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Wu Q, Liu H, Zhu Z, Liu L, Luo E. Characterization of upper airway and analysis of potential risk factor associated with OSA in patients with unilateral temporomandibular ankylosis and micrognathia deformities. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101708. [PMID: 38006945 DOI: 10.1016/j.jormas.2023.101708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVE To ascertain the airway characteristics in patients with unilateral temporomandibular joint ankylosis and maxilla-mandibular deformities (UTMAMD) and investigate the potential risk factors associated with obstructive sleep apnea (OSA) among UTMAMD patients. METHODS Authors conducted a retrospective single-center study to assess and compare study group consisting of a cohort of 32 patients diagnosed with UTMAMD between January 2011 and July 2022 with control group including 54 participants. The study group was further divided into two subgroups based on the presence or absence of OSA in patients. Parameters related to the upper airway were measured and analyzed using three-dimensional reconstruction of computed tomographic scans. The measurements of airway parameters were compared between study group and control group and between two subgroups. Pearson correlation analysis was used to identify the factors associated with the presence of OSA, and a multiple variable regression model was used to identify risk factors for OSA. RESULTS Airway volume (VOL), Minimum cross-section area (min CSA), mean CSA, tilt in sagittal plane (TS), and tilt in sagittal plane (TC) in velopharynx; VOL, airway length (AL), min CSA, mean CSA, TS, TC, and airway deviation (AD) in glossopharynx; min CSA, TS, and AD in hypopharynx were found difference with significance between study group and control group. Lateral dimension/anterior-posterior dimension (LAT/AP) ratio in velopharynx and min CSA, TC, and LAT/AP ratio in glossopharynx were significant different between patients with UTMAMD with OSA and without OSA. CONCLUSIONS The upper airway of patients with UTMAMD exhibits significant narrowing and distortion, rendering them susceptible to suffer from OSA. Patients with UTMAMD and OSA demonstrate more elliptical airways, and the glossopharyngeal LAT/AP ratio is a predictive indicator for the occurrence of OSA.
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Affiliation(s)
- Qionghui Wu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Center of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Hanghang Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Center of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Zhaokun Zhu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Center of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Linan Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Center of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - En Luo
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Center of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China.
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Ho CY, Lu TC, Hsieh YJ, Chang CS, Chen YA, Liao YF. Changes in the upper airway and its surrounding structures after bimaxillary surgery in patients with cleft-related Class III deformity. Angle Orthod 2024; 94:441-447. [PMID: 39229954 PMCID: PMC11210512 DOI: 10.2319/082523-579.1] [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: 08/01/2023] [Accepted: 03/01/2024] [Indexed: 09/05/2024] Open
Abstract
OBJECTIVES To compare upper airway changes following bimaxillary surgery for correction of Class III deformity between patients with unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) and to compare the preoperative and postoperative upper airway among patients with UCLP and BCLP to healthy controls. MATERIALS AND METHODS Sixty adults with CLP-related skeletal Class III deformity (30 UCLP and 30 BCLP) who consecutively underwent bimaxillary surgery were studied retrospectively. Cone-beam computed tomography (CBCT) was performed before and after surgery to measure upper airway and movements of facial skeletal and surrounding structures. CBCT images from 30 noncleft skeletal Class I adults, matched by age, gender, and body mass index and without surgical intervention, served as controls. RESULTS After surgery, the volume of the nasopharynx increased in patients with CLP (both P < .001). Patients with CLP did not differ from controls in postoperative volume of the nasopharynx or oropharynx. However, the nasal cavity differed significantly between patients with CLP and controls (P < .001). CONCLUSIONS After bimaxillary surgery, the nasal cavity of patients with CLP differed significantly compared with the controls. Volumes of the nasopharynx and oropharynx did not differ between patients with CLP after surgery and controls.
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Affiliation(s)
| | | | | | | | | | - Yu-Fang Liao
- Corresponding author: Dr Yu-Fang Liao, Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, No. 123, Dinghu Road, Guishan District, Taoyuan City 333, Taiwan (e-mail: )
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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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Keardkhong P, Chen YF, Yao CF, Chen YA, Liao YF, Chen YR. Comparison of regional soft tissue changes after bimaxillary rotational surgery between class III deformity with overbite and open bite: A 3D imaging analysis. Biomed J 2023; 46:100562. [PMID: 36184027 PMCID: PMC10498407 DOI: 10.1016/j.bj.2022.09.003] [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: 05/26/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This prospective study aimed to compare regional soft tissue changes between patients with class III overbite and open bite deformities treated with bimaxillary surgery involving clockwise and counter-clockwise mandibular setback, respectively. MATERIAL AND METHODS Class III deformity adults receiving Le Fort I and bilateral sagittal split osteotomies were grouped according to the incisal occlusion: overbite (n = 30) and open bite (n = 30). Combined cone-beam CT scans and 3D facial photographs preoperative and at least 1-year postoperative were taken to assess the soft tissue changes. RESULTS Postoperative changes for the overbite and open bite groups included anterior repositioning of nose (-0.8 ± 1.2 mm and -1.1 ± 1.1 mm, respectively) and cheek (-1.9 ± 1.3 mm and -1.7 ± 2.6 mm, respectively), posterior repositioning of chin (5.2 ± 4.0 mm and 4.9 ± 3.2 mm, respectively), and medial (-1.7 ± 2.0 mm and -1.9 ± 2.1 mm, respectively) and posterior (2.7 ± 1.4 mm and 2.8 ± 2.3 mm, respectively) repositioning of bilateral angles. Posterior (1.2 ± 2.0 mm and 5.1 ± 3.3 mm) and inferior (-1.4 ± 2.2 mm and -2.4 ± 2.7 mm) repositioning of upper lip and lower lip occurred in overbite group. Inferior (-2.3 ± 2.4 mm) and superior (3.7 ± 3.4 mm) repositioning of chin occurred in the overbite and open bite groups, respectively. CONCLUSIONS Treatment of class III overbite and open bite deformities with bimaxillary rotational surgery resulted in comparable regional soft tissue changes, except for upper lip, lower lip and chin.
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Affiliation(s)
- Piyanan Keardkhong
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Fang Chen
- Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital at Taipei, Taipei, Taiwan
| | - Chuan-Fong Yao
- Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ying-An Chen
- Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yu-Fang Liao
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Yu-Ray Chen
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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Steegman R, Hogeveen F, Schoeman A, Ren Y. Cone beam computed tomography volumetric airway changes after orthognathic surgery: a systematic review. Int J Oral Maxillofac Surg 2022; 52:60-71. [PMID: 35788289 DOI: 10.1016/j.ijom.2022.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 05/22/2022] [Accepted: 05/31/2022] [Indexed: 10/17/2022]
Abstract
The aim of this systematic review was to provide a structured overview of three-dimensional airway volume changes in relation to various orthognathic surgeries. Clinical human studies performing pre- and postoperative three-dimensional airway volume assessments to investigate volumetric changes of the airway after orthognathic surgery were included. Pre-determined inclusion and exclusion criteria were applied in an extensive search of the PubMed, Embase, and Web of Science electronic databases. The cut-off date was set to January 1, 2022. Forty-one articles reporting retrospective and prospective case-control and case series studies were included. All studies were determined to be of medium quality (moderate risk of bias). The included studies were categorized by type of intervention. Pre- and postoperative volumes were extracted from the available data, and volume changes as a percentage of the preoperative levels were calculated. Isolated mandibular setback surgery generally decreased the airway volume. Isolated maxillary or mandibular advancement, bimaxillary advancement, and surgically assisted maxillary expansion generally increased the airway volume in the total airway and oropharynx, among which the effect of bimaxillary advancement surgery appeared most significant. High heterogeneity exists in the terminology and definitions of the airway and its segments. A more uniform methodology for airway volume measurement is needed to provide an insight into the impact on the airway of specific types of surgical intervention. In conclusion, airway volumes are affected after orthognathic surgery, which may be of clinical significance, especially in patients who are predisposed to obstructive sleep apnoea.
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Affiliation(s)
- R Steegman
- Department of Orthodontics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - F Hogeveen
- Department of Orthodontics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - A Schoeman
- Department of Orthodontics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Y Ren
- Department of Orthodontics, W.J. Kolff Institute, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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Aoyagi M, Oshima M, Oishi M, Kita S, Fujita K, Imai H, Oishi S, Ohmori H, Ono T. Computational fluid dynamic analysis of the nasal respiratory function before and after postero-superior repositioning of the maxilla. PLoS One 2022; 17:e0267677. [PMID: 35482658 PMCID: PMC9049540 DOI: 10.1371/journal.pone.0267677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/12/2022] [Indexed: 11/19/2022] Open
Abstract
Morphological changes in the upper airway and the resulting alteration in the nasal respiratory function after jawbone repositioning during orthognathic surgery have garnered attention recently. In particular, nasopharyngeal stenosis, because of the complex influence of both jaws, the effects of which have not yet been clarified owing to postero-superior repositioning of the maxilla, may significantly impact sleep and respiratory function, necessitating further functional evaluation. This study aimed to perform a functional evaluation of the effects of surgery involving maxillary repositioning, which may result in a larger airway resistance if the stenosis worsens the respiratory function, using CFD for treatment planning. A model was developed from CT images obtained preoperatively (PRE) and postoperatively (POST) in females (n = 3) who underwent maxillary postero-superior repositioning using Mimics and ICEM CFD. Simultaneously, a model of stenosis (STENOSIS) was developed by adjusting the severity of stenosis around the PNS to simulate greater repositioning than that in the POST. Inhalation at rest and atmospheric pressure were simulated in each model using Fluent, whereas pressure drop (ΔP) was evaluated using CFD Post. In this study, ΔP was proportional to airway resistance because the flow rate was constant. Therefore, the magnitude of ΔP was evaluated as the level of airway resistance. The ΔP in the airway was lower in the POST compared to the PRE, indicating that the analysis of the effects of repositioning on nasal ventilation showed that current surgery is appropriate with respect to functionality, as it does not compromise respiratory function. The rate of change in the cross-sectional area of the mass extending pharynx (α) was calculated as the ratio of each neighboring section. The closer the α-value is to 1, the smaller the ΔP, so ideally the airway should be constant. This study identified airway shapes that are favorable from the perspective of fluid dynamics.
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Affiliation(s)
- Misaki Aoyagi
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Marie Oshima
- Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
- * E-mail:
| | - Masamichi Oishi
- Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
| | - Soma Kita
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Koichi Fujita
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Department of Oral and Maxillofacial Surgery, Yokohama City University Medical Center, Kanagawa, Japan
| | - Haruki Imai
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Department of Oral and Maxillofacial Surgery, Yokohama City University Medical Center, Kanagawa, Japan
| | - Shuji Oishi
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hiroko Ohmori
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takashi Ono
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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One-Jaw versus Two-Jaw Orthognathic Surgery for Patients with Cleft: A Comparative Study Using 3D Imaging Virtual Surgical Planning. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Whether a one-jaw or two-jaw design is used in orthognathic surgery for patients with cleft remains varied and controversial. This study aimed to compare the two approaches using 3-dimensional imaging surgical simulation. This study was conducted on 41 consecutive patients with complete unilateral cleft lip and palate treated in the craniofacial center. All patients had original two-jaw virtual planning and orthognathic surgery. Simulation of one-jaw LeFort I surgery was performed using the same final dental occlusion on 3-dimensional images. Cephalometric data and asymmetry index were collected and compared among the designs. Average advancement of the maxilla was 7.46 mm in one-jaw and 4.80 mm in two-jaw design. SNA, SNB, and A-N perpendicular were significantly greater and close to normative data in the one-jaw design. ANB angles were similar in both designs. The anterior and posterior occlusal plane cants, the deviation of midline landmarks, and the asymmetry index were more improved in the two-jaw approach. It is concluded that the two-jaw cleft orthognathic surgery could significantly improve facial midline and symmetry compared with the one-jaw approach. However, the two-jaw surgery with mandibular setback produced less protrusive facial contour although a harmonious relationship between the maxilla and mandible was achieved.
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Yoshino N, Nishii Y, Kamio T, Takaki T, Shibahara T, Sueishi K. Three-Dimensional Evaluation of Pharyngeal Morphology in Bimaxillary Surgery with and without Horseshoe Osteotomy in Skeletal Class III Cases. THE BULLETIN OF TOKYO DENTAL COLLEGE 2021; 62:215-226. [PMID: 34776475 DOI: 10.2209/tdcpublication.2021-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Repositioning of the jaw in orthognathic treatment generates changes in the soft tissues of the maxillofacial region, with consequent changes in the airway. The purpose of this study was to determine how type of orthognathic surgical procedure affected the 3-dimensional morphology of the upper airway. Forty patients were divided into the following 2 groups according to the type of surgical procedure used: a horseshoe osteotomy (HS) group (20 patients, comprising 11 men and 9 women; average age 24.3±4.5 years) who underwent bimaxillary surgery; and a LeFort I osteotomy (LF) group (20 patients, comprising 8 men and 12 women; average age 22.5±4.6 years) who also underwent bimaxillary surgery. Cephalometric measurements were taken and 3-dimensional pharyngeal morphology evaluated in each group. The amounts of maxilla rotation, posterior maxilla impaction, and mandibular setback all revealed a significantly larger value in the HS group. Evaluation of pharyngeal volume revealed a significant decrease in the upper pharyngeal segment in the LF group. A significant decrease in the lower pharyngeal segment was observed in both groups. Differences were noted in postoperative pharyngeal morphology between the two groups. The results of this study suggest that HS has less effect on the upper pharyngeal segment, regardless of the amount of posterior maxilla impaction.
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Affiliation(s)
| | | | - Takashi Kamio
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College
| | - Takashi Takaki
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College
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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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10
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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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Kim JW, Kwon TG. Why most patients do not exhibit obstructive sleep apnea after mandibular setback surgery? Maxillofac Plast Reconstr Surg 2020; 42:7. [PMID: 32206666 PMCID: PMC7078420 DOI: 10.1186/s40902-020-00250-x] [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: 02/25/2020] [Accepted: 03/05/2020] [Indexed: 11/18/2022] Open
Abstract
Maxillomandibular advancement (MMA) is effective for the treatment of obstructive sleep apnea (OSA). In previous studies, the airway was increased in the anteroposterior and transverse dimensions after MMA. However, the effect of the opposite of mandibular movement (mandibular setback) on the airway is still controversial. Mandibular setback surgery has been suggested to be one of the risk factors in the development of sleep apnea. Previous studies have found that mandibular setback surgery could reduce the total airway volume and posterior airway space significantly in both the one-jaw and two-jaw surgery groups. However, a direct cause-and-effect relationship between the mandibular setback and development of sleep apnea has not been clearly established. Moreover, there are only a few reported cases of postoperative OSA development after mandibular setback surgery. These findings may be attributed to a fundamental difference in demographic variables such as age, sex, and body mass index (BMI) between patients with mandibular prognathism and patients with OSA. Another possibility is that the site of obstruction or pattern of obstruction may be different between the awake and sleep status in patients with OSA and mandibular prognathism. In a case-controlled study, information including the BMI and other presurgical conditions potentially related to OSA should be considered when evaluating the airway. In conclusion, the preoperative evaluation and management of co-morbid conditions would be essential for the prevention of OSA after mandibular setback surgery despite its low incidence.
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Affiliation(s)
- Jin-Wook Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-daero, Jung-gu, Daegu, 41940 Republic of Korea
| | - Tae-Geon Kwon
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-daero, Jung-gu, Daegu, 41940 Republic of 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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Three-Dimensional Morphological Changes of the Upper Airway in Patients With Skeletal Class III Malocclusion After Orthognathic Surgery. J Craniofac Surg 2019; 30:2451-2455. [PMID: 31689729 DOI: 10.1097/scs.0000000000005738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To evaluate the morphological changes of the upper airway of patients with skeletal Class III malocclusion after undergoing bilateral mandibular ramus dislocated mandibular retrogression (SSRO) or SSRO combined with Le Fort I maxillary osteotomy and 3-dimensional imaging. METHODS All previous studies related to the upper airway in patients with skeletal class III malocclusion and orthognathic surgery were collected from the PubMed, EMB, Cochrane Library, Web of science, ClinicalKey, EBSCO, Weipu, Wanfang, China National Knowledge Infrastructure, and Chinese BioMedical Literature databases. The search date ends in August 2017. RevMan5.3 software was used to perform a meta-analysis related to upper airway morphology. Ten studies were included. RESULTS The meta-analysis showed that 6 months after SSRO, CV1, and CV2 did not change significantly (P >0.05), whereas CV3 and CV4 narrowed (P <0.05) and remained narrow after 1 year (P <0.05). (CV1,CV2,CV3,CV4: Plans parallel to the FH plane passing through the most anterior inferior point of the anterior arch of the atlas, the 2nd cervical vertebra, the 3rd cervical vertebra, the 4th cervical vertebra.) There was no significant change in nasopharyngeal volume or laryngeal pharyngeal volume (P >0.05), but oropharyngeal volume and total volume decreased (P ≤0.01). Six months after SSRO combined with Le Fort I maxillary osteotomy, the minimum cross-sectional area of the upper airway was smaller (P <0.05), there was no significant change in nasopharyngeal volume or oropharyngeal volume (P >0.05), and oropharynx volume and total volume decreased (P <0.05). CONCLUSIONS Single and double jaw surgery has no significant effect on nasopharynx and oropharynx, but reduces laryngopharynx and total volume; however, whether this will result in postoperative obstructive sleep apnea-hypopnea syndrome or become ameliorated over time requires more in-depth study and a longer period of clinical observation.
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Simultaneous Surgical Correction of Skeletal Class III Dentofacial Deformity During Acute Management of Facial Fractures. Ann Plast Surg 2019; 83:e20-e27. [DOI: 10.1097/sap.0000000000002037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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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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Furche S, Edwards SP, Aronovich S, Hummon G, Shah KB, Conley RS. 3D Airway changes using cone beam computed tomography in patients following mandibular advancement surgery with and without constriction. Orthod Craniofac Res 2019; 22 Suppl 1:36-42. [PMID: 31074130 DOI: 10.1111/ocr.12292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to compare three-dimensional airway changes resulting from mandibular advancement surgery and mandibular advancement surgery with constriction. SETTING AND SAMPLE POPULATION The University of Michigan School of Dentistry and Medical Center. A total of 42 patients undergoing mandibular advancement with or without simultaneous constriction. MATERIALS AND METHODS A retrospective airway evaluation of patients undergoing mandibular advancement with or without simultaneous mandibular constriction was performed. Cross-sectional evaluation at standardized locations, minimum cross section and volumetric analysis were performed using Dolphin Imaging TM Version 11.7. RESULTS Patients undergoing mandibular advancement with or without constriction experienced significant airway increases (P < 0.05). Patients who underwent mandibular advancement only gained nearly twice as much airway volume as mandibular advancement with simultaneous constriction (8.69 mm3 vs 4.3 mm3 ). The largest increase for both groups was observed in the minimum axial area in the oropharynx segment (119.5 mm2 ) and the axial area of the retroglossal region (137.2 mm2 ). CONCLUSIONS The findings demonstrate mandibular advancement with constriction results in airway enlargement following surgery.
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Affiliation(s)
| | - Sean P Edwards
- Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan
| | - Sharon Aronovich
- Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gregory Hummon
- Department of Orthodontics and Pediatric Dentistry, University of Michigan, Ann Arbor, Michigan
| | | | - R Scott Conley
- Department of Orthodontics, University at Buffalo, Buffalo, New York
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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: 14] [Impact Index Per Article: 2.8] [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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Liao YF, Lo SH. Surgical Occlusion Setup in Correction of Skeletal Class III Deformity Using Surgery-First Approach: Guidelines, Characteristics and Accuracy. Sci Rep 2018; 8:11673. [PMID: 30076359 PMCID: PMC6076283 DOI: 10.1038/s41598-018-30124-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/22/2018] [Indexed: 11/25/2022] Open
Abstract
The aims of this study were to establish guidelines for the surgical occlusion setup of surgery-first orthognathic surgery, and evaluate the resulting characteristics and accuracy. Skeletal Class III patients (N = 53) underwent Le Fort I osteotomy and bilateral sagittal split osteotomy. Study models before orthognathic surgery were set according to the guidelines. Occlusion was measured and computer-aided surgical simulation was used to evaluate the characteristics and accuracy of the surgical occlusion. The mean age of participants was 25 ± 6 years with 24 males and 29 females. The occlusion was set as positive overjet (4.4 ± 2.0 mm) and overbite (1.4 ± 1.8 mm), Class II or I molar relation, and posterior cross bite (overjet: 4.9 ± 2.0 mm and 4.4 ±1.9 mm, respectively for the right and left second molars) and open bite (overbite: −2.0 ± 1.6 mm and −1.9 ± 1.3 mm, respectively for the right and left second molars). Normal jaw relationship and symmetry were noted after virtual surgery. None of the patients required new occlusal setup. Our data contribute the use of the surgery-first approach for skeletal Class III patients by establishing guidelines for a surgical occlusion setup in three dimensions.
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Affiliation(s)
- Yu-Fang Liao
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan. .,Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan. .,Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, 333, Taiwan.
| | - Shu Hsien Lo
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Linkou, 333, Taiwan
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Park JH, Kim S, Lee YJ, Bayome M, Kook YA, Hong M, Kim Y. Three-dimensional evaluation of maxillary dentoalveolar changes and airway space after distalization in adults. Angle Orthod 2018; 88:187-194. [PMID: 29337633 DOI: 10.2319/121116-889.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To evaluate the changes in position of the maxillary dentition and the airway space after distalization using a modified C-palatal plate (MCPP) in adult patients through CBCT images and to analyze the relationship between the amount of distalization and the changes in the airway space. MATERIALS AND METHODS CBCT images of 33 adult Class II patients (22.2 ± 4.0 years old; 27 women and 6 men) treated by total maxillary arch distalization using the MCPP were evaluated before and after distalization. The patients were divided into nonextraction and extraction groups. The changes in the airway space as well as the changes in the positions of the maxillary dentition were evaluated. The distalization effects were calculated and assessed using paired t-tests. RESULTS After distalization, the first molar showed significant distalization and intrusion ( P < .001) with no significant rotation of the crown and no significant buccal displacement of its root in the transverse dimension. There were no significant changes in the airway volume or the minimum cross-sectional area of the oropharynx. CONCLUSIONS The application of the MCPP resulted in significant total arch distalization without a significant effect on the transverse dimensions or changes in the oropharynx airway space. The MCPP can be considered a viable treatment option for patients with Class II malocclusion.
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Chang CS, Wallace CG, Hsiao YC, Hsieh YJ, Wang YC, Chen NH, Liao YF, Liou EJW, Chen PKT, Chen JP, Chen YR. Airway Changes after Cleft Orthognathic Surgery Evaluated by Three-Dimensional Computed Tomography and Overnight Polysomnographic Study. Sci Rep 2017; 7:12260. [PMID: 28947808 PMCID: PMC5612929 DOI: 10.1038/s41598-017-12251-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 09/04/2017] [Indexed: 11/12/2022] Open
Abstract
Cleft lip and palate is the most common congenital craniofacial anomaly. Up to 60% of these patients will benefit from cleft orthognathic surgery, which consists primarily of maxillary advancement and mandibular setback to address midface retrusion and relative mandibular protrusion, respectively. It is believed that maxillary advancement can enlarge the airway whilst mandibular setback can reduce the airway, but this has not previously been quantified for cleft patients undergoing orthognathic surgery. This unique longitudinal prospective study of 18 patients was conducted between April 2013 and July 2016. No significant changes occurred by six months postoperatively in body mass index, apnoea-hypopnoea index or lowest oxygen saturation (LSAT). There was a mean increase of 0.73 cm3 in velopharyngeal volume, a mean decrease of 0.79 cm3 in oropharyngeal volume, an improvement in snoring index, and no statistically significant change in hypopharyngeal volume. In conclusion, cleft orthognathic surgery that produced anterior advancement of the maxilla, setback of the mandible and clockwise rotation of the maxillo-mandibular complex resulted in increased velopharyngeal, decreased oropharyngeal and unchanged hypopharyngeal airways, and improved snoring, but did not significantly alter objective sleep-related breathing function.
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Affiliation(s)
- Chun-Shin Chang
- Department of Chemical and Materials Engineering, College of Engineering, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan (R.O.C.)
- Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Christopher Glenn Wallace
- Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Yen-Chang Hsiao
- Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Yuh-Jia Hsieh
- Craniofacial Research Center, Department of Medical Research, Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Yi-Chin Wang
- Craniofacial Research Center, Department of Medical Research, Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Ning-Hung Chen
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Yu-Fang Liao
- Craniofacial Research Center, Department of Medical Research, Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Eric Jen-Wein Liou
- Craniofacial Research Center, Department of Medical Research, Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
| | - Philip Kuo-Ting Chen
- Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.).
| | - Jyh-Ping Chen
- Department of Chemical and Materials Engineering, College of Engineering, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan (R.O.C.)
| | - Yu-Ray Chen
- Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.)
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He J, Wang Y, Hu H, Liao Q, Zhang W, Xiang X, Fan X. Impact on the upper airway space of different types of orthognathic surgery for the correction of skeletal class III malocclusion: A systematic review and meta-analysis. Int J Surg 2017; 38:31-40. [DOI: 10.1016/j.ijsu.2016.12.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/09/2016] [Accepted: 12/18/2016] [Indexed: 11/15/2022]
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