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Rodrigues J, Evangelopoulos E, Anagnostopoulos I, Sachdev N, Ismail A, Samsudin R, Khalaf K, Pattanaik S, Shetty SR. Impact of class II and class III skeletal malocclusion on pharyngeal airway dimensions: A systematic literature review and meta-analysis. Heliyon 2024; 10:e27284. [PMID: 38501020 PMCID: PMC10945137 DOI: 10.1016/j.heliyon.2024.e27284] [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: 04/06/2023] [Revised: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 03/20/2024] Open
Abstract
Background This study is a pioneer systematic review and meta-analysis aimed at comparing the influence of Class II and Class III skeletal malocclusions on pharyngeal airway dimensions. It stands as the inaugural comprehensive assessment to collate and analyze the disparate findings from previously published articles on this topic. The objective of this study was to identify published articles that compare the effects of class II and class III skeletal malocclusion on the pharyngeal airway dimensions. Methods An all-inclusive search for existing published studies was done to identify peer-reviewed scholarly articles that compared the influence of class II and class III skeletal malocclusion on pharyngeal airway dimensions. The search was done via five electronic databases: Cochrane Library, EMBASE, Scopus, Web of Science, and PubMed. Screening of the articles was done and the eligible studies were critically assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Results The initial search yielded 476 potential articles of which, nine were finally included in this study for a total of 866 patients. Three studies were of cross-sectional design and six were of retrospective study design. Following a critical analysis and review of the studies, class III skeletal malocclusion had significantly larger volume and area measurements compared to class II skeletal malocclusion. Conclusion Research in the field of literature has established that variations in skeletal classifications have a discernible effect on the size of the pharyngeal airways. With the advancement of skeletal malocclusions to a class III, there is an observed increase in both the volume and cross-sectional area of the airways.
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Affiliation(s)
- Jensyll Rodrigues
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | | | | | | | - Ahmad Ismail
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Rani Samsudin
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Khaled Khalaf
- Institute of Dentistry, University of Aberdeen, United Kingdom
| | - Snigdha Pattanaik
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Shishir Ram Shetty
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
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Saran S, Saccomanno S, Viti S, Mastrapasqua RF, Viti G, Giannotta N, Fioretti P, Lorenzini E, Raffaelli L, Levrini L. Analysis of General Knowledge on Obstructive Sleep Apnea Syndrome (OSAS) among Italian Pediatricians. CHILDREN (BASEL, SWITZERLAND) 2024; 11:148. [PMID: 38397260 PMCID: PMC10887165 DOI: 10.3390/children11020148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Obstructive sleep apnea syndrome (OSAS) is a disorder characterized by partial or total airway obstruction during sleep. Studies have shown variability in the level of knowledge and awareness about OSAS among pediatricians. The management of childhood obstructive sleep apnea syndrome (OSAS) depends on the severity of the disease, the presence of comorbidities, and the child's age. The American Pediatric Academy recommends a multidisciplinary approach involving a pediatrician, a sleep specialist, and an otolaryngologist to provide comprehensive care for children with OSAS. The aim of this cross-sectional study is to evaluate the level of knowledge among pediatricians in Italy regarding the diagnosis of pediatric OSAS. MATERIAL AND METHODS An anonymized survey was conducted among Italian pediatricians. The survey was administered electronically using Google Forms, and a total of 350 pediatricians were invited to participate. Out of the 350 invitations, 299 pediatricians responded to the survey. The statistical analysis performed consisted of descriptive analysis. The study included 297 pediatricians. RESULTS Pediatricians demonstrated proficiency in identifying common nocturnal and day symptoms of OSAS. A majority (68.9%) considered the oral and otorhinolaryngologist areas during checkups. Approximately 70.6% took patient weight into account, and 62.8% were aware of the regional diagnostic-therapeutic-assistance pathway. CONCLUSIONS According to the results of this manuscript, there is evidence of a good level of knowledge about OSAS, but disseminating more information about OSAS and all the health issues associated with this syndrome is suggested. This study also has limitations caused by the complexity of the pathology.
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Affiliation(s)
- Stefano Saran
- Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy (N.G.); (L.L.)
| | - Sabina Saccomanno
- Orthodontic Residency, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Simonetta Viti
- Department of Dentistry, Dental School, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | | | - Grazia Viti
- Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy (N.G.); (L.L.)
| | - Nicola Giannotta
- Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy (N.G.); (L.L.)
| | - Paola Fioretti
- Department of Medicine and Surgery, Hygiene and Public Health Section, University of Perugia, 06123 Perugia, Italy; (P.F.); (E.L.)
| | - Elisa Lorenzini
- Department of Medicine and Surgery, Hygiene and Public Health Section, University of Perugia, 06123 Perugia, Italy; (P.F.); (E.L.)
| | - Luca Raffaelli
- Dental School, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Luca Levrini
- Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy (N.G.); (L.L.)
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Zhang Z, Wang S, Li J, Yang Z, Zhang X, Bai X. Quantification of pharyngeal airway space changes after two-jaw orthognathic surgery in skeletal class III patients. BMC Oral Health 2023; 23:345. [PMID: 37264397 DOI: 10.1186/s12903-023-03075-y] [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: 08/16/2022] [Accepted: 05/25/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Skeletal class III malocclusion is a common dentofacial deformity. Orthognathic treatment changes the position of the jaws and affects the shape of the upper airway to some extent. The aim of this study was to use multislice spiral computer tomography data and orthognathic knowledge to quantify the relationship between the amount of surgical movement of the maxilla or mandible in all three spatial planes and the changes in airway volume that occurred. METHODS A retrospective study of 50 patients was conducted. Preoperative and postoperative linear changes related to skeletal movements of the maxilla and mandible were measured and compared to changes in the most constricted axial level (MCA) and its anteroposterior (MCA-AP) and transverse diameters (MCA-TV). Correlation tests and linear regression analysis were performed. RESULTS Significant interactions were observed between the anterior vertical movement of the maxilla and the MCA-AP. The anteroposterior movement distance of the mandible was significantly correlated with changes in the oropharyngeal, velopharyngeal, total airway volume, MCA, MCA-AP, and MCA-TV. The change in the mandibular plane angle was significantly correlated with the change in velopharyngeal volume, total airway volume (nasopharynx, oropharynx, velopharynx), and MCA. The linear regression model showed that oropharyngeal volume decreased by 350.04 mm3, velopharyngeal volume decreased by 311.50 mm3, total airway volume decreased by 790.46 mm3, MCA decreased by 10.96 mm2 and MCA-AP decreased by 0.73 mm2 when point B was setback by 1 mm. CONCLUSIONS Anteroposterior mandibular control is the key to successful airway management in all patients. This study provides estimates of volume change per millimeter of setback to guide surgeons in treatment planning.
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Affiliation(s)
- Ziqi Zhang
- Department of Oral and Maxillofacial SurgerySchool and Hospital of StomatologyLiaoning Provincial Key Laboratory of Oral Diseases, China Medical University, Shenyang, 110002, China
| | - Shuze Wang
- Department of Oral and Maxillofacial SurgerySchool and Hospital of StomatologyLiaoning Provincial Key Laboratory of Oral Diseases, China Medical University, Shenyang, 110002, China
| | - Jing Li
- Department of Oral and Maxillofacial SurgerySchool and Hospital of StomatologyLiaoning Provincial Key Laboratory of Oral Diseases, China Medical University, Shenyang, 110002, China
| | - Zhijie Yang
- Department of Oral and Maxillofacial SurgerySchool and Hospital of StomatologyLiaoning Provincial Key Laboratory of Oral Diseases, China Medical University, Shenyang, 110002, China
| | - Xia Zhang
- Department of Oral and Maxillofacial SurgerySchool and Hospital of StomatologyLiaoning Provincial Key Laboratory of Oral Diseases, China Medical University, Shenyang, 110002, China
| | - Xiaofeng Bai
- Department of Oral and Maxillofacial SurgerySchool and Hospital of StomatologyLiaoning Provincial Key Laboratory of Oral Diseases, China Medical University, Shenyang, 110002, China.
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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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Warwas FB, Heim N, Berger M, Kramer FJ, Wiedemeyer V. Retrospective study on the pharyngeal airspace in the lateral cephalogram - A mathematical model to predict changes due to bimaxillary orthognathic surgery. J Craniomaxillofac Surg 2022; 50:817-824. [PMID: 36376159 DOI: 10.1016/j.jcms.2022.10.003] [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: 04/25/2022] [Revised: 09/15/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was the development of a statistical model for reliable prediction of Posterior Airway Space (PAS) changes in lateral cephalograms (LCR) of patients after bimaxillary orthognathic surgery. The LCRs of patients who underwent bimaxillary orthognathic surgery were retrospectively analyzed. The anteroposterior dimension of the PAS was measured at three levels in the pre-operative and postoperative LCR: On the nasopharyngeal (SPAS), oropharyngeal (MAS), and hypopharyngeal level (IAS). The data of 139 patients were collected. The following changes of the PAS were measured: in class II patients SPAS: 0.291 mm (SD = 2.570 mm); MAS: 2.444 mm (SD = 2.986 mm); IAS: 0.750 mm (SD = 3.017 mm); in class III patients SPAS: 1.377 mm (SD 3.212 mm); MAS: 0.962 (SD: = 3.135 mm); IAS: 0.370 mm (SD = 3.468 mm). Linear regression analysis showed for class II patients, a significant influence of mandibular movement on MAS (p = 0.049) and a significant effect of maxillary and mandibular movements on SPAS (p = 0.001) and MAS (p = 0.022) in class III patients. The other jaw displacements had no significant impact on the investigated PAS levels. While the presented method does not permit exact prediction of the dimension of the PAS, it is still an easily accessible method of orientation for the surgeon. The surgeon can initiate three-dimensional examinations to provide exact three-dimensional prediction based on this calculation.
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Affiliation(s)
- F B Warwas
- Universityclinic of Bonn, Department of Oral, Cranio-Maxillo and Facial Plastic Surgery, Venusberg Campus 1, 53127, Bonn, Germany.
| | - N Heim
- Universityclinic of Bonn, Department of Oral, Cranio-Maxillo and Facial Plastic Surgery, Venusberg Campus 1, 53127, Bonn, Germany
| | - M Berger
- University of Bonn, Faculty of Medicine, Department of Medical Biometry, Informatics and Epidemiology Venusberg Campus 1, 53127, Bonn, Germany
| | - F-J Kramer
- Universityclinic of Bonn, Department of Oral, Cranio-Maxillo and Facial Plastic Surgery, Venusberg Campus 1, 53127, Bonn, Germany
| | - V Wiedemeyer
- Universityclinic of Bonn, Department of Oral, Cranio-Maxillo and Facial Plastic Surgery, Venusberg Campus 1, 53127, Bonn, Germany
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Li H, Sun C, Chen Y, Sun Z, Gao X. Quantitative changes of upper airway in class III patients undergoing bimaxillary surgery after one-year follow-up: a retrospective study. Head Face Med 2022; 18:14. [PMID: 35440012 PMCID: PMC9016938 DOI: 10.1186/s13005-022-00317-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 04/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Bimaxillary surgery is often performed for class III malocclusion, and its complex influence on the upper airway has been well considered. The aim of this research was to provide a scaled formula between upper airway volume changes and bone movements in Class III patients after orthognathic surgery. Materials and methods Using a retrospective study design, the investigators enrolled a total of 30 class III malocclusion patients who were undergoing bimaxillary surgery as the study subjects. The subjects included 15 males and 15 females, and their average age was 23.3 ± 3.4 years. CBCT (cone beam tomography) was performed both before and one year after the surgery for each patient. The changes in the soft palate, tongue and upper airway were measured by using CBCT data that was collected before and after surgery. 3D superimposition of CBCT was performed to calculate three-dimensional jaw movements. A multiple regression analysis was used to calculate the quantitative relationship between airway volume changes and jaw movements. Results The nasopharynx airway volume was observed to be increased by 1064.0 ± 1336.2 mm3, whereas the retropalatal and retroglossal airway volumes were observed to be decreased by 1399.0 ± 2881.6 mm3 and 1433.8 ± 3043.4 mm3, respectively, after the surgery. One millimetre forward and downward movements of the PNS resulted in increases of 626.90 mm3 and 392.18 mm3 in nasopharynx airway volume, respectively. Moreover, one millimetre retrogression of the B point caused decreases of 314.6 mm3 and 656.6 mm3 in the retropalatal and retroglossal airway volume, respectively. The changes in the soft palate contributed to the decrease in the retropalatal airway volume, whereas the tongue compensated for the decrease in the retroglossal airway volume. Conclusion The movements of the PNS and B points could be used to predict upper airway volumetric changes in Class III patients after maxillary advancement and mandibular setback.
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Affiliation(s)
- Haizhen Li
- Department of Orthodontics, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Chongke Sun
- Department of Radiology, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, People's Republic of China
| | - Yanlong Chen
- Department of Orthodontics, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Zhipeng Sun
- Department of Radiology, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, People's Republic of China
| | - Xuemei Gao
- Department of Orthodontics, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China.
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Kim H, Lee KC. Sequential Changes in Pharyngeal Airway Dimensions After Mandibular Setback Surgery and Its Correlation With Postsurgical Stability in Patients With Mandibular Prognathism. J Oral Maxillofac Surg 2021; 79:2540-2547. [PMID: 34453904 DOI: 10.1016/j.joms.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to evaluate the sequential changes in the pharyngeal airway dimensions after mandibular setback surgery and to verify its correlation with postsurgical mandibular stability in patients with mandibular prognathism. PATIENTS AND METHODS This retrospective study included 28 patients with mandibular prognathism who underwent surgical orthodontic treatment and isolated mandibular setback surgery. Patients who had cone-beam computed tomography before surgery, immediately after surgery, at short-term follow-up (11.8 ± 5.1 months), and long-term follow-up (43.0 ± 13.1 months) were included. Airway dimensions, including distance, minimum cross-sectional area, and airway volume, were measured to evaluate the changes following mandibular setback surgery. With the measurements of postsurgical mandibular relapse, the relationship between sequential changes in airway dimensions and the mandible was verified using correlation analysis. RESULTS Airway dimensions decreased immediately after mandibular setback surgery. The decreased airway dimensions recovered during short-term follow-up and maintained to the long-term follow-up. The mandible was set back 7.7 ± 5.1 mm at pogonion immediately after surgery. Postsurgical skeletal relapse was 1.1 mm at pogonion during short-term follow-up. During long-term follow-up, the mandible moved 0.4 mm anteriorly, which was about 50% of the changes during short-term follow-up. Statistically significant correlations were found between the sequential changes in airway dimensions and the postsurgical skeletal relapse. CONCLUSION The decreased airway dimensions following mandibular setback surgery recovered during short-term follow-up and maintained to the long-term follow-up. Dimensional recovery of the pharyngeal airway was correlated with postsurgical skeletal relapse during the 1-year follow-up period.
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Affiliation(s)
- Hyunmin Kim
- Postgraduate Student, Department of Orthodontics, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Kyungmin Clara Lee
- Professor, Department of Orthodontics, School of Dentistry, Dental Science Research Institute, Dental 4D Research Institute, Chonnam National University, Gwangju, Korea.
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Peng QL, Zhang ZY, Tang XJ, Yin L, Xu X, Liu W. The influences of distraction osteogenesis therapy on airway morphology in patients with craniofacial microsomia. J Craniomaxillofac Surg 2021; 49:443-448. [PMID: 33941436 DOI: 10.1016/j.jcms.2021.03.008] [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: 11/22/2020] [Revised: 03/02/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to explore how mandibular distraction osteogenesis influences morphological changes in the oropharynx and laryngopharynx. This was a retrospective study of airway parameter measurements in CFM patients undergoing mandibular distraction osteogenesis treatment. The indication for surgical treatment was the obvious facial asymmetry. Mimics 17.0 (Materialise Inc., Belgium) was used to build 3D models of the oro- and laryngopharynx. The minimum cross-sectional area (CSA), mean CSA, volume, length, and surface area were measured in the 3D models. All data were entered into SPSS v. 23.0 (SPSS Inc. USA), with statistical differences assessed pre- and postoperatively using the Wilcoxon test. Thirty-two patients diagnosed with CFM were included in this study. Five were classified as type IIa, 21 as type IIb, and six as type III, using the Pruzansky-Kaban classification. The average age of the patients was 8.34 years; 14 were females and 18 were males. The average traction time was 35.59 days and the average length of traction was 35.81 mm. The total volume of the airway was significantly increased after MDO (p = 0.001). In the oropharynx and laryngopharynx segments, the mean CSA, minimum CSA, and surface area were statistically significantly different. According to the results, expansion of oropharynx and laryngopharynx were evident after MDO. Mandibular distraction osteogenensis (MDO) can expand the volume of the oropharynx and laryngopharynx. Therefore, MDO can be considered a clinically useful treatment for changing the structure of the oropharynx and laryngopharynx.
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Affiliation(s)
- Qi-Li Peng
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Science, Peking Union Medical College, China
| | - Zhi-Yong Zhang
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Science, Peking Union Medical College, China
| | - Xiao-Jun Tang
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Science, Peking Union Medical College, China
| | - Lin Yin
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Science, Peking Union Medical College, China
| | - Xi Xu
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Science, Peking Union Medical College, China
| | - Wei Liu
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Science, Peking Union Medical College, China.
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Existence of a Neutral-Impact Maxillo-Mandibular Displacement on Upper Airways Morphology. J Pers Med 2021; 11:jpm11030177. [PMID: 33806410 PMCID: PMC7999116 DOI: 10.3390/jpm11030177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 02/07/2023] Open
Abstract
Current scientific evidence on how orthognathic surgery affects the airways morphology remains contradictory. The aim of this study is to investigate the existence and extension of a neutral-impact interval of bony segments displacement on the upper airways morphology. Its upper boundary would behave as a skeletal displacement threshold differentiating minor and major jaw repositioning, with impact on the planning of the individual case. Pre- and post-operative cone beam computed tomographies (CBCTs) of 45 patients who underwent maxillo-mandibular advancement or maxillary advancement/mandibular setback were analysed by means of a semi-automated three-dimensional (3D) method; 3D models of skull and airways were produced, the latter divided into the three pharyngeal subregions. The correlation between skeletal displacement, stacked surface area and volume was investigated. The displacement threshold was identified by setting three ∆Area percentage variations. No significant difference in area and volume emerged from the comparison of the two surgical procedures with bone repositioning below the threshold (approximated to +5 mm). A threshold ranging from +4.8 to +7 mm was identified, varying in relation to the three ∆Area percentages considered. The ∆Area increased linearly above the threshold, while showing no consistency in the interval ranging from -5 mm to +5 mm.
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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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Rosaria B, Roberto R, Paolo B, Rosa V, Ambrosina M, Vincenzo D. Effects of surgical mandibular advancement on the upper airways of adult class II patients: A systematic review with meta-analysis. J Oral Rehabil 2021; 48:210-232. [PMID: 33377557 DOI: 10.1111/joor.13140] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/21/2020] [Indexed: 01/31/2023]
Abstract
AIM To systematically review the effects of surgical mandibular advancement (SMA) regarding changes of the upper airways in adult patients with skeletal Class II malocclusion. MATERIALS AND METHODS Five electronic databases were searched up to April 2020. Human studies focusing on the morphology and dimension of the upper airways after SMA were included. 'Quality assessment for Before-After (Pre-Post) Studies' was used to assess the risk of bias of the individual studies. Standard mean differences (SMD) with 95% confidence intervals (CI) were calculated for random effect model meta-analysis. The certainty of evidence was assessed using the GRADE tool. RESULTS Twenty cohort studies of only treated patients without control group were eligible for qualitative synthesis, of which 17 were used for quantitative synthesis. Very low certainty of evidence indicated that SMA resulted in significant increase of the volume and of the smallest cross-sectional area (SMC) of the nasopharynx (volume SMD: 1.43, CI: 0.62, 2.24, P = .001, I2 = 87.8%; SMC SMD: 1.53, CI: 0.59, 2.47, P = .001, I2 = 90.5%) and oropharynx (volume SMD: 1.36, CI: 0.37,2.35, P = .007, I2 = 92.1%; SMC SMD: 1.21, CI: 0.11,2.32, P = .032, I2 = 93.1%). Significant augmentation of the distances between the posterior pharynx wall and the uvala (SMD: 0.73, CI: 0.46,0.98, P < .001, I2 = 72.7%), the posterior border of the tongue (SMD: 0.52, CI: 0.21,0.84, P = .001; I2 : 60.5%), the gonion (SMD: 1.24, CI: 0.56,1.91, P < .001; I2 = 88.8%) and the epiglottis (SMD: 0.40, CI: 0.06,0.74, P = .033; I2 = 84.8%) were observed. CONCLUSIONS Weak evidence suggests enlargement of the upper airways of adult Class II subjects following SMA, with major increases in the oropharynx.
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Affiliation(s)
- Bucci Rosaria
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy.,Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Rongo Roberto
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
| | - Bucci Paolo
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
| | - Valletta Rosa
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
| | - Michelotti Ambrosina
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
| | - D'Antò Vincenzo
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
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Accuracy of Three-Dimensional Upper Airway Prediction in Orthognathic Patients Using Dolphin Three-Dimensional Software. J Craniofac Surg 2020; 31:1098-1100. [PMID: 32487834 DOI: 10.1097/scs.0000000000006566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Orthodontists and surgeons have been looking for more accurate methods to predict surgical outcomes in patients with skeletal discrepancies. METHODS The sample consisted of 20 patients from the surgical clinic of a graduate orthodontic program who had been treated with Le Fort I maxillary movement, bilateral sagittal split osteotomy, with or without genioplasty. All patients had to have preoperative (T0) and at least 6 months postoperative (T1) cone-beam computed tomographies that were imported to Dolphin 3-dimensional (3D) software. The 3D voxel-based superimposition on the cranial base was performed for T0 and T1 to accurately measure the skeletal surgical movements. A virtual orthognathic surgery was performed on T0 to mimic the actual skeletal osteotomies using the treatment simulation tool in Dolphin 3D. A prediction 3D soft-tissue image (Tp) was generated based on the Dolphin virtual skeletal planning. The upper airway was segmented and exported as stereolithography surface files in both T1 and Tp. The measurements of the 3D volume of the airway were calculated and compared among T1 and Tp by using surface superimposition technique. Mean and standard deviations of upper airway volume were compared and correlated using paired t-test. RESULTS There was no statistically significant difference between the upper airway volume of T1 and Tp. CONCLUSION Dolphin 3D delivers accurate airway prediction which is an important step in 3D virtual planning.
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