3D Airway changes using CBCT in patients following mandibular setback surgery ± maxillary advancement

Abstract

Structured Abstract Introduction The aim of this study was to determine the 3D airway changes that occur following mandibular setback surgery alone vs bimaxillary surgery in patients with similar skeletal start forms. Setting and Sample Population The University of Michigan School of Dentistry and Medical Center. A total of 85 patients undergoing mandibular setback with or without simultaneous maxillary advancement. Materials and Methods A retrospective evaluation of pre‐ and post‐surgical CBCT scans for patients undergoing mandibular setback surgery alone (14) vs bimaxillary surgery (71) was performed. Cross‐sectional evaluation at standardized locations, minimum cross section and volumetric analysis were performed (Dolphin Imaging & Management Solutions). Results Patients who underwent mandibular setback surgery alone showed a statistically significant average increase of 47.5 mm2 in minimum axial area. Patients who underwent bimaxillary surgery showed a statistically significant increase in airway volume, minimum axial area, location of minimum axial area, and axial area at the retropalatal and retroglossal regions. Conclusions The results demonstrate that the mandible can be setback safely without decreasing airway dimensions. In borderline OSA patients, bimaxillary surgery remains the preferred approach due to the larger airway increases observed. Long‐term follow‐up with polysomnography must be conducted to determine the full functional implications of both procedures.

Three-Dimensional Evaluation Of The Oropharyngeal Airway Changes After Bimaxillary Orthognathic Surgery Using Cone-Beam Computer Tomography: A Retrospective Analysis

“…In the current study, our results showed decrease in surface area post-operatively in both groups with no statistically significant difference was observed. This was in agreement with He et al (31) and Hsieh et al (37) , Who found the minimum cross-sectional area of the upper airway was narrower 6 months after bimaxillary surgery, while in consistent with Havron et al (36) who found that statistically significant increases in the axial areas at both C1 (retropalatal region) and C2 (retroglossal region) in the group underwent mandibular setback with maxillary advancement.…”

“…. following orthognathic surgeries (12,(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) may be attributed to many factors as the complexity of the airway and it's response after different surgeries, differences imaging modalities (2, 3, 5-7, 10) in addition to pharyngeal airway segmentation limits (20)(21) and follow-up time (42) .Each study, including the present one, used unique amount movements and positioning of the maxilla and mandible besides simple anterior or posterior repositioning, Superior movements or rotations. All these asymmetric changes make uniform evaluation impossible, and all these factors lead to different results obtained.…”

“…(2,26,(32)(33)(34) While our results were in consistent with Vaezi et al (35) who reported that total and oropharyngeal volumes increased and nasopharyngeal and hypopharyngeal volumes decreased after maxillary advancement by Le Fort I osteotomy and mandibular setback, with no significant difference. Havron et al (36) who found that statistically significant increases in airway volume in the group underwent maxillary advancement with mandibular setback. Jokobsone et al (6) also reported increase CT volumetric measurements in the Oropharyngeal and hypopharyngeal with increase in the total volume of the posterior airway space in all patients underwent to maxillary advancement and mandibular Setback for correction of Class III malocclusion, but the increase was not statistically significant.…”

Effect of Orthopedic Treatment for Class III Malocclusion on Upper Airways: A Systematic Review and Meta-Analysis

“…Specifically, significantly more orthognathic patients report a perceived improvement in breathing through maxillary advancement (with or without mandibular setback) (95%) than with mandibular setback alone (56%) [ 5 ]. Bimaxillary surgery results in greater increases than mandibular setback in the volume of the airway, which are primarily apparent due to an increase in the retropalatal region [ 6 ]. For growing Class III patients, orthopedic appliances are sometimes used to protract the maxilla, restrict or redirect mandibular growth, or both, while at the same time, both approaches lead to a mandibular rotation.…”

A community detection analysis of malocclusion classes from orthodontics and upper airway data

“…Back in 2012, Van Vlijmen, based on the then‐available evidence, could claim that only the studies assessing airway diagnostics showed a scientific impact of CBCT in the orthodontic field 3 . Different aspects were analysed by other authors: effects produced by conventional fixed appliance therapy and/or orthognathic surgery, effects produced by extractive treatments and outcomes generated by functional appliance therapy 4‐10 . Among them, a special interest was devoted to the possible relationships between airway dimensions and different anteroposterior facial patterns 11‐18 .…”