry and Oral Health, Faculty of Health Science, Aarhus University, Aarhus C, Denmark
| | - Søren Rafael Rafaelsen
- Faculty of Health Sciences, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Radiology, Vejle Hospital, Vejle, Denmark
| | - Malene Roland Pedersen
- Faculty of Health Sciences, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Radiology, Vejle Hospital, Vejle, Denmark
| | - Jens Jørgen Thorn
- Department of Oral & Maxillofacial Surgery, Hospital of South West Denmark, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Else Marie Pinholt
- Department of Oral & Maxillofacial Surgery, Hospital of South West Denmark, University Hospital of Southern Denmark, Esbjerg, Denmark.,Faculty of Health Sciences, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Giralt-Hernando M, Valls-Ontañón A, Guijarro-Martínez R, Masià-Gridilla J, Hernández-Alfaro F. Impact of surgical maxillomandibular advancement upon pharyngeal airway volume and the apnoea-hypopnoea index in the treatment of obstructive sleep apnoea: systematic review and meta-analysis. BMJ Open Respir Res 2019; 6:e000402. [PMID: 31673361 PMCID: PMC6797338 DOI: 10.1136/bmjresp-2019-000402] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 09/06/2019] [Accepted: 09/06/2019] [Indexed: 01/14/2023] Open
Abstract
Background A systematic review was carried out on the effect of surgical maxillomandibular advancement (MMA) on pharyngeal airway (PA) dimensions and the apnoea-hypopnoea index (AHI) in the treatment of obstructive sleep apnoea (OSA), with the aim of determining whether increased PA in the context of MMA is the main factor conditioning the subsequent decrease in AHI. Methods A search was made of the PubMed, Embase, Google Scholar and Cochrane databases. A total of 496 studies were identified. The inclusion criteria were a diagnosis of moderate to severe OSA, MMA success evaluated by polysomnography, reporting of the magnitude of MMA achieved, PA increase and a minimum follow-up of 6 months. Results Following application of the eligibility criteria, eight articles were included. Metaregression analysis showed MMA to significantly increase both pharyngeal airway volume (PAV) (mean 7.35 cm3 (range 5.35-9.34)) and pharyngeal airway space (mean 4.75 mm (range 3.15-6.35)) and ensure a final AHI score below the threshold of 20 (mean 12.9 events/hour). Conclusions Although subgroup analysis showed MMA to be effective in treating OSA, more randomised trials are needed to individualise the required magnitude and direction of surgical movements in each patient, and to standardise the measurements of linear and nonlinear PAV parameters.
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Affiliation(s)
- Maria Giralt-Hernando
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya Facultat de Medicina i Ciencies de la Salut, Sant Cugat del Valles, Spain
| | - Adaia Valls-Ontañón
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya Facultat de Medicina i Ciencies de la Salut, Sant Cugat del Valles, Spain.,Department of Oral and Maxillofacial Surgery, Centro Medico Teknon, Barcelona, Spain
| | - Raquel Guijarro-Martínez
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya Facultat de Medicina i Ciencies de la Salut, Sant Cugat del Valles, Spain.,Department of Oral and Maxillofacial Surgery, Centro Medico Teknon, Barcelona, Spain
| | - Jorge Masià-Gridilla
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya Facultat de Medicina i Ciencies de la Salut, Sant Cugat del Valles, Spain.,Department of Oral and Maxillofacial Surgery, Centro Medico Teknon, Barcelona, Spain
| | - Federico Hernández-Alfaro
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya Facultat de Medicina i Ciencies de la Salut, Sant Cugat del Valles, Spain.,Department of Oral and Maxillofacial Surgery, Centro Medico Teknon, Barcelona, Spain
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Klazen YP, Caron CJ, Schaal SC, Borghi A, Van der Schroeff MP, Dunaway DJ, Padwa BL, Koudstaal MJ. What Are the Characteristics of the Upper Airway in Patients With Craniofacial Microsomia? J Oral Maxillofac Surg 2019; 77:1869-1881. [DOI: 10.1016/j.joms.2019.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/03/2019] [Accepted: 03/16/2019] [Indexed: 10/27/2022]
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da Silva Machado V, Cantharino de Carvalho BA, Vedovello SAS, Valdrighi H, Santamaria Júnior M. Pharyngeal Airway Modifications in Skeletal Class III Patients Undergoing Bimaxillary Advancement Surgery. J Oral Maxillofac Surg 2019; 77:2126.e1-2126.e8. [PMID: 31276653 DOI: 10.1016/j.joms.2019.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 05/13/2019] [Accepted: 05/31/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The purposes were to study the pharyngeal airway in patients with skeletal Class III malocclusion submitted to surgical orthodontic treatment and to correlate the alterations with bone movements. MATERIALS AND METHODS The sample consisted of multislice computed tomography images from 13 patients obtained before and 6 months after maxillomandibular advancement surgery. The following measurements were obtained using Dolphin Imaging software (Dolphin Imaging, Chatsworth, CA): volume and area of the oropharynx, nasopharynx, and total airway, as well as the most constricted area, anteroposterior and lateral dimensions of the narrowest axial cross-sectional area, and airway length. The paired t test was applied at a significance level of 5%. RESULTS Sagittal displacement of the maxilla and mandible was correlated with airway alterations using the Pearson correlation test. Alterations in airway measurements were observed in all patients after surgery. We noted a significant increase (P < .05) in total airway area, oropharyngeal area, and anteroposterior dimension of the most constricted area, as well as a significant reduction (P < .05) in airway length. A significant correlation (P < .05) was observed between nasopharyngeal area and maxillary movement and between airway length and mandibular movement (P < .05). CONCLUSIONS The results of this study suggest significant alterations in pharyngeal airway measurements when preoperative and postoperative periods of bimaxillary advancement surgery were compared.
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Affiliation(s)
- Viviane da Silva Machado
- Master in Orthodontics, Graduate Program, University Center of the Hermínio Ometto Foundation, Araras, Brazil
| | | | | | - Heloisa Valdrighi
- Professor, Graduate Program of Orthodontics, University Center of the Hermínio Ometto Foundation, Araras, Brazil
| | - Milton Santamaria Júnior
- Professor, Graduate Program of Orthodontics, and Graduate Program of Biomedical Sciences, University Center of the Hermínio Ometto Foundation, Araras, Brazil.
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Silent Changes in Sleep Quality Following Mandibular Setback Surgery in Patients with Skeletal Class III Malocclusion: A Prospective Study. Sci Rep 2019; 9:9737. [PMID: 31278306 PMCID: PMC6611882 DOI: 10.1038/s41598-019-46166-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 06/17/2019] [Indexed: 11/23/2022] Open
Abstract
Mandibular setback surgery (MSS) for skeletal class III patients can result in a relative reduction of pharyngeal airway space (PAS). Consequently, there is a possibility of the decline of sleep quality after surgery. We investigated changes in sleep quality measured by overnight polysomnography (PSG) and the three-dimensional (3D) volumes of PAS following MSS with or without Le Fort I osteotomy (LF I) in class III patients (N = 53). Overnight PSG and cone beam computed tomography were conducted at preoperative stage (T0) and postoperative 3 months (T1). Measurements of PAS volumes were performed, and the subjective symptoms of sleep were evaluated by self-questionnaires. There were significant increases in respiratory disturbance index (RDI) and total respiratory effort-related arousal (RERA) index during T0-T1. The 3D volumes of PAS showed significant decreases in the oropharyngeal airway, hypopharyngeal airway, and total airway spaces. No significant changes were observed in subjective symptoms of sleep. MSS with or without LF I for class III patients could worsen sleep quality by increasing sleep parameters such as the RDI and RERA in PSG, and reduce volumes of PAS at postoperative 3 months. Although subjective symptoms may not show significant changes, objective sleep quality in PSG might decrease after MSS.
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Two-Year Postoperative Upper Airway Cone-Beam Computed Tomographic Outcomes Based on a Verified Upper Airway Analysis Following Bimaxillary Orthognathic Surgery. J Oral Maxillofac Surg 2019; 77:1435-1445. [DOI: 10.1016/j.joms.2019.02.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/15/2019] [Accepted: 02/18/2019] [Indexed: 01/14/2023]
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Souza Pinto GND, Iwaki Filho L, Previdelli ITDS, Ramos AL, Yamashita AL, Stabile GAV, Stabile CLP, Iwaki LCV. Three-dimensional alterations in pharyngeal airspace, soft palate, and hyoid bone of class II and class III patients submitted to bimaxillary orthognathic surgery: A retrospective study. J Craniomaxillofac Surg 2019; 47:883-894. [DOI: 10.1016/j.jcms.2019.03.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 02/11/2019] [Accepted: 03/11/2019] [Indexed: 11/29/2022] Open
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Abstract
BACKGROUND Complete reoperation is defined as undergoing reoperative/repeated jaw osteotomies, in a patient who previously underwent orthognathic surgery. The purpose of this study is to (1) describe jaw positions at three time-points (before primary and before and after reoperative surgery), (2) investigate factors necessitating reoperation, and (3) outline the technical challenges. METHODS Repeated orthognathic surgery cases >1-year out were included. Demographic, radiologic, and perioperative data were compiled. Repeated osteotomies (Le-Fort and/or bilateral split sagittal osteotomy, with or without genioplasty), were compared to their respective primary procedures. Statistical analysis was performed using t tests and z-scores. RESULTS Fifteen patients were included (28.1 years; 71 percent female). Reoperative/repeated surgery was most often needed to address iatrogenic bony malposition and asymmetry. Relapse was a less common indication. Time between reoperative and primary surgery was 14 months. Sagittal discrepancies (p = 0.029) were the most frequent reason for primary orthognathic surgery (e.g., mandibular hypoplasia (p = 0.023). Reoperative/repeated orthognathic was performed for asymmetry (p = 0.014). Repeated procedures used more 3-dimensional planning (p < 0.001), required all three osteotomies (p = 0.034), had longer operative times (p = 0.078), and all required hardware removal (p < 0.001). Anatomical outcomes were good with 100% patient satisfaction at long-term follow-up. CONCLUSIONS Reoperative/repeated orthognathic surgery is challenging and underreported in the literature. Whereas primary orthognathic typically addressed sagittal discrepancies, reoperative/repeated osteotomies were needed to correct iatrogenic bone malposition and asymmetries. Challenges include: re-planning, scar burden, need to remove integrated hardware, and repeated osteotomy/fixation. Despite these difficulties, outcomes and patient acceptance were good. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Lee ST, Park JH, Kwon TG. Influence of mandibular setback surgery on three-dimensional pharyngeal airway changes. Int J Oral Maxillofac Surg 2019; 48:1057-1065. [PMID: 30777711 DOI: 10.1016/j.ijom.2019.01.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/15/2018] [Accepted: 01/29/2019] [Indexed: 11/28/2022]
Abstract
The aim of this study was to investigate the factors influencing three-dimensional changes in pharyngeal airway space after mandibular setback surgery. Airway changes in 48 skeletal class III patients who had undergone mandibular setback surgery alone (n=25, group 1) or with maxillary surgery (n=23, group 2) were analyzed. Linear parameters, cross-sectional area, and volumes of the pharyngeal airway were evaluated before (T0), immediately after (T1), and 1year after surgery (T2) by cone beam computed tomography. Although the reduced airway volume and cross-sectional area recovered slightly in the long term after surgery, the total pharyngeal airway volume (TPV) was significantly reduced compared to baseline, by 15% in group 1 and 12% in group 2. Regression analysis showed that maxillary posterior impaction in two-jaw surgery had a protective effect on preserving TPV. A change in body mass index from T0 to T2 was an important predictor of decreased TPV in one-jaw surgery patients. Maxillary posterior impaction can be a reliable option for compensating the pharyngeal airway reduction after mandibular setback surgery. Postoperative weight gain can increase the risk of postoperative pharyngeal airway reduction. Therefore, these factors need to be considered before and after mandibular setback surgery.
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Affiliation(s)
- S-T Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
| | - J-H Park
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
| | - T-G Kwon
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea.
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Jang SI, Ahn J, Paeng JY, Hong J. Three-dimensional analysis of changes in airway space after bimaxillary orthognathic surgery with maxillomandibular setback and their association with obstructive sleep apnea. Maxillofac Plast Reconstr Surg 2018; 40:33. [PMID: 30474021 PMCID: PMC6224326 DOI: 10.1186/s40902-018-0171-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/12/2018] [Indexed: 11/10/2022] Open
Abstract
Background Bimaxillary orthognathic surgery with maxillomandibular setback is often accompanied by changes in airway space. We analyzed the changes in airway space before and after surgery and assessed their association with obstructive sleep apnea. Methods This study is based on the cohort of 13 adult patients (9 males, 4 females, average age 23.85 years) who underwent bimaxillary orthognathic surgery with maxillomandibular setback.We performed computed tomography and portable polysomnography before and after the surgery to assess changes in airway space and Apnea-Hypopnea Index (AHI) values (total, supine, non-supine). Results The oropharyngeal airway volume decreased by 29% after the surgery, which was statistically significant (p < .05). The upper airway volume and hypopharyngeal airway volume were decreased, but not significantly (4 and 19%, respectively). The changes in airway surface area were statistically significant at all levels examined (p < .05). Changes in the maximum anteroposterior width of the airway were also significant at all levels (p < .05). However, the changes in maximum lateral width were only statistically significant at C2 level (p < .05). AHI values were increased after the surgery but not significantly at any position. Conclusions Although bimaxillary surgery with maxillomandibular setback significantly reduces the airway space, it does not affect AHI values or induce obstructive sleep apnea.
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Affiliation(s)
- Seung-Il Jang
- Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-Gu, Seoul, 06351 Republic of Korea
| | - Jaemyung Ahn
- Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-Gu, Seoul, 06351 Republic of Korea
| | - Jun Young Paeng
- Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-Gu, Seoul, 06351 Republic of Korea
| | - Jongrak Hong
- Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-Gu, Seoul, 06351 Republic of Korea
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The Relationship Between Cephalogram Analysis and Oxygen Desaturation Index During Sleep in Patients Submitted for Mandibular Setback Surgery. J Craniofac Surg 2018; 29:e375-e380. [DOI: 10.1097/scs.0000000000004386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Gottsauner-Wolf S, Laimer J, Bruckmoser E. Posterior Airway Changes Following Orthognathic Surgery in Obstructive Sleep Apnea. J Oral Maxillofac Surg 2018; 76:1093.e1-1093.e21. [DOI: 10.1016/j.joms.2017.11.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 11/17/2017] [Accepted: 11/22/2017] [Indexed: 12/16/2022]
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45
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Three-dimensional changes to the upper airway after maxillomandibular advancement with counterclockwise rotation: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2018; 47:622-629. [DOI: 10.1016/j.ijom.2017.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/18/2017] [Accepted: 11/10/2017] [Indexed: 11/18/2022]
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Tepecik T, Ertaş Ü, Akgün M. Effects of bimaxillary orthognathic surgery on pharyngeal airway and respiratory function at sleep in patients with class III skeletal relationship. J Craniomaxillofac Surg 2018; 46:645-653. [DOI: 10.1016/j.jcms.2018.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/18/2017] [Accepted: 01/22/2018] [Indexed: 11/28/2022] Open
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Park JE, Bae SH, Choi YJ, Choi WC, Kim HW, Lee UL. The structural changes of pharyngeal airway contributing to snoring after orthognathic surgery in skeletal class III patients. Maxillofac Plast Reconstr Surg 2017; 39:22. [PMID: 28824888 PMCID: PMC5544661 DOI: 10.1186/s40902-017-0120-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Two-jaw surgery including mandibular and maxillary backward movement procedures are commonly performed to correct class III malocclusion. Bimaxillary surgery can reposition the maxillofacial bone together with soft tissue, such as the soft palate and the tongue base. We analyzed changes of pharyngeal airway narrowing to ascertain clinical correlations with the prevalence of snoring after two-jaw surgery. METHODS A prospective clinical study was designed including a survey on snoring and three-dimensional (3D) computed tomography (CT) in class III malocclusion subjects before and after bimaxillary surgery. We conducted an analysis on changes of the posterior pharyngeal space find out clinical correlations with the prevalence of snoring. RESULTS Among 67 subjects, 12 subjects complained about snoring 5 weeks after the surgical correction, and examining the 12 subjects after 6 months, 6 patients complained about the snoring. The current findings demonstrated the attenuation of the largest transverse width (LTW), anteroposterior length (APL), and cross-sectional area (CSA) following bimaxillary surgery given to class III malocclusion patients, particularly at the retropalatal level. The average distance of maxillary posterior movements were measured to be relatively higher (horizontal distance 3.9 mm, vertical distance 2.6 mm) in case of new snorers. CONCLUSIONS This study found that bimaxillary surgery could lead to the narrowing of upper airway at the retropalatal or retroglossal level as well as triggering snoring in subjects with class III malocclusion. Based on the current clinical findings, we also found that upper airway narrowing at retropalatal level may contribute to increasing the probability of snoring and that polysonography may need to be performed before orthognathic surgery in subjects with class III malocclusion.
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Affiliation(s)
- Jung-Eun Park
- Department of Orthodontics, Dental Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Seon-Hye Bae
- Department of orthodontics, Estar dental clinic, Seoul, Republic of Korea
| | - Young-Jun Choi
- Department of Oral and Maxillofacial Surgery, Dental Center, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul, South Korea
| | - Won-Cheul Choi
- Department of Orthodontics, Dental Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Hye-Won Kim
- Department of Orthodontics, Dental Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Ui-Lyong Lee
- Department of Oral and Maxillofacial Surgery, Dental Center, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul, South Korea
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Yamashita AL, Iwaki Filho L, Leite PCC, Navarro RDL, Ramos AL, Previdelli ITS, Ribeiro MHDM, Iwaki LCV. Three-dimensional analysis of the pharyngeal airway space and hyoid bone position after orthognathic surgery. J Craniomaxillofac Surg 2017; 45:1408-1414. [PMID: 28743605 DOI: 10.1016/j.jcms.2017.06.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/11/2017] [Accepted: 06/27/2017] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate changes in the pharyngeal airway space (PAS) and hyoid bone position after orthognathic surgery with cone-beam computed tomography (CBCT). MATERIAL AND METHODS This study was conducted with the tomographic records of 30 patients with skeletal class II or III deformities submitted to two different types of orthognathic surgery: Group 1 (n = 15), maxillary advancement, and mandibular setback; and Group 2 (n = 15), maxillomandibular advancement. CBCT scans were acquired preoperatively (T0); and at around 1.5 months (T1) and 6.7 months (T2) postoperatively. PAS volume, minimum cross-sectional area (min CSA), and hyoid bone position changes were assessed with Dolphin Imaging 3D software, and results analyzed with ANOVA and a Tukey-Kramer test (p < 0.05). RESULTS The hyoid bone was significantly displaced in the horizontal dimension, moving posteriorly in Group 1, and anteriorly in Group 2. Although PAS volume and min CSA increased after both surgeries, these measurements were significantly larger only in Group 2. The significant differences that existed between groups preoperatively no longer existed after the surgeries. CONCLUSIONS Both orthognathic surgeries assessed resulted in changes in hyoid bone position and increased PAS volume and min CSA, particularly after maxillomandibular advancement surgery.
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Affiliation(s)
- Amanda Lury Yamashita
- Dentistry Department (Head: Prof. Carlos Alberto Herrero de Morais, DDS, PhD), State University of Maringá, Avenida Mandacaru, nº 1550, 87080-000, Maringá, Paraná, Brazil
| | - Liogi Iwaki Filho
- Dentistry Department (Head: Prof. Carlos Alberto Herrero de Morais, DDS, PhD), State University of Maringá, Avenida Mandacaru, nº 1550, 87080-000, Maringá, Paraná, Brazil
| | - Pablo Cornélius Comelli Leite
- Dentistry Department (Head: Prof. Carlos Alberto Herrero de Morais, DDS, PhD), State University of Maringá, Avenida Mandacaru, nº 1550, 87080-000, Maringá, Paraná, Brazil
| | - Ricardo de Lima Navarro
- Dentistry Department (Head: Prof. Carlos Alberto Herrero de Morais, DDS, PhD), State University of Maringá, Avenida Mandacaru, nº 1550, 87080-000, Maringá, Paraná, Brazil
| | - Adilson Luiz Ramos
- Dentistry Department (Head: Prof. Carlos Alberto Herrero de Morais, DDS, PhD), State University of Maringá, Avenida Mandacaru, nº 1550, 87080-000, Maringá, Paraná, Brazil
| | - Isolde Terezinha Santos Previdelli
- Dentistry Department (Head: Prof. Carlos Alberto Herrero de Morais, DDS, PhD), State University of Maringá, Avenida Mandacaru, nº 1550, 87080-000, Maringá, Paraná, Brazil
| | - Matheus Henrique Dal Molin Ribeiro
- Dentistry Department (Head: Prof. Carlos Alberto Herrero de Morais, DDS, PhD), State University of Maringá, Avenida Mandacaru, nº 1550, 87080-000, Maringá, Paraná, Brazil
| | - Lilian Cristina Vessoni Iwaki
- Dentistry Department (Head: Prof. Carlos Alberto Herrero de Morais, DDS, PhD), State University of Maringá, Avenida Mandacaru, nº 1550, 87080-000, Maringá, Paraná, Brazil.
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Lee UL, Oh H, Min SK, Shin JH, Kang YS, Lee WW, Han YE, Choi YJ, Kim HJ. The structural changes of upper airway and newly developed sleep breathing disorders after surgical treatment in class III malocclusion subjects. Medicine (Baltimore) 2017; 96:e6873. [PMID: 28562535 PMCID: PMC5459700 DOI: 10.1097/md.0000000000006873] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Bimaxillary surgery is the traditional treatment of choice for correcting class III malocclusion which is reported to cause an alteration of oropharyngeal structures and upper airway narrowing that might be a predisposing factor for obstructive sleep apnea (OSA). This study aimed to analyze sleep parameters in class III malocclusion subjects and ascertain the prevalence of snoring or OSA following bimaxillary surgery.A total of 22 patients with Le Fort I osteotomy and mandibular setback for class III malocclusion were prospectively enrolled. All patients received endoscopic examination, cephalometry, 3-dimensional computed tomography (3D-CT), and sleep study twice at 1 month before and 3 months after surgery.The patient population consisted of 5 males and 17 females with a mean body mass index of 22.5 kg/m and mean age of 22.1 years. No patients complained of sleep-related symptoms, and the results of sleep study showed normal values before surgery. Three patients (13%) were newly diagnosed with mild or moderate OSA and 6 patients (27%) showed increased loudness of snoring (over 40 dB) after bimaxillary surgery. According to cephalometric analysis and 3D-CT results, the retropalatal and retroglossal areas were significantly narrowed in class III malocclusion patients, showing snoring and sleep apnea after surgery. In addition, the total volume of the upper airway was considerably reduced following surgery in the same patients.Postoperative narrowing of the upper airway and a reduction of total upper airway volume can be induced, and causes snoring and OSA in class III malocclusion subjects following bimaxillary surgery.
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Affiliation(s)
| | - Hoon Oh
- Department of Otolaryngology and Head & Neck Surgery
| | - Sang Ki Min
- Department of Otolaryngology and Head & Neck Surgery
| | | | - Yong Seok Kang
- Chung-Ang University College of Medicine, Department of Otorhinolaryngology, Seoul University College of Medicine, Seoul, South Korea
| | - Won Wook Lee
- Chung-Ang University College of Medicine, Department of Otorhinolaryngology, Seoul University College of Medicine, Seoul, South Korea
| | - Young Eun Han
- Chung-Ang University College of Medicine, Department of Otorhinolaryngology, Seoul University College of Medicine, Seoul, South Korea
| | | | - Hyun Jik Kim
- Chung-Ang University College of Medicine, Department of Otorhinolaryngology, Seoul University College of Medicine, Seoul, South Korea
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Alsufyani NA, Noga ML, Witmans M, Major PW. Upper airway imaging in sleep-disordered breathing: role of cone-beam computed tomography. Oral Radiol 2017. [DOI: 10.1007/s11282-017-0280-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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