Upper airway asymmetry in skeletal Class III malocclusions with mandibular deviation

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Three-dimensional evaluation of upper pharyngeal airway, hyoid bone, and craniocervical changes following stabilization splint therapy in adult patients with temporomandibular joint disorders and mandibular deviation: A retrospective study

OBJECTIVE

This study aimed primarily to analyze the three-dimensional (3D) changes in the pharyngeal airway (PA), and secondarily, the hyoid bone (HB) and the craniocervical (CC) following stabilization splint (SS) therapy in adult patients with temporomandibular joint disorders (TMD) and mandibular deviation (MD).

METHODS

Thirty-five adult patients with TMD and MD, who were treated using SS with a mean age of 25.14 ± 6.11 years, were enrolled in this retrospective clinical study. Pre- and post-therapeutic cone-beam computed tomography (CBCT) scans were analyzed. PA dimension,nasopharyngeal, oropharyngeal, hypopharyngeal, sub-hypopharyngeal, and total pharyngeal airway spaces were measured in surface area, volume, minimum constricted area (MCA) and width, HB position, and CC posture were analyzed three-dimensionally using InVivo 6.0.3 and Dolphin 11.95 software. Wilcoxon rank-sum or Paired t-test was conducted, and P < 0.05 was considered significant.

RESULTS

SS therapy was administered for a period of 9.49 ± 4.02 months. The oropharyngeal airway space showed a significant decrease in sagittal width. The hypopharyngeal surface area, volume, MCA, and sagittal width decreased significantly. In terms of HB, hyoid-mandibular plane (H-MP), retrognathia-third vertebra's most inferior-anterior (RGN-C3ia), and retrognathia-Sella (RGN-S) distances significantly decreased. The Nasion-Sella line and the line that passes through C2ip to the odontoid process posterior tangent (NSL-OPT) angle in CC posture also decreased significantly.

CONCLUSION

SS therapy in TMD patients with MD mainly results in narrowing of the hypopharyngeal region, no change in HB position and improvement in head posture. These results undoubtedly assist in diagnosis and treatment of clinical conditions.

Pharyngeal Airway Morphology in Skeletal Class III With Mandibular Asymmetry is Improved After Bimaxillary Orthognathic Surgery

PURPOSE

The relationship between pharyngeal airway morphology and jawbone movements in skeletal Class III patients with mandibular asymmetry after orthognathic surgery remains unclear. This study was to measure the changes in pharyngeal airway morphology in skeletal Class III patients with mandibular asymmetry after bimaxillary surgery and evaluate associations between changes in pharyngeal airway morphology and skeletal movements.

METHODS

In this retrospective cohort study, skeletal Class III patients who underwent bimaxillary surgery were enrolled. The predictor variable was facial symmetry status divided into 2 groups, asymmetric (Group A) and symmetric (Group B). The primary outcome variables were changes in airway parameters, including cross-sectional linear distances, cross-sectional area (CSA), minimum CSA (Min-CSA), and volume; and airway asymmetry index between the preoperative and 6-month postoperative imaging studies. Correlation analysis was performed between upper airway and skeletal changes.

RESULTS

Twenty-five patients were included in this study, with 15 patients in Group A (mean age: 23.00 years; BMI: 22.83) and 10 patients in Group B (mean age: 22.30 years; BMI: 22.48). Group A showed a higher asymmetry index than Group B at T0; however, no significant differences compared to Group B at T1. The airway volume was significantly decreased in the oropharynx in Group A at T1, whereas it showed no significant differences in Group B (P < .05). Lateral movement of B point and Menton showed positive correlations with changes in Min-CSA in the oropharynx and negative correlations with changes in airway asymmetry index (P < .05).

CONCLUSIONS

Pharyngeal airway exhibited an asymmetrical and constricted morphology in Group A before surgery. The airway morphology in Group A showed a tendency to adopt a symmetrical and less constricted shape after surgery. The airway space was reduced in the oropharynx in Group A after surgery. Surgical correction of mandibular asymmetry correlated with the improvement of pharyngeal airway morphology.

Upper airways evaluation in young adults with an anterior open bite: A CBCT retrospective controlled and cross-sectional study

OBJECTIVE

To compare the dimensions of the upper airway in young adults with anterior open bite versus matched individuals with an adequate overbite (control group) using different measurement approaches (linear, area, and volume measures).

MATERIALS AND METHODS

The sample included 137 cone-beam computed tomographies (CBCTs) of young adults (74 men and 63 women) divided into two groups: 47 CBCTs of individuals (mean age 27.89) with open bite (overbite depth indicator (ODI) 56.84°±9.48° and Frankfort mandibular plane angle (FMA) 31.21°±6.44°) and 90 CBCTs of individuals (mean age 26.87) without an open bite (ODI 62.24°±9.47°, FMA 26.79°±5.81°). Two trained and calibrated orthodontists made all linear, area, and volume measurements on the CBCT records of the upper airways using Planmeca Romexis software. The Mann-Whitney U-test, chi-squared test, and multiple linear regression were applied. Significance was set at P<0.05.

RESULTS

There were no differences in linear or volume measurements between groups, but there was a greater area in the open bite group (greater mean difference between groups 928.3 mm²) than the control group. No variable influenced nasopharyngeal airway volume, but ANB angle affected oropharyngeal airway volume (β=-623.87) and total airway volume (β=-651.48).

CONCLUSIONS

Orthodontists should be aware that the airways diagnosis can vary depending on the measurement approach used, the volumetric method being the gold standard. The pharyngeal airway volume was similar in individuals with vs. without an open bite and is mainly influenced by ANB angle in both groups.