nach oben

Clinical Oral Investigations

Erschienen in:

26.11.2021 | Original Article

Long-term three-dimensional effects of orthognathic surgery on the pharyngeal airways: a prospective study in 128 healthy patients

verfasst von: Gert-Jan Hassing, Vincent The, Eman Shaheen, Constantinus Politis, Maria Cadenas de Llano-Pérula

Erschienen in: Clinical Oral Investigations | Ausgabe 3/2022

Einloggen, um Zugang zu erhalten

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.

Chen H, Aarab G, de Ruiter MH, de Lange J, Lobbezoo F, van der Stelt PF (2016) Three-dimensional imaging of the upper airway anatomy in obstructive sleep apnea: a systematic review. Sleep Med 21:19–27. https://doi.org/10.1016/j.sleep.2016.01.022CrossRefPubMed

Christovam IO, Lisboa CO, Ferreira DMTP, Cury-Saramago AA, Mattos CT (2016) Upper airway dimensions in patients undergoing orthognathic surgery: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 45:460–471. https://doi.org/10.1016/j.ijom.2015.10.018CrossRefPubMed

Mattos CT, Vilani GN, Sant’Anna EF, Ruellas AC, Maia LC (2011) Effects of orthognathic surgery on oropharyngeal airway: a meta-analysis. Int J Oral Maxillofac Surg 40:1347–1356. https://doi.org/10.1016/j.ijom.2011.06.020CrossRefPubMed

Gokce SM, Gorgulu S, Gokce HS, Bengi AO, Karacayli U, Ors F (2014) Evaluation of pharyngeal airway space changes after bimaxillary orthognathic surgery with a 3-dimensional simulation and modeling program. Am J Orthod Dentofac Orthop 146:477–492. https://doi.org/10.1016/j.ajodo.2014.06.017CrossRef

Lye KW (2008) Effect of orthognathic surgery on the posterior airway space (PAS). Ann Acad Med Singapore 37:677–682PubMed

Li YM, Liu JL, Zhao JL, Dai J, Wang L, Chen JW (2014) Morphological changes in the pharyngeal airway of female skeletal class III patients following bimaxillary surgery: a cone beam computed tomography evaluation. Int J Oral Maxillofac Surg 43:862–867. https://doi.org/10.1016/j.ijom.2014.03.009CrossRefPubMed

Schendel SA, Broujerdi JA, Jacobson RL (2014) Three-dimensional upper-airway changes with maxillomandibular advancement for obstructive sleep apnea treatment. Am J Orthod Dentofac Orthop 146:385–393. https://doi.org/10.1016/j.ajodo.2014.01.026CrossRef

Gandedkar NH, Chng CK, Por YC, Yeow VKL, Ow ATC, Seah TE (2017) Influence of Bimaxillary Surgery on Pharyngeal Airway in Class III Deformities and Effect on Sleep Apnea: A STOP-BANG Questionnaire and Cone-Beam Computed Tomography Study. J Oral Maxillofac Surg 75:2411–2421. https://doi.org/10.1016/j.joms.2017.05.028CrossRefPubMed

Lee UL, Oh H, Min SK, Shin JH, Kang YS, Lee WW, Han YE, Choi YJ, Kim HJ (2017) The structural changes of upper airway and newly developed sleep breathing disorders after surgical treatment in class III malocclusion subjects. Medicine 96:e6873. https://doi.org/10.1097/md.0000000000006873CrossRefPubMedPubMedCentral

10.

Guijarro-Martínez R, Swennen GRJ (2011) Cone-beam computerized tomography imaging and analysis of the upper airway: a systematic review of the literature. Int J Oral Maxillofac Surg 40:1227–1237. https://doi.org/10.1016/j.ijom.2011.06.017CrossRefPubMed

11.

Fernández-Ferrer L, Montiel-Company JM, Pinho T, Almerich-Silla JM, Bellot-Arcís C (2015) Effects of mandibular setback surgery on upper airway dimensions and their influence on obstructive sleep apnoea – A systematic review. J Cranio-Maxillofac Surg 43:248–253. https://doi.org/10.1016/j.jcms.2014.11.017CrossRef

12.

John CR, Gandhi S, Sakharia AR, James TT (2018) Maxillomandibular advancement is a successful treatment for obstructive sleep apnoea: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 47:1561–1571. https://doi.org/10.1016/j.ijom.2018.05.015CrossRefPubMed

13.

Steiner CC (1959) Cephalometrics In Clinical Practice. Angle Orthod 29:8–29. https://doi.org/10.1043/0003-3219(1959)029%3c0008:CICP%3e2.0.CO;2CrossRef

14.

Abé-Nickler MD, Pörtner S, Sieg P, Hakim SG (2017) No correlation between two-dimensional measurements and three-dimensional configuration of the pharyngeal upper airway space in cone-beam computed tomography. J Cranio-Maxillofac Surg 45:371–376. https://doi.org/10.1016/j.jcms.2017.01.004CrossRef

15.

Burkhard JPM, Dietrich AD, Jacobsen C, Roos M, Lübbers H-T, Obwegeser JA (2014) Cephalometric and three-dimensional assessment of the posterior airway space and imaging software reliability analysis before and after orthognathic surgery. J Cranio-Maxillofac Surg 42:1428–1436. https://doi.org/10.1016/j.jcms.2014.04.005CrossRef

16.

Sears CR, Miller AJ, Chang MK, Huang JC, Lee JS (2011) Comparison of Pharyngeal Airway Changes on Plain Radiography and Cone-Beam Computed Tomography After Orthognathic Surgery. J Oral Maxillofac Surg 69:e385–e394. https://doi.org/10.1016/j.joms.2011.03.015CrossRefPubMed

17.

Aboudara CA, Hatcher D, Nielsen IL, Miller A (2003) A three-dimensional evaluation of the upper airway in adolescents. Orthod Craniofac Res 6(Suppl 1):173–175. https://doi.org/10.1034/j.1600-0544.2003.253.xCrossRefPubMed

18.

Kim YJ, Hong JS, Hwang YI, Park YH (2010) Three-dimensional analysis of pharyngeal airway in preadolescent children with different anteroposterior skeletal patterns. Am J Orthod Dentofacial Orthop 137:306.e1–11. https://doi.org/10.1016/j.ajodo.2009.10.025 (discussion 306-7)CrossRef

19.

Lenza MG, Lenza MM, Dalstra M, Melsen B, Cattaneo PM (2010) An analysis of different approaches to the assessment of upper airway morphology: a CBCT study. Orthod Craniofac Res 13:96–105. https://doi.org/10.1111/j.1601-6343.2010.01482.xCrossRefPubMed

20.

van Vlijmen OJ, Kuijpers MA, Berge SJ, Schols JG, Maal TJ (1939) Breuning H and Kuijpers-Jagtman AM (2012) Evidence supporting the use of cone-beam computed tomography in orthodontics. J Am Dent Assoc 143:241–52. https://doi.org/10.14219/jada.archive.2012.0148CrossRef

21.

Bucci R, Roberto R, Bucci P, Valletta R, Michelotti A, D’Antò V (2020) Effects of surgical mandibular advancement on the upper airways of adult Class II patients: a systematic review with meta-analysis. J Oral Rehabil. https://doi.org/10.1111/joor.13140CrossRefPubMed

22.

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. Int J Surg 38:31–40. https://doi.org/10.1016/j.ijsu.2016.12.033CrossRefPubMed

23.

Stratis A, Zhang G, Lopez-Rendon X, Politis C, Hermans R, Jacobs R, Bogaerts R, Shaheen E, Bosmans H (2017) Two examples of indication specific radiation dose calculations in dental CBCT and Multidetector CT scanners. Phys Med 41:71–77. https://doi.org/10.1016/j.ejmp.2017.03.027CrossRefPubMed

24.

Guijarro-Martínez R, Swennen GRJ (2013) Three-dimensional cone beam computed tomography definition of the anatomical subregions of the upper airway: a validation study. Int J Oral Maxillofac Surg 42:1140–1149. https://doi.org/10.1016/j.ijom.2013.03.007CrossRefPubMed

25.

Chiang CC, Jeffres MN, Miller A, Hatcher DC (2012) Three-dimensional airway evaluation in 387 subjects from one university orthodontic clinic using cone beam computed tomography. Angle Orthod 82:985–992. https://doi.org/10.2319/122811-801.1CrossRefPubMedPubMedCentral

26.

Jiang YY, Xu X, Su HL, Liu DX (2015) Gender-related difference in the upper airway dimensions and hyoid bone position in Chinese Han children and adolescents aged 6–18 years using cone beam computed tomography. Acta Odontol Scand 73:391–400. https://doi.org/10.3109/00016357.2014.978366CrossRefPubMed

27.

Sheng CM, Lin LH, Su Y, Tsai HH (2009) Developmental changes in pharyngeal airway depth and hyoid bone position from childhood to young adulthood. Angle Orthod 79:484–490. https://doi.org/10.2319/062308-328.1CrossRefPubMed

28.

Schendel SA, Jacobson R, Khalessi S (2012) Airway growth and development: a computerized 3-dimensional analysis. J Oral Maxillofacial Surg 70:2174–2183. https://doi.org/10.1016/j.joms.2011.10.013CrossRef

29.

Brunetto DP, Velasco L, Koerich L, Araújo MTdS (2014) Prediction of 3-dimensional pharyngeal airway changes after orthognathic surgery: a preliminary study. Am J Orthod Dentofac Orthop 146:299–309. https://doi.org/10.1016/j.ajodo.2014.05.024CrossRef

30.

Degerliyurt K, Ueki K, Hashiba Y, Marukawa K, Nakagawa K, Yamamoto E (2008) A comparative CT evaluation of pharyngeal airway changes in class III patients receiving bimaxillary surgery or mandibular setback surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 105:495–502. https://doi.org/10.1016/j.tripleo.2007.11.012CrossRefPubMed

31.

Kim JS, Kim JK, Hong SC, Cho JH (2010) Pharyngeal airway changes after sagittal split ramus osteotomy of the mandible: a comparison between genders. J Oral Maxillofacial Surg 68:1802–1806. https://doi.org/10.1016/j.joms.2009.11.010CrossRef

32.

Jakobsone G, Neimane L, Krumina G (2010) Two- and three-dimensional evaluation of the upper airway after bimaxillary correction of Class III malocclusion. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 110:234–242. https://doi.org/10.1016/j.tripleo.2010.03.026CrossRefPubMed

33.

Joss CU, Vassalli IM (2009) Stability After Bilateral Sagittal Split Osteotomy Advancement Surgery With Rigid Internal Fixation: A Systematic Review. J Oral Maxillofac Surg 67:301–313. https://doi.org/10.1016/j.joms.2008.06.060CrossRefPubMed

34.

Alsufyani NA, Al-Saleh MA, Major PW (2013) CBCT assessment of upper airway changes and treatment outcomes of obstructive sleep apnoea: a systematic review. Sleep & breathing = Schlaf & Atmung 17:911–23. https://doi.org/10.1007/s11325-012-0799-7CrossRef

35.

Gokce SM, Gorgulu S, Gokce HS, Bengi O, Sabuncuoglu F, Ozgen F, Bilgic H (2012) Changes in posterior airway space, pulmonary function and sleep quality, following bimaxillary orthognathic surgery. Int J Oral Maxillofac Surg 41:820–829. https://doi.org/10.1016/j.ijom.2012.01.003CrossRefPubMed

36.

Becker OE, Avelar RL, Goelzer JG, Dolzan Ado N, Haas OL Jr, De Oliveira RB (2012) Pharyngeal airway changes in Class III patients treated with double jaw orthognathic surgery–maxillary advancement and mandibular setback. J Oral Maxillofacial Surg 70:e639–e647. https://doi.org/10.1016/j.joms.2012.07.052CrossRef

37.

Alves PV, Zhao L, O’Gara M, Patel PK, Bolognese AM (2008) Three-dimensional cephalometric study of upper airway space in skeletal class II and III healthy patients. J Craniofac Surg 19:1497–1507. https://doi.org/10.1097/SCS.0b013e31818972efCrossRefPubMed

38.

Dalmau E, Zamora N, Tarazona B, Gandia JL, Paredes V (2015) A comparative study of the pharyngeal airway space, measured with cone beam computed tomography, between patients with different craniofacial morphologies. J Cranio-Maxillofac Surg 43:1438–1446. https://doi.org/10.1016/j.jcms.2015.06.016CrossRef

39.

Di Carlo G, Polimeni A, Melsen B, Cattaneo PM (2015) The relationship between upper airways and craniofacial morphology studied in 3D. A CBCT study. Orthod Craniofac Res 18:1–11. https://doi.org/10.1111/ocr.12053CrossRefPubMed

40.

Grauer D, Cevidanes LSH, Styner MA, Ackerman JL, Proffit WR (2009) Pharyngeal airway volume and shape from cone-beam computed tomography: Relationship to facial morphology. Am J Orthod Dentofac Orthop 136:805–814. https://doi.org/10.1016/j.ajodo.2008.01.020CrossRef

41.

El H, Palomo JM (2011) Airway volume for different dentofacial skeletal patterns. Am J Orthod Dentofac Orthop 139:e511–e521. https://doi.org/10.1016/j.ajodo.2011.02.015CrossRef

42.

Hong JS, Oh KM, Kim BR, Kim YJ, Park YH (2011) Three-dimensional analysis of pharyngeal airway volume in adults with anterior position of the mandible. Am J Orthod Dentofac Orthop 140:e161–e169. https://doi.org/10.1016/j.ajodo.2011.04.020CrossRef

43.

El H, Palomo JM (2013) An airway study of different maxillary and mandibular sagittal positions. Eur J Orthod 35:262–270. https://doi.org/10.1093/ejo/cjr114CrossRefPubMed

44.

Torres HM, Valladares-Neto J, Torres ÉM, Freitas RZ, Silva MAG (2017) Effect of Genioplasty on the Pharyngeal Airway Space Following Maxillomandibular Advancement Surgery. J Oral Maxillofac Surg 75:189.e1-189.e12. https://doi.org/10.1016/j.joms.2016.09.005CrossRef

45.

Giralt-Hernando M, Valls-Ontañón A, Guijarro-Martínez R, Masià-Gridilla J, Hernández-Alfaro F (2019) Impact of surgical maxillomandibular advancement upon pharyngeal airway volume and the apnoea-hypopnoea index in the treatment of obstructive sleep apnoea: systematic review and meta-analysis. BMJ Open Respir Res 6:e000402. https://doi.org/10.1136/bmjresp-2019-000402CrossRefPubMedPubMedCentral

46.

Shin J-H, Kim M-A, Park I-Y, Park Y-H (2015) A 2-Year Follow-Up of Changes After Bimaxillary Surgery in Patients With Mandibular Prognathism: 3-Dimensional Analysis of Pharyngeal Airway Volume and Hyoid Bone Position. J Oral Maxillofac Surg 73:340.e1-340.e9. https://doi.org/10.1016/j.joms.2014.10.009CrossRef

47.

Mulier D, Gaitán Romero L, Führer A, Martin C, Shujaat S, Shaheen E, Politis C, Jacobs R (2020) Long-term dental stability after orthognathic surgery: a systematic review. Eur J Orthod 43:104–112. https://doi.org/10.1093/ejo/cjaa022CrossRef

48.

Knudsen TB, Laulund AS, Ingerslev J, Homoe P, Pinholt EM (2015) Improved apnea-hypopnea index and lowest oxygen saturation after maxillomandibular advancement with or without counterclockwise rotation in patients with obstructive sleep apnea: a meta-analysis. J Oral Maxillofacial Surg 73:719–726. https://doi.org/10.1016/j.joms.2014.08.006CrossRef

49.

Zinser MJ, Zachow S, Sailer HF (2013) Bimaxillary ‘rotation advancement’ procedures in patients with obstructive sleep apnea: a 3-dimensional airway analysis of morphological changes. Int J Oral Maxillofac Surg 42:569–578. https://doi.org/10.1016/j.ijom.2012.08.002CrossRefPubMed

50.

Sutherland K, Phillips CL, Yee BJ, Grunstein RR, Cistulli PA (2016) Maxillomandibular Volume Influences the Relationship between Weight Loss and Improvement in Obstructive Sleep Apnea. Sleep 39:43–49. https://doi.org/10.5665/sleep.5314CrossRefPubMedPubMedCentral

Titel: Long-term three-dimensional effects of orthognathic surgery on the pharyngeal airways: a prospective study in 128 healthy patients
verfasst von: Gert-Jan Hassing
Vincent The
Eman Shaheen
Constantinus Politis
Maria Cadenas de Llano-Pérula
Publikationsdatum: 26.11.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Oral Investigations / Ausgabe 3/2022
Print ISSN: 1432-6981
Elektronische ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-021-04295-8

Extending the working properties of liquid platelet-rich fibrin using chemically modified PET tubes and the Bio-Cool device

Original Article

Captopril inhibits matrix metalloproteinase activity and improves dentin bonding durability

Original Article

Effects of the association of high fluoride- and calcium-containing caries-preventive agents with regular or high fluoride toothpaste on enamel: an in vitro study

Original Article

Efficacy of biocompatible trilayers nanofibrous scaffold with/without allogeneic adipose-derived stem cells on class II furcation defects of dogs’ model

Original Article

Is the clinical performance of composite resin restorations in posterior teeth similar if restored with incremental or bulk-filling techniques? A systematic review and meta-analysis

Review

Topical application of Otosporin® before in-office bleaching: a split mouth, triple-blind, multicenter randomized clinical trial

Original Article

Neu im Fachgebiet Zahnmedizin

Das alles ändert sich für Arztpraxen in 2025

31.12.2024
EBM
Nachrichten

Ab Januar greifen jede Menge Neuerungen – ob im EBM, Arbeits- und Steuerrecht oder bei der digitalen Vernetzung. Darunter einige Verbesserungen, aber teils auch Mehraufwand. „Same procedure as every year?“ – Ein Überblick.

Wenn Praxen Termine absagen müssen: So geht’s ohne Ärger und Stress

22.12.2024
Praxis und Beruf
Nachrichten

Bundesweit sind viele Praxen von Krankheitsfällen in den eigenen Reihen betroffen. Die Praxis-EDV und strukturierte Abläufe können notwendige Terminabsagen erleichtern.

Wie gefährlich sind suspekte Veränderungen in der Mundhöhle?

17.12.2024
Mundhöhlenkarzinom
Nachrichten

Wie hoch ist das Risiko, dass sich aus einer bereits verdächtigen Veränderung der Mundschleimhaut ein Karzinom entwickelt? Ein US-Team hat dazu das Patientenregister der Universität San Francisco ausgewertet.

Das deutsche Gesundheitssystem kränkelt und hat Fieber

22.11.2024
Gesundheitspolitik
Nachrichten

OECD und Europäische Kommission haben zusammen einen Bericht zum Zustand der europäischen Gesundheitssysteme herausgegeben. Diagnose für Deutschland: Wäre das Land ein menschliches Wesen, würde man es wohl krankschreiben.

Update Zahnmedizin

Bestellen Sie unseren kostenlosen Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Springer Medizin

Long-term three-dimensional effects of orthognathic surgery on the pharyngeal airways: a prospective study in 128 healthy patients