Upper airway volume changes after bimaxillary surgery for Class III skeletal malocclusion correction: A case series
DOI:
https://doi.org/10.33448/rsd-v11i1.25238Keywords:
Orthognathic Surgery; Airway Remodeling; Oropharynx; Nasopharynx; Tomography.Abstract
The aim of this study was to assess the airway volume of patients with Class III skeletal malocclusion undergoing bimaxillary orthognathic surgery. The sample consisted of 10 patients with Class III skeletal malocclusion undergoing bimaxillary orthognathic surgery. Through computed tomography, the three-dimensional volumetric measurements of the airways were determined using the Dolphin Imaging® 11.7 program and were compared between the pre- and postoperative periods. Patients were divided into two groups, (1) airway narrowing and (2) airway enlargement. Group 1 showed a mean reduction of 66.16 ± 52.48 mm² in the two-dimensional assessment of the airways and 2311.16 ± 1653.71 mm³ in the three-dimensional assessment (p≤ 0.05). On the other hand, group 2 increased 166.5 ± 73.13 mm² and 4116 ± 1323.85 mm³. There was no correlation between the values obtained with bone movement, in mm (p≥0.05). Patients with class III deformities undergoing bimaxillary surgery, most with reduced airways, however, this decrease does not always occur to the same extent for all patients.
References
Aboudara, C., Nielsen, I., Huang, J. C., Maki, K., Miller, A. J., & Hatcher, D. (2009). Comparison of airway space with conventional lateral headfilms and 3-dimensional reconstruction from cone-beam computed tomography. American Journal of Orthodontics and Dentofacial Orthopedics, 135(4), 468–479. https://doi.org/10.1016/j.ajodo.2007.04.043
Alcalde, L. F. A., Faria, P. E. P., Nogueira, R. L. M., Chihara, L., & Sant’Ana, E. (2019a). Computed tomography visualizing alterations in the upper airway after orthognathic surgery. Journal of Cranio-Maxillofacial Surgery, 47(7), 1041–1045. https://doi.org/10.1016/j.jcms.2019.04.006
American association of oral and maxillofacial surgeons. Parameters of care: clinical practice guidelines for oral and maxillofacial surgery (AAOMS ParCare2012). J Oral Maxillofac Surg. 2012;70(11):107-36.
Ayappa, I., & Rapoport, D. M. (2003). The upper airway in sleep: Physiology of the pharynx. In Sleep Medicine Reviews (Vol. 7, Issue 1, pp. 9–33). W.B. Saunders Ltd. https://doi.org/10.1053/smrv.2002.0238
Azevêdo, M. S., Machado, A. W., da Silva Barbosa, I., Esteves, L. S., Rocha, V. Á. C., & Bittencourt, M. A. V. (2016). Evaluation of upper airways after bimaxillary orthognathic surgery in patients with skeletal class III pattern using cone-beam computed tomography. Dental Press Journal of Orthodontics, 21(1), 34–41. https://doi.org/10.1590/2177-6709.21.1.034-041.oar
Azambuja Alcalde, L. F., Pinto Faria, P. E., Maia Nogueira, R. L., Chihara, L., & Sant’Ana, E. (2019). Computed tomography visualizing alterations in the upper airway after orthognathic surgery. Journal of Cranio-Maxillofacial Surgery. doi: 10.1016/j.jcms.2019.04.006.
Burkhard, J. P. M., Dietrich, A. D., Jacobsen, C., Roos, M., Lübbers, H. T., & Obwegeser, J. A. (2014). Cephalometric and three-dimensional assessment of the posterior airway space and imaging software reliability analysis before and after orthognathic surgery. Journal of Cranio-Maxillofacial Surgery, 42(7), 1428–1436. https://doi.org/10.1016/j.jcms.2014.04.005
Daluz, A. D. J., da Silva, T. V. S., Tôrres, B. O., Costa, D. F. N., & Santos, L. A. de M. (2021). Long-term airway evolution after orthognathic surgery: Systematic Review. In Journal of Stomatology, Oral and Maxillofacial Surgery. Elsevier Masson s.r.l. https://doi.org/10.1016/j.jormas.2021.04.006
de Souza Carvalho, A. C. G., Magro Filho, O., Garcia, I. R., Araujo, P. M., & Nogueira, R. L. M. (2012). Cephalometric and three-dimensional assessment of superior posterior airway space after maxillomandibular advancement. International Journal of Oral and Maxillofacial Surgery, 41(9), 1102–1111. https://doi.org/10.1016/j.ijom.2012.05.009
Elshebiny, T., Bous, R., Withana, T., Morcos, S., & Valiathan, M. (2020). Accuracy of Three-Dimensional Upper Airway Prediction in Orthognathic Patients Using Dolphin Three-Dimensional Software. The Journal of Craniofacial Surgery, 31(4), 1098–1100. https://doi.org/10.1097/SCS.0000000000006566
Foronda, R., & Melhem Elias, F. (2011). Avaliação de dois programas de computador na previsão do perfil facial de pacientes submetidos à cirurgia ortognática (Vol. 18, Issue 4).
Giralt-Hernando, M., Valls-Ontañón, A., Haas Junior, O. L., Masià-Gridilla, J., & Hernández-Alfaro, F. (2021). What are the Surgical Movements in Orthognathic Surgery That Most Affect the Upper Airways? A Three-Dimensional Analysis. Journal of Oral and Maxillofacial Surgery, 79(2), 450–462. https://doi.org/10.1016/j.joms.2020.10.017
Gokce, S. M., Gorgulu, S., Gokce, H. S., Bengi, A. O., Karacayli, U., & Ors, F. (2014). Evaluation of pharyngeal airway space changes after bimaxillary orthognathic surgery with a 3-dimensional simulation and modeling program. American Journal of Orthodontics and Dentofacial Orthopedics, 146(4), 477–492. https://doi.org/10.1016/j.ajodo.2014.06.017
Hatab, N. A., Konstantinović, V. S., & Mudrak, J. K. H. (2015). Pharyngeal airway changes after mono- and bimaxillary surgery in skeletal class III patients: Cone-beam computed tomography evaluation. Journal of Cranio-Maxillofacial Surgery, 43(4), 491–496. https://doi.org/10.1016/j.jcms.2015.02.007
He, J., Wang, Y., Hu, H., Liao, Q., Zhang, W., Xiang, X., & Fan, X. (2017). 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. In International Journal of Surgery (Vol. 38, pp. 31–40). Elsevier Ltd. https://doi.org/10.1016/j.ijsu.2016.12.033
He, L., He, S., Wu, X., & Huang, Y. (2019). Three-Dimensional Morphological Changes of the Upper Airway in Patients With Skeletal Class III Malocclusion After Orthognathic Surgery. The Journal of Craniofacial Surgery, 30(8), 2451–2455. https://doi.org/10.1097/SCS.0000000000005738
Hsieh Y.J, Chen Y.C., Chen Y.A., Liao Y.F., Chen Y.R. Effect of bimaxillary rotational setback surgery on upper airway structure in skeletal class III deformities. Plast Reconstr Surg. 2015;135(2):361e-9e. doi:10.1097/PRS.0000000000000913
Hinton, V. A., Warren, D. W., Hairfield, W. M., & Seaton, D. (1987). The relationship between nasal cross-sectional area and nasal air volume in normal and nasally impaired adults. American Journal of Orthodontics and Dentofacial Orthopedics, 92(4), 294–298. https://doi.org/10.1016/0889-5406(87)90329-5
Hsieh, Y. J., Chen, Y. C., Chen, Y. A., Liao, Y. F., & Chen, Y. R. (2015). Effect of bimaxillary rotational setback surgery on upper airway structure in skeletal class III deformities. Plastic and Reconstructive Surgery, 135(2), 361e–369e. https://doi.org/10.1097/PRS.0000000000000913
Kawakami, M., Yamamoto, K., Fujimoto, M., Ohgi, K., Inoue, M., & Kirita, T. (2005). Changes in tongue and hyoid positions, and posterior airway space following mandibular setback surgery. Journal of Cranio-Maxillofacial Surgery, 33(2), 107–110. https://doi.org/10.1016/j.jcms.2004.10.005
Kim, H. S., Kim, G. T., Kim, S., Lee, J. W., Kim, E. C., & Kwon, Y. D. (2016). Three-dimensional evaluation of the pharyngeal airway using cone-beam computed tomography following bimaxillary orthognathic surgery in skeletal class III patients. Clinical Oral Investigations, 20(5), 915–922. https://doi.org/10.1007/s00784-015-1575-4
Li, L., Liu, H., Cheng, H., Han, Y., Wang, C., Chen, Y., Song, J., & Liu, D. (2014). CBCT Evaluation of the upper airway morphological changes in growing patients of class ii division 1 malocclusion with mandibular retrusion using twin block appliance: A comparative research. PLoS ONE, 9(4). https://doi.org/10.1371/journal.pone.0094378
Mattos, C. T., Vilani, G. N. L., Sant’Anna, E. F., Ruellas, A. C. O., & Maia, L. C. (2011). Effects of orthognathic surgery on oropharyngeal airway: A meta-analysis. In International Journal of Oral and Maxillofacial Surgery (Vol. 40, Issue 12, pp. 1347–1356). https://doi.org/10.1016/j.ijom.2011.06.020
McIntyre B.P. Volumetric airway changes in patients undergoing orthognathic surgery: a conebeam CT evaluation [thesis]. Oklahoma City, Okla: University of Oklahoma; 2011.
Muto, T., Takeda, S., Kanazawa, M., Yamazaki, A., Fujiwara, Y., & Mizoguchi, I. (2002). The effect of head posture on the pharyngeal airway space (PAS). International Journal of Oral and Maxillofacial Surgery, 31(6), 579–583. https://doi.org/10.1054/ijom.2002.0279
Oltramari-Navarro, P. V. P., Almeida, R. R. de, Conti, A. C. de C. F., Navarro, R. de L., Almeida, M. R. de, & Fernandes, L. S. A. F. P. (2013). Early treatment protocol for skeletal class III malocclusion. Brazilian Dental Journal, 24(2), 167–173. https://doi.org/10.1590/0103-6440201301588
Proffit W.R., White R.P., Sarver D.M. Contemporary Treatment of Dentofacial Deformity. Preface. In: Proffit WR, White RP, Sarver DM, editors. CV Mosby; St Louis, Mo: 2003. p. vii.
Raffaini, M., & Pisani, C. (2013). Clinical and cone-beam computed tomography evaluation of the three-dimensional increase in pharyngeal airway space following maxillo-mandibular rotation-advancement for Class II-correction in patients without sleep apnoea (OSA). Journal of Cranio-Maxillofacial Surgery, 41(7), 552–557. https://doi.org/10.1016/j.jcms.2012.11.022
Rajagopal, M. R., & Paul, J. (2005). 251-256 applied anatomy and physiology of the airway and breathing. In Indian J. Anaesth (Vol. 49, Issue 4). http://journals.lww.com/ijaweb
Riley, R. W., Powell, N. B., & Ware, W. (1997). Obstructive Sleep Apnea Syndrome Folio wing Surgery for Mandibular Prognathism. In J Oral Maxillofac Surg (Vol. 45).
Schendel, S. A., Broujerdi, J. A., & Jacobson, R. L. (2014). Three-dimensional upper-airway changes with maxillomandibular advancement for obstructive sleep apnea treatment. American Journal of Orthodontics and Dentofacial Orthopedics, 146(3), 385–393. https://doi.org/10.1016/j.ajodo.2014.01.026
Sheng, C. M., Lin, L. H., Su, Y., & Tsai, H. H. (2009). Developmental changes in pharyngeal airway depth and hyoid bone position from childhood to young adulthood. Angle Orthodontist, 79(3), 484–490. https://doi.org/10.2319/062308-328.1
Sologuren, N. (n.d.). Anatomía de la vía aérea. Retrieved January 4, 2022, from https://revistachilenadeanestesia.cl/anatomia-de-la-via-aerea/
Tan, S. K., Leung, W. K., Tang, A. T. H., & Zwahlen, R. A. (2017). 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.” In International Journal of Surgery (Vol. 45, pp. 156–157). Elsevier Ltd. https://doi.org/10.1016/j.ijsu.2017.03.083
van Spronsen, P. H. (2010). Long-Face Craniofacial Morphology: Cause or Effect of Weak Masticatory Musculature? Seminars in Orthodontics, 16(2), 99–117. https://doi.org/10.1053/j.sodo.2010.02.001
Yang, H. J., Jung, Y. E., Kwon, I. J., Lee, J. Y., & Hwang, S. J. (2020). Airway changes and prevalence of obstructive sleep apnoea after bimaxillary orthognathic surgery with large mandibular setback. International Journal of Oral and Maxillofacial Surgery, 49(3), 342–349. https://doi.org/10.1016/j.ijom.2019.07.012
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