1
|
Wittayakornlerk P, Kriangcherdsak Y, Manosuthi P. The Relation Between Mandibular Relapse and the Postoperative Mandibular Ramus Rotation Following BSSO Setback. J Maxillofac Oral Surg 2023; 22:886-892. [PMID: 38105835 PMCID: PMC10719186 DOI: 10.1007/s12663-022-01760-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/29/2022] [Indexed: 10/17/2022] Open
Abstract
Objectives This retrospective study aimed to determine the angulation changes of the proximal segment following bilateral sagittal split osteotomy (BSSO) setback and its correlation with the amount of immediate postoperative surgical movement. The correlation between postoperative relapse of the distal and proximal segment at six months postoperatively was also evaluated. Materials and methods The CBCT-generated lateral cephalometric images of 39 patients who underwent BSSO setback with or without Le Fort I osteotomy were evaluated preoperatively (T0), immediately postoperative (T1), and six months postoperatively (T2). Results The mean surgical setback was 7.28 ± 4.45 mm at B point. The proximal segment's immediate postoperative mean posterior rotation was 2.13 ± 3.59 degrees. Six months after the operation, the mean distal segment relapse was 0.89 ± 3.03 mm at B point. The proximal segment relapse was 0.81 ± 1.63 degrees. A significant moderate correlation was found (P < 0.05) between the surgical movement and the immediate postoperative proximal segment rotation and between the surgical movement and the distal segment relapse. A significant correlation was found between the distal segment relapse and the average and left proximal segment relapse. There was no significant correlation between immediate postoperative proximal segment rotation and distal segment relapse. Conclusion The immediate postoperative posterior rotation of the proximal segment had a negligible effect on mandibular relapse. The amount of surgical movement, on the other hand, was more related to distal segment relapse. The intraoperative proximal segment rotation should thus be minimized in cases with a significant surgical setback.
Collapse
Affiliation(s)
- Phathaitip Wittayakornlerk
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, 6 Yothi street, Ratchathewi, Bangkok, 10400 Thailand
| | - Yutthasak Kriangcherdsak
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, 6 Yothi street, Ratchathewi, Bangkok, 10400 Thailand
| | - Pattamawan Manosuthi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, 6 Yothi street, Ratchathewi, Bangkok, 10400 Thailand
| |
Collapse
|
2
|
Park CH, Jeon JB, Oh S, Oh HK, Lee KM, Cho JH, Hwang HS, Oh MH. Comparison of short-term condylar positional changes in mandibular prognathism after surgery-first approach: Symmetric setback versus asymmetric setback. J Stomatol Oral Maxillofac Surg 2022; 123:e940-e947. [PMID: 35817318 DOI: 10.1016/j.jormas.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/09/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
Abstract
The aim of this study was to compare how the displacement of the mandibular condyle changed after symmetric or asymmetric mandibular setback surgery using the surgery-first approach (SFA). Patients who underwent mandibular setback surgery using the SFA were selected and divided into a symmetry group (n = 18) with differences of less than 2 mm between the right and left setback, and an asymmetry group (n = 18) with a difference of greater than 2 mm. Cone-beam computed tomography (CBCT)-generated cephalograms were obtained after three-dimensional superimposition of CBCT images taken before surgery (T0), within one week after surgery (T1), and seven months after surgery (T2). The condylar positions were measured. Condylar positional changes according to time were compared between the two groups and correlation analysis was performed. There were significant positional changes in mandibular condyles over time in both groups. However, most of these changes returned to their initial state. In the asymmetry group, there was a greater internal rotation of the mandibular condyle on the lesser setback side. The correlation analysis results revealed that only the setback difference was associated with rotational displacement of the condyle on the lesser setback side at two time points (T1-T0, T2-T0). In the SFA, significant condylar displacement occurred immediately after both symmetric and asymmetric mandibular setback surgery, and the right/left difference in mandibular setback showed a significant positive correlation with rotational displacement. Although more significant rotational displacement of the mandibular condyle was observed after asymmetric mandibular setback surgery, the amount was not large enough to be clinically significant.
Collapse
Affiliation(s)
- Chae-Hee Park
- Department of Orthodontics, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Jun-Bo Jeon
- Department of Orthodontics, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Seungwon Oh
- Department of mathematics & Statistics, Chonnam National University, Gwangju, Korea
| | - Hee-Kyun Oh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - Kyung-Min Lee
- Department of Orthodontics, School of Dentistry, Dental 4D Research Institute, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - Jin-Hyoung Cho
- Department of Orthodontics, School of Dentistry, Dental 4D Research Institute, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - Hyeon-Shik Hwang
- Department of Orthodontics, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju; Korean Adult Orthodontic Research Institute, Seoul, Korea
| | - Min-Hee Oh
- Department of Orthodontics, School of Dentistry, Dental 4D Research Institute, Dental Science Research Institute, Chonnam National University, Gwangju, Korea.
| |
Collapse
|
3
|
Chen CM, Hsu HJ, Hsu KJ, Tseng YC. Clinical significance of postoperative skeletal relapse in the treatment of mandibular prognathism: Receiver operating characteristic curve analysis. J Formos Med Assoc 2022; 121:2593-2600. [PMID: 35843789 DOI: 10.1016/j.jfma.2022.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/28/2022] [Accepted: 07/03/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND/PURPOSE Postoperative skeletal relapse is the most important issue in patients undergoing orthognathic surgery. This study aimed to investigate clinical skeletal relapse (≥2 mm) after mandibular setback surgery (intraoral vertical ramus osteotomy: IVRO) using receiver operating characteristic curve (ROC curve) analysis. METHODS Serial cephalograms of 40 patients with mandibular prognathism were obtained at different time points: (1) before surgery (T1), (2) immediately after surgery (T2), and (3) at least with a 2-year follow-up postoperatively (T3). The menton (Me) was used as the landmark for measuring the amount of mandibular setback and postoperative skeletal relapse. Postoperative stability (T32) was divided into groups A and B by skeletal relapse ≥2 mm and <2 mm, respectively. The area under the ROC curve (AUC) was used to determine the cut-off point for mandibular setback. RESULTS At the immediate surgical setback (T21), the amount of setback in group A (15.55 mm) was significantly larger than in group B (10.97 mm). Group A (T32) showed a significant relapse (4.07 mm), while group B showed a significant posterior drift (1.23 mm). The amount of setback had the highest AUC area (0.788). The cut-off point was 14.1 mm (T21) that would lead to a clinical relapse of 2 mm (T32). CONCLUSION In IVRO, the postoperative mandibular positions reveal posterior drift and anterior displacement (relapse). The experience of clinical observation and patient perception of postoperative skeletal relapse was ≥2 mm. In the ROC curve analysis, the cut-off point of setback was 14.1 mm.
Collapse
Affiliation(s)
- Chun-Ming Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Han-Jen Hsu
- Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; School of Oral Hygiene, College of Dental Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kun-Jung Hsu
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Family Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Yu-Chuan Tseng
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Orthodontics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| |
Collapse
|
4
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
5
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
6
|
Jeyaraj P, Juneja P. A case of extreme skeletal class III Malocclusion beyond the envelope of discrepancy, managed effectively by a modified ortho-surgical protocol. JPRAS Open 2020; 28:110-120. [PMID: 33889705 PMCID: PMC8047429 DOI: 10.1016/j.jpra.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 12/03/2020] [Indexed: 11/19/2022] Open
Abstract
Correction of severe anteroposterior skeletal discrepancy, as described in this case of Extreme Skeletal Class III Malocclusion, can be challenging and fraught with difficulties. Conventional, single stage Bi-jaw Orthognathic surgery, with pre-and post-surgical orthodontics is associated with drawbacks such as risk of relapse and an unsatisfactory outcome, with persisting occlusal discrepancies and skeletal abnormalities, especially when the magnitude of skeletal correction is large. Excessive mandibular setback restricts tongue space, narrows the posterior airway and pharyngeal spaces, and is prone to relapse from the forward pterygomasseteric pull; while large maxillary advancements are accompanied by wound dehiscence, bone exposure and delayed union at the site of pterygomaxillary disjunction, and risk of relapse due to backward palatopharyngeal pull. Bi-jaw surgeries invariably involve considerable blood loss and prolonged operating time with its attendant anaesthetic risks. These drawbacks may be obviated by employing a two staged protocol of Bi-jaw surgeries allowing a minimum time period of 3 months to elapse between them, which allows the oral and maxillofacial musculature to adapt itself to the new jaw position following the first surgery, thus creating a better and more stable environment for the succeeding one. This reduces the chance of relapse thereafter, and produces more effective and stable long term results. The intervening time period also allows for observation of the repositioned jaw and arch relations achieved, and scrutiny for any positional changes in this post-surgical phase, which thereby allows modifications in the planned surgery of the next jaw, thereby achieving the most ideal final outcome.
Collapse
Affiliation(s)
- Priya Jeyaraj
- Classified Specialist (Oral & Maxillofacial Surgery), Commanding Officer Military Dental Centre (Gough Lines), Secunderabad, India
- Corresponding author.
| | - Pankaj Juneja
- Classified Specialist (Orthodontia), Command Military Dental Centre (Northern Command), Jammu & Kashmir, India
| |
Collapse
|
7
|
Jafarian M, Alam M, Shafiei S, Moslemi H, Tabrizi R. Effect of fixation method on intergonial width stability after mandibular setback via bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg 2020; 49:1430-4. [PMID: 32423690 DOI: 10.1016/j.ijom.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 02/17/2020] [Accepted: 04/07/2020] [Indexed: 11/21/2022]
Abstract
Q4: Horizontal changes occur following bilateral sagittal split osteotomy (BSSO) in skeletal class III patients. The aim of this study was to assess the ostoperative changes in intergonial (IG) width and compare them between the positional screw and miniplate fixation methods in BSSO. This study evaluated patients who had mandibular prognathism and underwent BSSO for mandibular setback. Internal fixation was performed bilaterally, either with positional screws in the lateral ramus or with a miniplate. Postero-anterior cephalograms were obtained preoperatively (T1), at 1 month postoperative (T2), and at 6 months postoperative (T3). The IG widths and the alterations in IG width postoperative (T2-T1, T3-T2) were measured. No correlations were observed between the amount of setback and changes at T2 -T1 or T3-T2. The IG width values decreased after mandibular setback and internal fixation with both methods. Statistical analyses showed a significant difference between T3 and T1 in the miniplate group (P=0.045). No significant difference in the postoperative change in IG width (T2-T1 and T3-T2) was found between the two fixation groups. The magnitude of this change was smaller for positional screws when compared to miniplates for fixation. The amount of mandibular setback showed no correlation with postoperative changes in IG width..
Collapse
|
8
|
Jeyaraj P, Juneja P. A Case of Extreme Skeletal Class III Malocclusion Beyond the Envelope of Discrepancy, Managed Effectively by a Modified Ortho-Surgical Protocol. J Maxillofac Oral Surg 2021; 20:201-18. [PMID: 33927487 DOI: 10.1007/s12663-020-01352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022] Open
Abstract
Introduction Correction of a severe anteroposterior skeletal discrepancy, as described in this case of extreme skeletal class III malocclusion, can be quite challenging and fraught with difficulties. Conventional, single-stage bi-jaw orthognathic surgery with pre-and post-surgical orthodontics is associated with drawbacks such as the risk of relapse and an unsatisfactory overall long-term outcome, with persisting occlusal discrepancies and skeletal abnormalities, especially when the magnitude of skeletal correction required is large. Excessive mandibular setback can restrict tongue space, cause narrowing of posterior airway and pharyngeal space, and be prone to relapse from the forward pterygomasseteric muscle pull, while large maxillary advancements are often accompanied by wound dehiscence and bone exposure at the site of pterygomaxillary disjunction, delayed union or malunion at the osteotomy and disjunction sites, and risk of relapse due to backward palatopharyngeal muscle pull. In addition, bi-jaw surgeries invariably involve an appreciable blood loss and a prolonged operating time with its attendant anaesthetic risks such as respiratory insufficiency. Aim and Objectives To develop an orthosurgical protocol wherein excessive skeletal discrepancy can be successfully managed, achieving the desired magnitude of correction, with little or no relapse. To assess its efficacy and superiority over the hitherto-employed single-stage bi-jaw procedures in the management of severe skeletal discrepancies. Materials and Method A two-staged, shorter 'single-jaw at a time' operative procedure with an intervening period of three months between the two surgical phases was employed. Results Drawbacks of conventional orthognathic surgery may be obviated by employing a two-staged protocol of bi-jaw surgeries allowing a minimum time period of 3 months to elapse between them. This period of time intervening between the maxillary advancement and mandibular setback allows the oral and maxillofacial musculature to adapt itself to the new jaw position following the first surgery, thus creating a better and more stable environment for the succeeding one, thereby reducing the chances of relapse thereafter, and producing more effective and stable long-term results. Moreover, the intervening time period also allows for observation of the repositioned jaw and arch relations achieved, and scrutiny for any positional changes in this post-surgical phase, which thereby allows modifications in the planned surgery of the next jaw, so as to achieve the most ideal final outcome following the second jaw surgery. A shorter operating time, reduced operator fatigue and less blood loss are other obvious advantages over the conventional bi-jaw procedures. Conclusion An effective and stable correction of the extreme class III skeletal deformity and malocclusion was achieved, with a dramatic enhancement of facial balance, symmetry and proportion in this patient, following a modified orthosurgical management protocol. The staged protocol of 'maxilla first and mandible after' orthognathic surgery with conventional pre- and post-surgical orthodontics helped in pushing the envelope of skeletal discrepancy correctable by orthognathic surgery, thereby achieving large quantum of jaw movements, with ideal and stable functional as well as aesthetic results. This is suggestive of its efficacy and superiority over the hitherto-employed single stage bi-jaw procedures in the management of severe skeletal discrepancies.
Collapse
|
9
|
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: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
10
|
AlZayer MA, Leung YY. Skeletal and airway stability after mandibular setback in patients with mandibular prognathism: A systematic review. Saudi Dent J 2021; 33:169-76. [PMID: 34025077 DOI: 10.1016/j.sdentj.2020.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 02/18/2020] [Accepted: 02/23/2020] [Indexed: 11/24/2022] Open
Abstract
Aim To perform a systematic review to answer the clinical question “What are the longitudinal skeletal and airway changes after mandibular setback orthognathic procedures?” Materials and methods A systematic search including computer search of different databases with specific keywords, manual search through three international journals and reference list search was performed. Articles that were reporting the skeletal and airway changes after mandibular setback orthognathic procedures were evaluated with five predetermined criteria. Results Six articles with a total of 217 patients entered the final review. All were rated to be of moderate bias risk. Four studies evaluated the skeletal and airway changes using two-dimensional (lateral) cephalometric radiographic imaging, whereas the other two studies used three-dimensional imaging with cone-beam computed tomography. In the two-dimensional studies, skeletal relapses from T0 (immediate postoperative) to T1 (postoperative 1–6 months) ranged from −2.14 mm to 0.30 mm, whereas skeletal relapses from T1 to T2 (postoperative 1 year) ranged from −0.90 mm to 1.23 mm. In the three-dimensional studies, skeletal relapse from T1 to T2 ranged from −0.26 mm to 1.53 mm. All included studies reported that there were no significant skeletal relapses after mandibular setback procedures. Regarding airway changes, airway changes from preoperative to T0/T1 ranged from −0.30 mm to −2.32 mm in the two-dimensional studies. Airway changes from T0 to T1 ranged from −0.70 mm to −1.63 mm, whereas airway changes from T1 to T2 ranged from 0.11 mm to 0.60 mm, respectively. Conclusions This systematic review showed there was insignificant skeletal relapse after mandibular setback orthognathic procedures. It was noted a small increase of the airway over the first post-operative year in studies using 2-dimensional radiography. However, such finding was not consistent in studies using 3-dimensional imaging with volumetric analysis of the airway changes.
Collapse
|
11
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
12
|
Tseng YC, Yang C, Cheng JH, Pan CY, Chou ST, Chen CM. Improvement in lip appearance (lateral and frontal aspects) following mandibular setback surgery. J Stomatol Oral Maxillofac Surg 2019; 120:317-321. [PMID: 30794882 DOI: 10.1016/j.jormas.2019.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The post-operative facial profile is critical for patients who undergo orthognathic surgery. The present study investigated the improvement in lip appearance (lateral and frontal aspects) following mandibular setback surgery. MATERIAL AND METHODS Thirty-one patients with mandibular prognathism underwent mandibular setback surgery. Lateral and posteroanterior cephalograms were obtained before surgery (T0) and more than 1 year after surgery (T1). The landmarks (soft and hard tissues) and linear distances were compared by statistical analysis. RESULTS The lateral cheilion (Ch), point B (B), and pogonion (Pog) were significantly setbackin the horizontal plane: 5.59, 11.49, and 12.35 mm, respectively. In the vertical plane, B and Pog did not move significantly. The Ch moved significantly downward by 3.23 mm on average. The setback ratios of soft tissue/hard tissue, soft tissue of B/B, and soft tissue of Pog/Pog were 0.96. The Ch/Pog ratio was 0.45. The width of the frontal Ch was significantly reduced by 3.17 mm. CONCLUSIONS The relationship between the corresponding soft and hard tissues of the chin was approximately 1. The relationship between the lip corner and chin bone was nearly 50%. The width of the lip corner was also significantly reduced.
Collapse
Affiliation(s)
- Y-C Tseng
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Orthodontics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - C Yang
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Orthodontics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - J-H Cheng
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Orthodontics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - C-Y Pan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Orthodontics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - S-T Chou
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Orthodontics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - C-M Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| |
Collapse
|
13
|
Karan NB, Kahraman S. Evaluation of posterior airway space after setback surgery by simulation. Med Biol Eng Comput 2019; 57:1145-1150. [PMID: 30673976 DOI: 10.1007/s11517-018-1943-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 12/10/2018] [Indexed: 11/28/2022]
Abstract
The possible negative outcomes of mandibular setback surgery (MSS) on the upper airway (UA) have become an important issue in recent years. The purpose of the present study was to compare the different amounts of MSS and to confirm the accepted maximum amount of mandibular setback by using Computational Fluid Dynamics (CFD) method. An anatomically similar UA model was constructed from magnetic resonance images of a systemically healthy individual. Two out of six models were kept as control models and the remaining four models were created to represent MSS scenarios with different amounts to correct Class III skeletal abnormality. The airflow was assumed laminar, incompressible, and the surrounding soft tissue was assumed to be linear elastic. The sixth model that was representative of 15 mm of MSS showed statistically significant differences from the other models (p < 0.05). No significant differences were observed among other models in terms of all the parameters (p > 0.05). CFD has been recently used in researches by modeling the UA flow; however, to the best of our knowledge, none of the studies have proved the maximum limits of MSS amounts with this technique. Graphical abstract ᅟ.
Collapse
Affiliation(s)
- Nazife Begum Karan
- Department of Oral and Maxillofacial Surgery, Recep Tayyip Erdoğan University, Rize, Turkey.
| | - Sevil Kahraman
- Department of Oral and Maxillofacial Surgery, Gazi University, Ankara, Turkey
| |
Collapse
|
14
|
Jang SI, Ahn J, Paeng JY, Hong J. Three-dimensional analysis of changes in airway space after bimaxillary orthognathic surgery with maxillo mandibular 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
15
|
Tan SK, Leung WK, Tang ATH, Zwahlen RA. Letter to the editor on the article "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; 45:156-157. [PMID: 28433756 DOI: 10.1016/j.ijsu.2017.03.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 11/25/2022]
Affiliation(s)
- S K Tan
- Center of Oral & Maxillofacial Surgery Studies, Faculty of Dentistry, Universiti Teknologi MARA Sungai Buloh Campus, Jalan Hospital, Selangor Darul Ehsan, Malaysia; Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong, Hong Kong, China
| | - W K Leung
- Discipline of Periodontology, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong, China
| | - A T H Tang
- Private Practice, 503 Tak Shing House, 20 Des Voeux Road, Central, Hong Kong, China
| | - R A Zwahlen
- Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong, Hong Kong, China.
| |
Collapse
|
16
|
Woo JM, Choi JY. Tonsillectomy as prevention and treatment of sleep-disordered breathing: a report of 23 cases. Maxillofac Plast Reconstr Surg 2016; 38:47. [PMID: 27995120 PMCID: PMC5122598 DOI: 10.1186/s40902-016-0092-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The paradigm of tonsillectomy has shifted from a treatment of recurrent throat infection to one of multi-discipline management modalities of sleep-disordered breathing (SDB). While tonsillectomy as a treatment for throat problems has been performed almost exclusively by otorhinolaryngologists, tonsillectomy as a part of the armamentarium for the multifactorial, multidisciplinary therapy of sleep-disordered breathing needs a new introduction to those involved in treating SDB patients. This study has its purpose in sharing a series of tonsillectomies performed at the Seoul National University Dental Hospital for the treatment and prevention of SDB in adult patients. METHODS Total of 78 patients underwent tonsillectomy at the Seoul National University Dental Hospital from 1996 to 2015, and 23 of them who were operated by a single surgeon (Prof. Jin-Young Choi) were included in the study. Through retrospective chart review, the purpose of tonsillectomy, concomitant procedures, grade of tonsillar hypertrophy, surgical outcome, and complications were evaluated. RESULTS Twenty-one patients diagnosed with SDB received multiple surgical procedures (uvulopalatal flap, uvulopalatopharyngoplasty, genioglossus advancement genioplasty, tongue base reduction, etc.) along with tonsillectomy. Two patients received mandibular setback orthognathic surgery with concomitant tonsillectomy in anticipation of postoperative airway compromise. All patients showed improvement in symptoms such as snoring and apneic events during sleep. CONCLUSIONS When only throat infections were considered, tonsillectomy was a procedure rather unfamiliar to oral and maxillofacial surgeons. With a shift of primary indication from recurrent throat infections to SDB and emerging technological and procedural breakthroughs, simpler and safer tonsillectomy has become a major tool in the multidisciplinary treatment modality for SDB.
Collapse
Affiliation(s)
- Jae-Man Woo
- Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, 101 Daehakno, Jongno-Gu, Seoul, 110-768 Republic of Korea
| | - Jin-Young Choi
- Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, 101 Daehakno, Jongno-Gu, Seoul, 110-768 Republic of Korea ; Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| |
Collapse
|
17
|
Hemmatpour S, Kadkhodaei Oliadarani F, Hasani A, Rakhshan V. Frontal-view nasolabial soft tissue alterations after bimaxillary orthognathic surgery in Class III patients. J Orofac Orthop 2016; 77:400-408. [PMID: 27582287 DOI: 10.1007/s00056-016-0047-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 03/31/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The aim of this before-after clinical trial was to evaluate nasolabial soft tissue changes in the frontal plane after bimaxillary surgery. METHODS A total of 20 skeletal Class III Iranian patients needing bimaxillary Le Fort I osteotomy plus mandibular setback surgery were enrolled in this trial. Patients underwent 4.02 ± 1.02 mm of maxillary advancement (Le Fort I osteotomy, 4.33 ± 1.21 mm in men, 3.81 ± 0.86 mm in women) and 7.13 ± 1.74 mm of mandibular setback (intraoral vertical ramus osteotomy, 7.71 ± 2.33 mm in men, and 6.74 ± 1.16 mm in women). Data were acquired via 2D frontal photographs. We compared pretreatment baseline (T 1), preoperative postorthodontic treatment (T 2), and postoperative (T 3) anthropometric measurements using repeated-measures ANOVA and Bonferroni tests (α = 0.05). RESULT The 20 patients (12 men, 8 women) were aged 21.85 ± 1.75 years. Between T 1 and T 2, nasal width, cutaneous upper labial heights increased overall; cutaneous lower labial height decreased (P < 0.05). Between T 2 and T 3, nasal width, widths of the philtrum and mouth, cutaneous upper-lip height, vermilion height of the lower lip, lateral upper-lip height increased; the upper-lip vermilion height and cutaneous lower lip height decreased (P < 0.05). The changes ranged between 0.5 and 5 mm. CONCLUSION The applied orthognathic surgery procedures might widen the alar base and mouth width. It might increase the lateral upper-lip height, vermilion height of the lower lip, and cutaneous and overall upper-lip heights while reducing upper-lip vermilion height and shortening the overall lower-lip height.
Collapse
Affiliation(s)
- Siamak Hemmatpour
- Department of Orthodontics, Dental Branch, Islamic Azad University, Tehran, Iran
| | - Fatemeh Kadkhodaei Oliadarani
- Department of Pediatric Dentistry, Dental School, Shahed University, Tehran, Iran. .,, No. 12, Shahed 1 Alley, Sardar Jangal Blvd, Poonak Square, Tehran, Iran.
| | - Ali Hasani
- Department of Maxillofacial Surgery, Dental Branch, Islamic Azad University, Tehran, Iran
| | - Vahid Rakhshan
- Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Dental Anatomy, Dental Branch, Islamic Azad University, Tehran, Iran
| |
Collapse
|
18
|
Takahara N, Kabasawa Y, Sato M, Tetsumura A, Kurabayashi T, Omura K. MRI changes in the temporomandibular joint following mandibular setback surgery using sagittal split ramus osteotomy with rigid fixation. Cranio 2016; 35:38-45. [PMID: 27077250 DOI: 10.1080/08869634.2016.1143167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study examined the changes in temporomandibular joint dysfunction (TMD) symptoms and investigated the variations in the disc position, disc and condylar morphology following sagittal split ramus osteotomy (SSRO) with rigid fixation in patients with mandibular prognathism. Furthermore, the authors examined the correlation between mandibular setback and TMD symptoms. METHODS The study included 24 Japanese patients with jaw deformities who were treated using bilateral SSRO and Le Fort I osteotomy. The clinical and magnetic resonance imaging findings in the temporomandibular joint were evaluated preoperatively and at three and six months postoperatively. RESULTS The preoperative TMD symptoms were significantly associated with the prevalence of TMD symptoms at six months postoperatively. Anterior disc displacement improved in four joints with slight displacement and with no morphological change. There were no postoperative changes in condylar morphology. There was no significant correlation between mandibular setback and the postoperative TMD symptoms. CONCLUSION Postoperative TMD symptoms may be influenced mainly by preoperative TMD symptoms rather than mandibular setback using SSRO with rigid fixation. Therefore, patients with TMD symptoms require physical examination and MRI for appropriate diagnosis preoperatively.
Collapse
Affiliation(s)
- Namiaki Takahara
- a Department of Oral and Maxillofacial Surgery , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan
| | - Yuji Kabasawa
- a Department of Oral and Maxillofacial Surgery , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan
| | - Masaru Sato
- b Department of Dentistry and Oral Surgery , Tsuchiura Kyodo General Hospital , Ibaraki , Japan
| | - Akemi Tetsumura
- c Department of Oral and Maxillofacial Radiology , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan
| | - Tohru Kurabayashi
- c Department of Oral and Maxillofacial Radiology , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan
| | - Ken Omura
- d Department of Dentistry and Oral Surgery , Tokyo General Hospital , Tokyo , Japan
| |
Collapse
|
19
|
Cho HW, Kim IK, Cho HY, Seo JH, Lee DH, Park SH. Retrospective study of changes in pharyngeal airway space and position of hyoid bone after mandibular setback surgery by cephalometric analysis. Maxillofac Plast Reconstr Surg 2015; 37:38. [PMID: 26523276 DOI: 10.1186/s40902-015-0039-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 10/15/2015] [Indexed: 12/01/2022] Open
Abstract
Background The posterior movement of mandible was known as the main cause of the changes in the pharyngeal airway space (PAS) and the postoperative obstructive sleep apnea (OSA). The purpose of this study was to know the changes of PAS and position of hyoid bone. Methods Lateral cephalographies of 13 patients who had undergone sagittal split ramus osteotomy (SSRO) setback surgery were taken preoperatively (T1), postoperatively within 2 months (T2), and follow-up after 6 months or more (T3). On the basis of F-H plane, diameters of nasopharynx, oropharynx, and hypopharynx were measured. The movements of the soft palate, tongue, and hyoid bone were also measured. Results The amount of mandible setback was 7.5 ± 3.8 mm. In the measurements of PAS, there was a statistically significant decrease of 2.8 ± 2.5 mm in nasopharynx (P < 0.01), and 1.7 ± 2.4 mm in oropharynx (P < 0.01) were observed after surgery. The hypopharynx decreased 1.0 ± 2.1 mm after surgery and continuously decreased 1.0 ± 2.8 mm at follow-up. The changes in hyoid bone position showed the posterior movement only after surgery and posteroinferior movement at follow-up. Conclusions The PAS such as nasopharynx, oropharynx, and hypopharynx showed relatively high correlation with the amount of mandibular setback. The change of resistance in upper airway may be important for the prevention of OSA after mandibular setback surgery.
Collapse
|
20
|
Fernández-Ferrer L, Montiel-Company JM, Pinho T, Almerich-Silla JM, Bellot-Arcís C. Effects of mandibular setback surgery on upper airway dimensions and their influence on obstructive sleep apnoea - a systematic review. J Craniomaxillofac Surg 2014; 43:248-53. [PMID: 25547214 DOI: 10.1016/j.jcms.2014.11.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 11/06/2014] [Accepted: 11/17/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Mandibular setback used to be the traditional treatment of choice for correcting mandibular prognathism. Nowadays, bimaxillary surgery is preferred. Several authors have asserted that mandibular setback causes a relative narrowing of the upper airway (UA) that could trigger obstructive sleep apnoea (OSA); however, its potential role in OSA development is still much debated. Another controversial subject is whether changes in airway space caused by the procedure are permanent. OBJECTIVES To ascertain the consequences for UA size and shape of mandibular setback surgery in comparison with bimaxillary surgery (maxillary advancement with Le Fort I and mandibular setback), and to analyse the changes in oximetric indices and their relationship with OSA. SEARCH METHODS A systematic review was made of the bibliography in 4 databases: Medline, Scopus, Embase and Cochrane. SELECTION CRITERIA Systematic reviews, meta-analyses, clinical trials and cohort and case-control studies of adults published in the past 15 years were included. DATA COLLECTION AND ANALYSIS The initial search yielded 668 articles, of which 498 were eliminated because of duplication and 123 on the basis of their titles and abstracts or summaries. The remaining 47 papers were read in their entirety, and 14 were included in the final selection. RESULTS According to our observations, the nasopharyngeal space does not undergo significant changes after either of the two surgical procedures. In the oropharynx and hypopharynx, none of the measurements changed significantly with maxillary advancement; however, persistent and significant decreases in the area, horizontal linear dimensions, and volume of these spaces are encountered after mandibular setback alone. No long-term changes in oximetric indices were found. CONCLUSIONS Morphological changes are more pronounced following exclusively mandibular surgery. A decrease in the UA does take place but appears not to affect the patient's sleep quality. This study found no evidence to confirm that bimaxillary or mandibular orthognathic surgery predisposes to obstructive sleep apnoea development.
Collapse
Affiliation(s)
- Laura Fernández-Ferrer
- Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, C/ Gascó Oliag n° 1, CP: 46010, Valencia, Spain.
| | - José María Montiel-Company
- Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, C/ Gascó Oliag n° 1, CP: 46010, Valencia, Spain.
| | - Teresa Pinho
- Instituto Superior de Ciências da Saúde-Norte, Centro de Investigação Ciências da Saúde (CICS), Rua Central de Gandra, 1317 4585-116, Gandra, PRD, Portugal.
| | - José Manuel Almerich-Silla
- Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, C/ Gascó Oliag n° 1, CP: 46010, Valencia, Spain.
| | - Carlos Bellot-Arcís
- Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, C/ Gascó Oliag n° 1, CP: 46010, Valencia, Spain.
| |
Collapse
|
21
|
Ghassemi M, Hilgers RD, Jamilian A, Hölzle F, Fritz U, Gerressen M, Ghassemi A. Consideration of effect of the amount of mandibular setback on the submental region in the planning of orthodontic-orthognathic treatment. Br J Oral Maxillofac Surg 2014; 52:334-9. [PMID: 24593896 DOI: 10.1016/j.bjoms.2014.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 01/20/2014] [Indexed: 11/23/2022]
Abstract
Aesthetic outcome has gained in importance in the treatment of patients with orthognathic problems. Historically, Class III malocclusions have historically been treated by isolated mandibular setback and maxillary advancement, whereas bimaxillary procedures have recently become the more common option. Functional outcome and stability have been discussed previously. The aim of this observational study was to evaluate the effect of mandibular setback (BSSO) on the cervical region. We studied 38 Class III patients (20 women and 18 men, mean (SD) age 25 (0.8) years) who we identified from our clinical records and who were treated between 1 January 2002 and 30 December 2012 with mandibular setback procedures and followed up for 6 months. To study the effect of the amount of mandibular setback on the aesthetic outcome we have distinguished between patients with less than 5mm setback and those with 5mm or more. In patients whose mandibular setback was less than 5mm there was no significant change in cervical length. However, it decreased significantly in patients in whom the movement was 5mm or more. Postoperatively the lip-chin-throat angle (p=0.02), the length of the lower lip (p=0.002), and the length of the upper lip (p=0.003) from the aesthetic line also differed significantly between the 2 groups. Our observations strongly suggest that all these relations should be considered when treatment is being planned to avoid an unpleasant aesthetic impact on the chin region.
Collapse
|
22
|
Yang HJ, Hwang SJ. Contributing factors to intraoperative clockwise rotation of the proximal segment as a relapse factor after mandibular setback with sagittal split ramus osteotomy. J Craniomaxillofac Surg 2013; 42:e57-63. [PMID: 23830770 DOI: 10.1016/j.jcms.2013.05.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 05/21/2013] [Accepted: 05/21/2013] [Indexed: 11/28/2022] Open
Abstract
The aims of this study were to analyze possible contributing factors to intraoperative clockwise rotation (CWR) of the proximal segment (PS), which is known to be a primary factor for relapse after mandibular setback with sagittal split ramus osteotomy (SSRO) and to evaluate the correlation between the CWR of the PS and relapse tendency. The sample was comprised of 47 patients who underwent SSRO for mandibular setback. Lateral cephalograms were analyzed. The vertical difference between the inferior borders of the PS and the distal segment at the vertical osteotomy line for SSRO after setback of the distal segment (vertical bony step, VBS) was the most predictable factor for CWR of the PS (p < 0.001), and it correlated significantly with the gonial angle, the surgical change in SNB, and the downward movement of the maxilla (p < 0.05). Patients with large CWR of the PS showed a greater tendency in horizontal relapse than patients with small CWR of the PS (p < 0.05). Such relapse patterns could be prevented with adequate surgical planning designed to reduce the VBS, such as maxillary posterior impaction or the intentional guidance of the PS to maintain the original position of the PS without CWR.
Collapse
Affiliation(s)
- Hoon Joo Yang
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Soon Jung Hwang
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, Republic of Korea.
| |
Collapse
|
23
|
Gonçales ES, Rocha JF, Gonçales AGB, Yaedú RYF, Sant'Ana E. Computerized cephalometric study of the pharyngeal airway space in patients submitted to orthognathic surgery. J Maxillofac Oral Surg 2013; 13:253-8. [PMID: 25018597 DOI: 10.1007/s12663-013-0524-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Accepted: 04/13/2013] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Pharynx is a muscular organ with is sustained by craniofacial bones. It is divided into nasal, oral and hipopharynx, and can be considered as a tube that serves both respiratory and digestive systems. Its anatomical morphology permits that factors facilitate its obstruction, leading to the sleep apnea syndrome. One of the treatment consists of surgical mandibular advancement, increasing pharyngeal dimensions. The aim of this study was evaluate the cephalometric changes in the pharyngeal airway space after orthognathic surgery procedures for correction of mandibular prognathism. MATERIALS AND METHODS Pre and post-operative cephalometric analysis was performed on 19 patients submitted to mandibular setback by mandibular bilateral sagittal split osteotomy associated with maxillary advancement by Le Fort I osteotomy, using the Dolphin Imaging 10.0 software. RESULTS Results did not reveal statistically significant changes in the upper (nasopharyngeal), middle (oropharyngeal) and lower (hypopharyngeal) airway spaces, but showed increase in the nasal pharynx due the maxillary advancement and a lower position of the hyoid bone due the mandibular setback. DISCUSSION Maxillomandibular orthognathic surgery for correction of mandibular prognathism does not seem to statistically significantly change the pharyngeal airway space, but it increases the maxillary airway. CONCLUSION It seems to be important to consider the double jaw surgery in cases of mandibular prognathism, aiming prevention of a possible reduction of whole upper airway.
Collapse
Affiliation(s)
- Eduardo Sanches Gonçales
- Oral and Maxillofacial Surgery, Stomatology Department, Bauru Dental School, University of Sao Paulo (FOB-USP), 975 Octávio Pinheiro Brisola Ln, Bauru, SP 17012-901 Brazil
| | - Julierme Ferreira Rocha
- Department of Maxillofacial Surgery and Anatomy, Federal University of Campina Grande, Patos, Brazil
| | | | - Renato Yassutaka Faria Yaedú
- Oral and Maxillofacial Surgery, Stomatology Department, Bauru Dental School, University of Sao Paulo (FOB-USP), 975 Octávio Pinheiro Brisola Ln, Bauru, SP 17012-901 Brazil
| | - Eduardo Sant'Ana
- Oral and Maxillofacial Surgery, Stomatology Department, Bauru Dental School, University of Sao Paulo (FOB-USP), 975 Octávio Pinheiro Brisola Ln, Bauru, SP 17012-901 Brazil
| |
Collapse
|
24
|
Kolokitha OE. Validity of a manual soft tissue profile prediction method following mandibular setback osteotomy. Eur J Dent 2007; 1:202-11. [PMID: 19212468 PMCID: PMC2609908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine the validity of a manual cephalometric method used for predicting the post-operative soft tissue profiles of patients who underwent mandibular setback surgery and compare it to a computerized cephalometric prediction method (Dentofacial Planner). Lateral cephalograms of 18 adults with mandibular prognathism taken at the end of pre-surgical orthodontics and approximately one year after surgery were used. METHODS To test the validity of the manual method the prediction tracings were compared to the actual post-operative tracings. The Dentofacial Planner software was used to develop the computerized post-surgical prediction tracings. Both manual and computerized prediction printouts were analyzed by using the cephalometric system PORDIOS. Statistical analysis was performed by means of t-test. RESULTS Comparison between manual prediction tracings and the actual post-operative profile showed that the manual method results in more convex soft tissue profiles; the upper lip was found in a more prominent position, upper lip thickness was increased and, the mandible and lower lip were found in a less posterior position than that of the actual profiles. Comparison between computerized and manual prediction methods showed that in the manual method upper lip thickness was increased, the upper lip was found in a more anterior position and the lower anterior facial height was increased as compared to the computerized prediction method. CONCLUSIONS Cephalometric simulation of post-operative soft tissue profile following orthodontic-surgical management of mandibular prognathism imposes certain limitations related to the methods implied. However, both manual and computerized prediction methods remain a useful tool for patient communication.
Collapse
Affiliation(s)
- Olga-Elpis Kolokitha
- Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece,Corresponding Author: Olga-Elpis Kolokitha, DDS, MSD, Dr Dent Lecturer Department of Orthodontics, School of Dentistry Aristotle University of Thessaloniki GR - 54124 Thessaloniki Greece, Tel.: +30 2310 999556, Fax: +30 2310 999549, E-mail:
| |
Collapse
|