To evaluate 3-dimensional pharyngeal airway changes following 2-jaw orthognathic surgery in skeletal Class III patients and to assess their association with surgical movements.
Design
Retrospective observational study.
Setting
Single tertiary care center.
Patients
Twenty-seven adult patients with skeletal Class III malocclusion who underwent Le Fort I maxillary advancement combined with bilateral sagittal split osteotomy mandibular setback.
Interventions
All patients received 2-jaw orthognathic surgery with preoperative (T0) and postoperative (T1, 6 months) computed tomography imaging.
Main Outcome Measures
Three-dimensional airway volumes of the nasopharynx, oropharynx, and hypopharynx were measured. Correlations between airway volume changes and skeletal movements were analyzed.
Results
Significant regional differences in airway changes were observed. The nasopharyngeal airway volume increased (+1979.1 mm3), while the oropharyngeal airway showed minimal change (+336.4 mm3). In contrast, the hypopharyngeal airway demonstrated a significant reduction (−1087.5 mm3). A strong correlation was found between mandibular setback and hypopharyngeal airway reduction at Point B (r = 0.73, P = .023).
Conclusions
Two-jaw orthognathic surgery results in region-specific airway changes. Hypopharyngeal airway reduction is associated with mandibular setback, while maxillary advancement contributes to upper airway enlargement. These findings reflect morphological rather than functional changes, and further studies incorporating functional assessments are required to determine their clinical significance.
PettitNJAuvenshineRC. Change of hyoid bone position in patients treated for and resolved of myofascial pain. CRANIO®. 2020;38(2):74-90.
2.
DegerliyurtKUekiKHashibaYMarukawaKNakagawaKYamamotoE. A comparative CT evaluation of pharyngeal airway changes in class III patients receiving bimaxillary surgery or mandibular setback surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol. 2008;105(4):495-502.
3.
SantagataMTozziULamartETartaroG. Effect of orthognathic surgery on the posterior airway space in patients affected by skeletal class III malocclusion. J Maxillofac Oral Surg.2015;14(3):682-686.
4.
IraniSKOliverDRMovahedRKimYIThiesenGKimKB. Pharyngeal airway evaluation after isolated mandibular setback surgery using cone-beam computed tomography. Am J Orthod Dentofacial Orthop.2018;153(1):46-53.
5.
RileyRWPowellNBGuilleminaultCWareW. Obstructive sleep apnea syndrome following surgery for mandibular prognathism. J Oral Maxillofac Surg.1987;45(5):450-452.
6.
FriedlanderAHWalkerLAFriedlanderIKFelsenfeldAL. Diagnosing and comanaging patients with obstructive sleep apnea syndrome. J Am Dent Assoc. 2000;131(8):1178-1184.
7.
SearsCRMillerAJChangMKHuangJCLeeJS. Comparison of pharyngeal airway changes on plain radiography and cone-beam computed tomography after orthognathic surgery. J Oral Maxillofac Surg.2011;69(11):e385-e394.
8.
LeeJYKimYIHwangDSParkSB. Effect of maxillary setback movement on upper airway in patients with class III skeletal deformities: Cone beam computed tomographic evaluation. J Craniofac Surg. 2013;24(2):387-391.
9.
PanouEMotroMAtesMAcarAErverdiN. Dimensional changes of maxillary sinuses and pharyngeal airway in Class III patients undergoing bimaxillary orthognathic surgery. Angle Orthod. 2013;83(5):824-831.
10.
GokceSMGorguluSGokceHSBengiAOKaracayliUOrsF. Evaluation of pharyngeal airway space changes after bimaxillary orthognathic surgery with a 3-dimensional simulation and modeling program. Am J Orthod Dentofacial Orthop.2014;146(4):477-492.
11.
EngboonmeskulTLeepongNChalidapongseP. Effect of surgical mandibular setback on the occurrence of obstructive sleep apnea. J Oral Biol Craniofac Res.2020;10(4):597-602.
12.
SaitohK. Long-term changes in pharyngeal airway morphology after mandibular setback surgery. Am J Orthod Dentofacial Orthop.2004;125(5):556-561.
13.
ChenFTeradaKHuaYSaitoI. Effect of bimaxillary surgery and mandibular setback surgery on pharyngeal airway measurements in patients with Class III skeletal deformities. Am J Dentofacial Orthop. 2007;131(3):372-377.
14.
ParkJKimNKimJWKimMJChangYI. Volumetric, planar, and linear analyses of pharyngeal airway change on computed tomography and cephalometry after mandibular setback surgery; 2010, pp. 292–299.
15.
MutoTTakedaSKanazawaMYamazakiAFujiwaraYMizoguchiI. The effect of head posture on the pharyngeal airway space (PAS). Int J Oral Maxillofac Surg. 2002;31(6):579-583.
16.
Vijayakumar JainSMuthusekharMRBaigMFSenthilnathanPLoganathanSAbdul WahabPUMadhulakshmiMVohraY. Evaluation of three-dimensional changes in pharyngeal airway following isolated lefort one osteotomy for the correction of vertical maxillary excess: A prospective study. J Maxillofac Oral Surg.2019;18(1):139-146.
17.
MommaertsMYLippensFAbeloosJVNeytLF. Nasal profile changes after maxillary impaction and advancement surgery. J Oral Maxillofac Surg.2000;58(5):470-475.
18.
Khamashta-LedezmaLNainiFBManisaliM. Review of nasal changes with maxillary orthognathic surgery. J Istanbul Univ Faculty Dent. 2017;51(3 Suppl 1):S52.
19.
KawamataAFujishitaMArijiYArijiE. Three-dimensional computed tomographic evaluation of morphologic airway changes after mandibular setback osteotomy for prognathism. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol. 2000;89(3):278-287.
20.
DemetriadesNChangDJLaskaridesCPapageorgeM. Effects of mandibular retropositioning, with or without maxillary advancement, on the oro-naso-pharyngeal airway and development of sleep-related breathing disorders. J Oral Maxillofac Surg. 2010;68(10):2431-2436.
21.
UesugiTKobayashiTHasebeDTanakaRIkeMSaitoC. Effects of orthognathic surgery on pharyngeal airway and respiratory function during sleep in patients with mandibular prognathism. Int J Oral Maxillofac Surg. 2014;43(9):1082-1090.
22.
KamanoETerajimaMKitaharaTTakahashiI. Three-dimensional analysis of changes in pharyngeal airway space after mandibular setback surgery. Orthod Waves. 2017;76(1):1-8.
23.
HongJSParkYHKimYJHongSMOhKM. Three-dimensional changes in pharyngeal airway in skeletal class III patients undergoing orthognathic surgery. J Oral Maxillofac Surg. 2011;69(11):e401-e408.
24.
EmataKMitaniHSakamotoT. Effect of orthognathic surgery on skeletal mandibular prognathism. Changes of the tissue profile, pharyngeal airway and hyoid position. Nihon Kyosei Shika Gakkai Zasshi. 1983;42(1):69-84.
25.
ReynekeJPBryantRSSuuronenRBeckerPJ. Postoperative skeletal stability following clockwise and counter-clockwise rotation of the maxillomandibular complex compared to conventional orthognathic treatment. Br J Oral Maxillofac Surg. 2007;45(1):56-64.
26.
ChoiJWParkYJLeeCY. Posterior pharyngeal airway in clockwise rotation of maxillomandibular complex using surgery-first orthognathic approach. Plast Reconstr Surg Glob Open. 2015;3(8):e485.
27.
SaatiSRamezaniKRamezaniNAlafchiB. Evaluation of pharyngeal airway volume and nasal septum deviation relation in different sagittal and vertical craniofacial patterns through cone beam computed tomography. J Oral Maxillofac Surg Med Pathol.2021;33(2):107-114.
28.
BuchananACohenRLooneySKalathingalSDe RossiS. Cone-beam CT analysis of patients with obstructive sleep apnea compared to normal controls. Imaging Sci Dent. 2016;46(1):9-16.
29.
ShokriAMiresmaeiliAAhmadiAAminiPFalah-KooshkiS. Comparison of pharyngeal airway volume in different skeletal facial patterns using cone beam computed tomography. J Clin Exp Dent. 2018;10(10):e1017-e1028.
