Airway changes after bimaxillary orthognatic surgery in patients with skeletal class III malocclusion
Keywords:Airway, Othognathic surgery, Oral physiology
Introduction: orthognathic surgery is a treatment alternative for patients with maxillary mandibular skeletal discrepancies. In this procedure hard and soft tissues of the craniofacial complex are modified, this includes the airway. The purpose of this study is to present a descriptive analysis of cephalometric changes in the airway of twenty patients, eleven females nine males, subjected to bimaxillary orthognathic surgery, (maxillary advance – mandibular retrusion at the Hospital Universitario San Vicente de Paúl), Medellín, Colombia. Methods: three lateral cephalometrics head plates were taken, scanned and digitalized in each patient, and the airway measurements were compared before, at eight and eighteen months after surgery. Results and Conclusions: significant increases in the upper pharyngeal space were found in the area of oro pharynx after surgery. The area of the lower pharyngeal space and the hypo pharynx did not show significant increases. Significant changes were found in the position of the hyoid bone between males and females. Bimaxillary orthognathic surgery increased the dimensions of the upper airway. These changes were determined by the type of surgical procedure (Le Fort I maxillary advancement osteotomy and mandibular retrusion) and by the magnitude of the movement performed in the maxilla and the mandible. Also, modification in the position of structures such as the soft palate, the hyoid bone and the tongue, were observed.
Greco JM, Frohberg U, Van Sickels JE. Long-term airway space changes after mandibular setback using bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg 1990; 19: 103-105.
Takagi Y, Gamble JW, Proffit WR, Christiansen RL. Postural of the hyoid bone following osteotomy of the mandible. Oral Surg Oral Med Oral Pathol 1967; 23: 688-692.
Wickwire NA, White RJ, Proffit WR. The effect of mandibular osteotomy on tongue position. J Oral Surg 1972; 30: 184-190.
Athanasiou AE, Melsen B, Mavreas D, Ritzau M, Wenzel. Alterations of hyoid bone and pharyngeal depth and their relationship after surgical correction of mandibular prognathism. Am J Orthod Dentofac Orthop 1991; 100: 259-265.
Lew KK. Changes in tongue and hyoid bone positions following anterior mandibular subapical osteotomy in patients with Class III malocclusion. Int J Adult Orthod Orthognath Surg 1993; 8: 123-128.
Enacar A, Aksoy AÜ, Sencift Y, Haydar B, Aras K. Changes in hypopharyngeal airway space and in tongue and hyiod bone positions following the surgical correction of mandibular prognathism. Int J Adult Orthod Orthognath Surg 1994; 9: 285-290.
Wenzel A, William S, Ritzau M. Changes in head posture, and nasopharyngeal airway size following surgical correction of mandibular prognathism. Eur J Orthod 1989; 11: 37-42.
Wenzel A, William S, Ritzau M. Relationship of changes in craniofacial morphology, head posture, and nasopharyngeal airway size following mandibular osteotomy. Am J Orthod Dentofac Orthop 1989; 96: 138-143.
Hochban W, Shürmann R. Mandibular setback for surgical correction of mandibular hyperplasia-Does it provoke sleep-related breathing disorders? Int J Oral Maxillofac Surg 1996; 25: 333-338.
Schendel SA, Epker BN. Results after mandibular advancement surgery. J Oral Surg 1980; 38: 265-282.
Valk JW, Zonnenberg AJ, Van Maanen CJ, Van Wonderen OG. The biomechanical effects of a sagittal split ramus osteotomy on the relationship of the mandible, the hyoid bone, and the cervical spine. Am J Orthod Dentofacial Orthop 1992; 102: 99-108.
Achilleos S, Olaf K, Lyberg T. Surgical mandibular advancement and changes in uvuloglossopharyngeal morphology and head posture: a short- and long term cephalometric study in males. Eur J Orthod 2000; 22: 367-381.
Achilleos S, Olaf K, Lyberg T. Surgical mandibular setback and changes in uvuloglossopharyngeal morphology and head posture: a short- and long term cephalometric study in males. Eur J Orthod 2000; 22: 383-394.
Sollow B, Sierbaek-Nielsen PW, Greve E. Airway adequacy, head posture and craniofacial morphology. Am J Orthod 1984; 86: 214-223.
Sollow B, Skov S, Ovesen J, Norup PW, Wildschiodtz G. Airway dimensions and head posture in obstructive sleep apnoea. Eur J Orthod 1996; 18: 571-579.
O’Rahilly R. Anatomía de Gadner. 5.a ed. México: Interamericana McGraw-Hill; 1986.
Delaire J, Schendel SA, Tulasne JF. An architectural and structural craniofacial analysis: A new lateral cephalometric analysis. Oral Surg 1981; 52: 226-238.
Lowe AA, Fleetham JA., Adachi S, Ryan CF. Cephalometric and computed tomographic predictors of obstructive sleep apnea severity. Am J Orthod Dentofacial Orthop 1995; 107: 589-595.
Argandoña J, Mercier J, Naranjo RF. Modificación de la vía aérea superior en las osteotomías mandibulares. Rev Fac Odontol Univ Antioq 1998; 10(1): 36-40.
Nakagawa F, Ono T, Ishiwata Y, Kuroda T. Morphologic changes in the upper airway structure following surgical correction of mandibular prognathism. Int J Adult Orthod Orthognath Surg 1998; 13: 299-306.
Liukkonen M, Vähätalo K, Peltomäki T, Tiekso J, Happonen RP. Effect of mandibular setback surgery on the posterior airway size. Int J Adult Orthod Orthognath Surg 2002; 17 (1): 41-46.
Eggensperger N, Smolka W, Iizuka T. Long-term changes of hyoid bone position and pharyngeal airway size following mandibular setback by sagittal split ramus osteotomy. J Craniomaxillofac Surg 2005; 33: 111-117.
Riley RW, Powell NB, Guilleminault C, William W. Obstructive sleep apnea syndrome following surgery for mandibular prognathism. J Oral Maxillofac Surg 1987; 45: 450-452.
Saitoh K. Long term changes in pharyngeal airway morphology after mandibular setback surgery. Am J Orthod Dentofacial Orthop 2004; 25: 556-561.
Riolo ML, Moyers RE, McNamara JA, Hunter WS. An atlas of craniofacial growth. Monograph 2, Craniofacial Growth Series. Ann Arbor: Center for Human Growth and development, University of Michigan; 1974.
Shen GF, Samman N, Qiu WL, Tang YS, Xia J, Huang YL. Cephalometric studies on the upper airway space in normal Chinese. Int J Oral MaxilloFacial Surg 1994; 23:243-247.
Poole MN, Engel GA, Chaconas SJ. Nasopharyngeal cephalometrics. Oral Surg Oral Med Oral Pathol 1980; 49: 266-271.
Houston WJB. The analysis of errors in orthodontic measurements. Am J Orthod 1983; 83:382-389.
Guenthner TA, Sather AH, Kern EB. The effect of Le Fort I maxillary impaction on nasal airway resistance. Am J Orthod 1984; 85: 308-315.
Götzfried HF, Masing H. Improvement of nasal breathing in cleft patients following midface osteotomy. Int J Oral Maxillofac Surg 1988; 17: 41-45.
Timms DJ. The effect of Le Fort I maxillary impaction on nasal airway resistance. Am J Orthod 1984; 86: 831-835.
Turvey TA, Hall DJ, Warren DW. Alterations in nasal airway resistance following superior repositioning of the maxilla. Am J Oral Surg 1984; 85: 109-112.
Turvey TA, Warren DW. Impact of maxillary osteotomy on nasal breathing. Oral Maxillofac Surg 1990; 2: 831-835.
Walker DA, Turvey TA, Warren DW. Alterations in nasal respiration and nasal airways size following superior repositioning of the maxilla. Oral Maxillofac Surg 1988; 46: 276-281.
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: 552-557.
Zarrinkelk HM, Throckgmorton GL, Ellis E, Sinn DP. A longitudinal study of changes in masticatory performance of patients undergoing orthognatic surgery. J Maxillofac Surg 1995; 53: 777-782.
Velásquez JM, Radi JN, Hernández M. Cambios en la articulación de la palabra en pacientes con oclusión clase III o mordida abierta anterior sometidos a cirugía ortognática. Rev Fac Odontol Univ Antioq 2003; 15: 6-16.
Schendel SA, Wolford LM, Epker BN. Mandibular deficiency syndrome. Oral Surg Oral Med Oral Pathol 1978; 45: 364-377.
Farole A, Mundenar MJ, Braitman LE. Posterior airway changes associated with mandibular advancement surgery: Implications for patients with obstructive sleep apnea. Int J Adult Orthod Orthognath Surg 1990; 5(4): 255-258.
Yu LF, Pogrel MA, Ajayi M. Pharyngeal airway changes associated with mandibular advancement. J Oral Maxillofac Surg 1994; 52: 40-43.
Riley RW, Powell NR. Maxillofacial Surgery and obstructive sleep apnea syndrome. Otolaryngol Clin North Am 1990; 23:809-826.
Miles PG, Maria O’ Reilly, Close J. The reliability of upper airway landmark identification. Aust Orthod J 1995; 14: 3-6.
Mehra P, Downie M, Pita M, Wolford L. Pharyngeal airway space changes after counterclockwise rotation of the maxillomandibular complex. Am J Orthod Dentofacial Orthop 2001; 120: 154-159
Turnbull NR, Battagel JM. The effects of orthognathic surgery on pharyngeal airway dimensions and quality of sleep. J Orthod 2000; 27: 235-247.
Tallgren A, Sollow B. Hyoid bone, facial morphology, and head posture in adults. Eur J Orthod 1987; 9: 1-8.
Fromm B, Lundberg M. Postural behavior of hyoid bone in normal occlusion and before and after surgical correction of mandibular protrusion. Swed Dent J 1970; 63: 425-433.
Bibby RE, Preston CB. The hyoid triangle. Am J Orthod 1981; 80: 92-97.
Tallgren A, Lang B, Walker GF, Ash MM. Changes in jaw relations, hyoid bone position, and head posture in complete denture wearers. J Prosthet Dent 1983; 50: 148-156.
Winnberg A, Pancherz H, Westesson PL. Head posture and hyomandibular function in man: a synchronized electromyographic and videoflurographic study of the open close-clench cycle. Am J Orthod Dentofacial Orthop 1998; 94: 393-404.
Tallgren A, Sollow B. Long-term changes in hyoid bone position and craniocervical posture in complete denture wearers. Acta Odontol Scand 1984; 42: 257-267.
Dattilo DJ, Drooger SA. Outcome assessment of patients undergoing maxillofacial procedures for the treatment of sleep apnea: Comparison of subjective and objective results. J Oral Maxillofac Surg 2004; 62:164-168.
How to Cite
Copyright comprises moral and patrimonial rights.
1. Moral rights: are born at the moment of the creation of the work, without the need to register it. They belong to the author in a personal and unrelinquishable manner; also, they are imprescriptible, unalienable and non negotiable. Moral rights are the right to paternity of the work, the right to integrity of the work, the right to maintain the work unedited or to publish it under a pseudonym or anonymously, the right to modify the work, the right to repent and, the right to be mentioned, in accordance with the definitions established in article 40 of Intellectual property bylaws of the Universidad (RECTORAL RESOLUTION 21231 of 2005).
2. Patrimonial rights: they consist of the capacity of financially dispose and benefit from the work trough any mean. Also, the patrimonial rights are relinquishable, attachable, prescriptive, temporary and transmissible, and they are caused with the publication or divulgation of the work. To the effect of publication of articles in the journal Revista de la Facultad de Odontología, it is understood that Universidad de Antioquia is the owner of the patrimonial rights of the contents of the publication.
The content of the publications is the exclusive responsibility of the authors. Neither the printing press, nor the editors, nor the Editorial Board will be responsible for the use of the information contained in the articles.
I, we, the author(s), and through me (us), the Entity for which I, am (are) working, hereby transfer in a total and definitive manner and without any limitation, to the Revista Facultad de Odontología Universidad de Antioquia, the patrimonial rights corresponding to the article presented for physical and digital publication. I also declare that neither this article, nor part of it has been published in another journal.
Open Access Policy
The articles published in our Journal are fully open access, as we consider that providing the public with free access to research contributes to a greater global exchange of knowledge.
Creative Commons License
The Journal offers its content to third parties without any kind of economic compensation or embargo on the articles. Articles are published under the terms of a Creative Commons license, known as Attribution – NonCommercial – Share Alike (BY-NC-SA), which permits use, distribution and reproduction in any medium, provided that the original work is properly cited and that the new productions are licensed under the same conditions.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.