Volumetric, planar, and linear analyses of pharyngeal airway change on computed tomography and cephalometry after mandibular setback surgery

Objectives: The purpose of this study was to perform a three-dimensional analysis on the pharyngeal airway of supine patients who have undergone mandibular setback surgery, using multislice computed tomography (MSCT). We also measured the respiratory disturbance index pre- and post-surgery, using a portable sleep monitor. Materials and Methods: The subjects included two males and nine females who were diagnosed with mandibular prognathism at Hiroshima University Hospital and were scheduled to undergo the bilateral sagittal split osteotomy. Using a CT scanner, baseline MSCT images were obtained from the subjects before surgery for morphological analysis, and then the two further scans were obtained after mandibular setback surgery. All patients were provided with at-hoeme sleep monitor to use it both at baseline and approximately 1 year after surgery. Results: Middle and epiglottis pharyngeal space and cross-sectional area were significantly decreased immediately after setback surgery, but did not change further over the 1-year period. Mandibular setback was not associated with the development of sleep breathing disorder (SBD) during the 1-year follow-up period. Conclusion: We found no evidence that the reduction in the pharyngeal airway space immediately after mandibular setback surgery recovered significantly during the follow-up period, although mandibular setback was not associated with development of SBD.

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Postoperative changes in the pharyngeal airway space through computed tomography evaluation after mandibular setback surgery in skeletal class III patients: 1-year follow-up

Maxillofacial Plastic and Reconstructive Surgery ◽

10.1186/s40902-021-00319-1 ◽

2021 ◽

Vol 43 (1) ◽

Author(s):

No Eul Kang ◽

Dae Hun Lee ◽

Ja In Seo ◽

Jeong Keun Lee ◽

Seung Il Song

Keyword(s):

Computed Tomography ◽

Class Iii ◽

Skeletal Class ◽

Pharyngeal Airway ◽

Mandibular Setback ◽

Bilateral Sagittal Split Osteotomy ◽

Mandibular Setback Surgery ◽

Group 2 ◽

Bimaxillary Surgery ◽

Group 1

Abstract Background This study evaluated the pharyngeal airway space changes up to 1 year after bilateral sagittal split osteotomy mandibular setback surgery and bimaxillary surgery with maxillary posterior impaction through three-dimensional computed tomography analysis. Methods A total of 37 patients diagnosed with skeletal class III malocclusion underwent bilateral sagittal split osteotomy setback surgery only (group 1, n = 23) or bimaxillary surgery with posterior impaction (group 2, n = 14). Cone-beam computed tomography scans were taken before surgery (T0), 2 months after surgery (T1), 6 months after surgery (T2), and 1 year after surgery (T3). The nasopharynx (Nph), oropharynx (Oph), hypopharynx (Hph) volume, and anteroposterior distance were measured through the InVivo Dental Application version 5. Results In group 1, Oph AP, Oph volume, Hph volume, and whole pharynx volume were significantly decreased after the surgery (T1) and maintained. In group 2, Oph volume and whole pharynx volume were decreased (T2) and relapsed at 1 year postoperatively (T3). Conclusion In class III malocclusion patients, mandibular setback surgery only showed a greater reduction in pharyngeal airway than bimaxillary surgery at 1 year postoperatively, and bimaxillary surgery was more stable in terms of airway. Therefore, it is important to evaluate the airway before surgery and include it in the surgical plan.

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