Esthetic outcome and airway evaluation following Bi-Jaw surgery V/S mandibular setback surgery in skeletal class III malocclusion using surgery first approach

Abstract

Background:Class III skeletal deformity is the result of mandibular prognathism, maxillary deficiency, or a combination. Treatment frequently requires a combination of orthodontics and orthognathic surgical procedures to improve facial esthetics and harmonize facial profile.Objectives:The objective of the study is to assess and quantify, by means of cephalometric analysis, the pre- and postoperative soft-tissue and airway changes following bi-jaw surgery and mandibular setback surgery after the correction of skeletal Class III deformities using surgery-first approach.Materials and Methods:Patients with skeletal Class III malocclusion were classified based on the A point–nasion–B point, beta angle, and Witt's appraisal. The cases were divided based on the type of surgery-first orthognathic approach they received. Group A (20 patients) comprised patients who underwent bi-jaw surgery (Le Fort I + bilateral sagittal split osteotomy [BSSO]) and Group B (20 patients) who underwent BSSO alone. After the lateral cephalograms were digitized, the cephalograms were evaluated for soft-tissue changes and airway changes.Results:The soft-tissue response to simultaneous two-jaw surgery was superior to those seen in mandibular setback procedures with the exception of the changes seen in the facial contour angle and soft-tissue facial angle. There was a significant decrease in lower airway in cases treated with mandibular setback alone.Conclusion:Cases treated with bi-jaw surgeries had a significant soft-tissue improvement in the long term compared to mandibular setback surgeries. Since there was a significant reduction in the lower airway in cases treated with isolated mandibular surgeries, bi-jaw surgeries maybe preferred over mandibular setback surgeries.