Cephalometric evaluation of the pharyngeal airway space after orthognathic surgery and distraction osteogenesis of the jaw bones

ABSTRACT

Objective: Orthognathic surgeries and distraction osteogenesis (DO) of the jaw bones cause a change in the pharyngeal airway space (PAS). The aim of our study was to evaluate the magnitude of changes occurring in the pharyngeal airway after mandibular set-back surgeries and DO of maxilla/mandible. Materials and Methods: The study undertaken was a retrospective cephalometric study. Subjects included in our study had undergone mandibular set-back surgery or DO of maxilla/mandible. Lateral cephalograms of the subjects taken pre-operatively (T0), immediate post-operatively (T1) and after a minimum follow-up period of 6 months (T2) were studied. The cephalograms were traced manually and the following parameters were evaluated: Surface area of the PAS, pharyngeal airway width at the level of the base of the tongue, position of the hyoid bone and the tongue. Repeated measure ANOVA test was done to assess the presence of any significant changes in the proposed parameters at T0, T1 and T2. A correlation analysis was made between the mandibular/maxillary movements and the corresponding changes in the PAS. Results: Surgical movements of maxilla and mandible do have an effect on the pharyngeal airway. Conclusion: It was clearly evident that the effects of mandibular movements on the PAS and the hyoid bone is more significant than the maxillary movements.

KEY WORDS

Distraction osteogenesis - orthognathic surgery - pharyngeal airway space

 

Conflict of Interest

None declared.

• REFERENCES

• 1 Wickwire NA, White Jr RP, Proffit WR. The effect of mandibular osteotomy on tongue position. J Oral Surg 1972; 30: 184-90
• 2 Guilleminault C, Riley R, Powell N. Obstructive sleep apnea and abnormal cephalometric measurements. Implications for treatment. Chestx 1984; 86: 793-4
• 3 Guilleminault C, Riley R, Powell N. Sleep apnea in normal subjects following mandibular osteotomy with retrusion. Chest 1985; 88: 776-8
• 4 Riley RW, Powell NB, Guilleminault C, Ware W. Obstructive sleep apnea syndrome following surgery for mandibular prognathism. J Oral Maxillofac Surg 1987; 45: 450-2
• 5 Riley RW, Powell NB, Guilleminault C. Maxillary, mandibular, and hyoid advancement for treatment of obstructive sleep apnea: A review of 40 patients. J Oral Maxillofac Surg 1990; 48: 20-6
• 6 Riley RW, Powell NB, Guilleminault C. Obstructive sleep apnea syndrome: A surgical protocol for dynamic upper airway reconstruction. J Oral Maxillofac Surg 1993; 51: 742-7
• 7 Graber LW. Hyoid changes following orthopedic treatment of mandibular prognathism. Angle Orthod 1978; 48: 33-8
• 8 Takagi Y, Gamble JW, Proffit WR, Christiansen RL. Postural change of the hyoid bone following osteotomy of the mandible. Oral Surg Oral Med Oral Pathol 1967; 23: 688-92
• 9 Athanasiou AE, Toutountzakis N, Mavreas D, Ritzau M, Wenzel A. Alterations of hyoid bone position and pharyngeal depth and their relationship after surgical correction of mandibular prognathism. Am J Orthod Dentofacial Orthop 1991; 100: 259-65
• 10 Tselnik M, Pogrel MA. Assessment of the pharyngeal airway space after mandibular setback surgery. J Oral Maxillofac Surg 2000; 58: 282-5
• 11 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: 111-7
• 12 Kawakami M, Yamamoto K, Fujimoto M, Ohgi K, Inoue M, Kirita T. Changes in tongue and hyoid positions, and posterior airway space following mandibular setback surgery. J Craniomaxillofac Surg 2005; 33: 107-10
• 13 Hernández-Alfaro F, Guijarro-Martínez R, Mareque-Bueno J. Effect of mono-and bimaxillary advancement on pharyngeal airway volume: Cone-beam computed tomography evaluation. J Oral Maxillofac Surg 2011; 69: e395-400
• 14 Turnbull NR, Battagel JM. The effects of orthognathic surgery on pharyngeal airway dimensions and quality of sleep. J Orthod 2000; 27: 235-47
• 15 Yu LF, Pogrel MA, Ajayi M. Pharyngeal airway changes associated with mandibular advancement. J Oral Maxillofac Surg 1994; 52: 40-3
• 16 Farole A, Mundenar MJ, Braitman LE. Posterior airway changes associated with mandibular advancement surgery: Implications for patients with obstructive sleep apnea. Int J Adult Orthodon Orthognath Surg 1990; 5: 255-8
• 17 Andrade NN, Kalra R, Shetye SP. New protocol to prevent TMJ reankylosis and potentially life threatening complications in triad patients. Int J Oral Maxillofac Surg 2012; 41: 1495-500
• 18 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
• 19 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
• 20 Schendel SA, Epker BN. Results after mandibular advancement surgery: An analysis of 87 cases. J Oral Surg 1980; 38: 265-82
• 21 LaBanc JP, Epker BN. Changes of the hyoid bone and tongue following advancement of the mandible. Oral Surg Oral Med Oral Pathol 1984; 57: 351-6
• 22 Enacar A, Aksoy AU, Sençift 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
• 23 Kawamata A, Fujishita M, Ariji Y, Ariji E. Three-dimensional computed tomographic evaluation of morphologic airway changes after mandibular setback osteotomy for prognathism. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 89: 278-87
• 24 Gu G, Gu G, Nagata J, Suto M, Anraku Y, Nakamura K. et al. Hyoid position, pharyngeal airway and head posture in relation to relapse after the mandibular setback in skeletal Class III. Clin Orthod Res 2000; 3: 67-77
• 25 Achilleos S, Krogstad O, 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: 383-94
• 26 Samman N, Tang SS, Xia J. Cephalometric study of the upper airway in surgically corrected class III skeletal deformity. Int J Adult Orthodon Orthognath Surg 2002; 17: 180-90
• 27 Lee JW, Park KH, Kim SH, Park YG, Kim SJ. Correlation between skeletal changes by maxillary protraction and upper airway dimensions. Angle Orthod 2011; 81: 426-32
• 28 Yu L, Pogrel M, Ajayi M. Pharyngeal airway changes associated with mandibular advancement. J Oral Maxillofac Surgery 1994; 52: 40-43
• 29 Partinen M, Guilleminault C, Quera-Salva MA, Jamieson A. Obstructive sleep apnea and cephalometric roentgenograms. The role of anatomic upper airway abnormalities in the definition of abnormal breathing during sleep. Chest 1988; 93: 1199-205
• 30 Berger G, Gilbey P, Hammel I, Ophir D. Histopathology of the uvula and the soft palate in patients with mild, moderate, and severe obstructive sleep apnea. Laryngoscope 2002; 112: 357-63
• 31 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
• 32 Hiyama S, Suda N, Ishii-Suzuki M, Tsuiki S, Ogawa M, Suzuki S. et al. ffects of maxillary protraction on craniofacial structures and upper-airway dimension. Angle Orthod 2002; 72: 43-7
• 33 Schendel SA, Oeschlaeger M, Wolford LM, Epker BN. Velopharyngeal anatomy and maxillary advancement. J Maxillofac Surg 1979; 7: 116-24
• 34 Proffit WR, White RP. Combined orthodontic and surgical management of maxillary protrusion in adults. Am J Orthod 1973; 64: 368-83