Volumetric analysis of pharyngeal airway dimensions and hyoid bone position following orthognathic surgery in skeletal class III patients: a cross sectional cephalometric study

Authors

  • Amrit Thapa Department of Orthodontics, Armed Forces Medical College, Pune, Maharashtra, India
  • I. D. Roy Department of Dental Surgery and Oral Health Sciences, Armed Forces Medical College, Pune, Maharashtra, India
  • B. Jayan CMDC (CC), Lucknow, Uttar Pradesh, India
  • Saugat Ray Department of Orthodontics, Armed Forces Medical College, Pune, Maharashtra, India
  • Andrews Navin Kumar Department of Oral and Maxillofacial Surgery, OC-1209 DU, Leh, Ladakh, India
  • Amit Antil Department of Orthodontics, Armed Forces Medical College, Pune, Maharashtra, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20233536

Keywords:

BSSO, Pharyngeal airway, Bijaw, Class III

Abstract

Background: Objective of the study was to determine linear and volumetric changes in pharyngeal airway dimensions in class III patients treated by different modalities of orthognathic surgery and to compare the results of different orthognathic surgical modalities, and determine the change at the position of the hyoid bone.

Methods: Pre and post-treatment lateral cephalogram of 53 class III adult patients who were treated by different modalities of orthognathic surgery studied to assess the changes in pharyngeal airway dimensions and hyoid bone position after orthognathic surgery. 28 patients were treated with mandibular set back, and 25 patients were treated with Bijaw surgery. Lateral cephalogram records were taken before treatment (T1), after surgery (T2), the end of the fixed treatment (T3) and 1 year after debonding (T4).  

Results: Interception of both surgical modalities has significant impact on various skeletal and pharyngeal parameters i.e., BMeH (0.00), PNS (0.009), MPS (0.13), GOP (0.001), IPS (0.007), SAS (0.006), and MAS (0.00). OJ (overjet) and OB (overbite) was significant especially after time interval of one year. In Bijaw groups, PPST4 parameter was significantly increased (0.0000), SPST4 (0.000), GOP (0.000), EPS (0.000) and IPS parameter was significantly decreased (0.045). Significant difference was observed in T4 time interval in superior pharyngeal airway space, posterior airway space and middle airway space with (p<0.05).

Conclusions: Pharyngeal airway is significantly altered following orthognathic surgery in class III patients and it depends on the type of surgical modality employed were Bijaw surgery has significant impact on oropharyngeal and hypopharyngeal airway space.

References

Freitas MR, Alcazar NMPV, Janson G. Upper and lower pharyngeal airways in subjects with Class I and Class II malocclusions and different growth patterns. Am J Orthod Dentofacial Orthop. 2006;130:742-5.

Mergen DC, Jacobs MR. The size of nasopharynx associated with normal occlusion and class II malocclusion. Angle Orthod. 1970;40:342-6.

Kerr WJ. The nasopharynx, face height and overbite. Angle Orthod. 1985;55:31-6.

Paul JL, Nanda RS. Effect of mouth breathing on dental occlusion. Angle Orthod. 1973;43:201-6.

Obwegeser HL. Surgical correction of small or retrodisplaced maxillae. The ‘dish face’ deformity. Plast Reconstr Surg. 1969;43:351-65.

Busby BR, Bailey LJ, Proffit WR, Phillips C, White RP Jr. Long-term stability of surgical Class III treatment: a study of 5-year post-surgical results. Int J Adult Orthodon Orthognath Surg. 2002;17:159-70.

Chen F, Terada K, Hua Y, Saito I. Effects of bijaw surgery and mandibular set back surgery on pharyngeal airway measurements in patients with Class III skeletal deformities. Am J Orthod Dentofacial Orthop. 2007;131:372-7.

Wenzel A, Williams S, Ritzau M. Changes in head posture and nasopharyngeal airway following surgical correction of mandibular prognathism. Eur J Orthod. 1989;11:37-42.

Greco JM, Frohberg U, Van Sickels JE. Cephalometric analysis of long-term airway space changes with maxillary osteotomies. Oral Surg Oral Med Oral Pathol. 1990;70:552-4.

Enacar A, Aksoy AU, Sencift Y, Haydar B, Aras K. Changes in hypopharyngeal airway space and in tongue and hyoid bone positions following the surgical correction of mandibular prognathism. Int J Adult Orthodon Orthognath Surg.1994;9:285-90.

Hochban W, Schurmann R, Brandenburg U, Conradt R. Mandibular setback for the surgical correction of mandibular hyperplasia—does it provoke sleep-related breathing disorders. Int J Oral Maxillofac Surg. 1996;25:333-8.

Achilleos S, Krogstad O, Lyberg T. Surgical mandible set back and changes in uvuloglossopharyngeal morphology and head posture: a short- and long-term cephalometric study in males. Eur J Orthod. 2000;22:383-94.

Kawamata A, Fujishita M. Three-dimensional computed tomographic evaluation of morphologic airway changes after mandibular set back osteotomy for prognathism. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89:278-87.

Riley RW, Powell NB, Guilleminault C, William W. Obstructive sleep apnea syndrome following surgery for mandibular prognathism. J Oral Maxillofac Surg. 1987;45:450-2.

Goodday R. Diagnosis, treatment planning, and surgical correction of obstructive sleep apnea. J Oral Maxillofac Surg. 2009;67:2183.

Pereira-Filho VA, Castro-Silva LM, Moraes M. Cephalometric evaluation of pharyngeal airway space changes in class III patients undergoing orthognathic surgery. J Oral Maxillofac Surg. 2011;69(11):e409-15.

Prinsell JR. Maxillomandibular advancement surgery in a site-specific treatment approach for obstructive sleep apnoea in 50 consecutive patients. Chest. 1999;116:1519-29.

Samman N, Tang SS, Xia J. Cephalometric study of the upper airway in surgically corrected Class III deformity. Int J Adult Orthodon Orthognath Surg. 2002;17:180-90.

Ono T, Lowe AA, Ferguson KA, Fleetham JA. Associations among upper airway structure, body position and obesity in skeletal Class I male patients with obstructive sleep apnea. Am J Orthod Dentofacial Orthop. 1996;109:625-34.

Tsuiki S, Hiyama S, Ono T, Immura N, Ishiwata N, Kuroda T. Effect of a titratable oral appliance on supine airway size in awake non-apneic individuals. Sleep. 2001;24:554-60.

Riley RW, Powell NB. Maxillofacial surgery and obstructive sleep apnea syndrome. Otolaryngol Clin North Am. 1990;23:809-26.

Saitoh K. Long-term changes in pharyngeal airway morphology after mandibular setback surgery. Am J Orthod Dentofacial Orthop. 2004;125:556-61.

Chen F, Terada K, Hanada K, Saito I. Predicting the pharyngeal airway space after mandibular setback surgery. J Oral Maxillofac Surg. 2005;63:1509-14.

Kawakami M, Yamamoto K, Fujimoto M, Ohgi K, Inoue M, Kirita T. Changes in tongue and hyoid positions, and posterior airway space following mandibular set back surgery. J Craniomaxillofac Surg. 2005;33:107-10.

Degerliyurt K, Koichiro U, Hashiba Y, Marukawa K, Nakagawa K, Yamamato E. A comparative CT evaluation of pharyngeal airway changes in class III patients receiving bijaw surgery or mandibular set back surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105:495-502.

Samman N, Tang SS, Xia J. Cephalometric study of the upper airway in surgically corrected Class III deformity. Int J Adult Orthodon Orthognath Surg. 2002;17:180-90.

Lew K. Changes in tongue and hyoid bone positions following anterior mandibular subapical osteotomy in patients with Class III malocclusion. Int J Adult Orthodon Orthognath Surg. 1993;8:123-8.

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Published

2023-11-10

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Original Research Articles