Skip to main content
SpringerLink
Log in

Orthognathic Surgical Considerations for Obstructive Sleep Apnea

  • Chapter
  • First Online:
Management of Obstructive Sleep Apnea

  • 1284 Accesses

Abstract

Orthognathic surgery changes the anteroposterior or vertical position of the maxilla or the mandible for aesthetic improvement with better functionality. This skeletal modification inevitably induces alterations in the soft tissue that may lead to changes in the upper airway space. Therefore, clinicians should consider these inevitable changes in the airway space when performing orthognathic surgery in case of obstructive sleep apnea. Various imaging modalities have been used to evaluate the upper airway space, peripheral soft tissues, and skeletal structure for this purpose. This chapter introduces how to visualize the upper airway space and assess the specific airway region of interest using cone beam computed tomographic images. 3D image reconstruction in “Visualization of the airway space for volumetric analysis” allows a detailed comparative evaluation of the pattern of the airway space pre- and postoperatively. “Airway space change and stability related to orthognathic surgery” covers how airway space is related to the movements of maxilla and mandible after orthognathic surgery. Moreover, it discusses the long-term stability with airway space change as well.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 64.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 69.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bell WH, Epker BN. Surgical-orthodontic expansion of the maxilla. Am J Orthod. 1976;70(5):517–28.

    Article  CAS  PubMed  Google Scholar 

  2. Bell WH, Jacobs JD. Surgical-orthodontic correction of maxillary retrusion by Le Fort I osteotomy and proplast. J Maxillofac Surg. 1980;8(2):84–94.

    Article  CAS  PubMed  Google Scholar 

  3. Bell WH, Jacobs JD, Legan HL. Treatment of class II deep bite by orthodontic and surgical means. Am J Orthod. 1984;85(1):1–20.

    Article  CAS  PubMed  Google Scholar 

  4. Epker BN, Fish LC. The surgical-orthodontic correction of mandibular deficiency. Part I. Am J Orthod. 1983;84(5):408–21.

    Article  CAS  PubMed  Google Scholar 

  5. Proffit WR, White RP Jr. Who needs surgical-orthodontic treatment? Int J Adult Orthodon Orthognath Surg. 1990;5(2):81–9.

    CAS  PubMed  Google Scholar 

  6. Wolford LM, Hilliard FW, Dugan DJ. STO, surgical treatment objective : a systematic approach to the prediction tracing. St. Louis: Mosby; 1985.

    Google Scholar 

  7. Proffit WR, Turvey TA, Phillips C. Orthognathic surgery: a hierarchy of stability. Int J Adult Orthodon Orthognath Surg. 1996;11(3):191–204.

    CAS  PubMed  Google Scholar 

  8. Proffit WR, Turvey TA, Phillips C. The hierarchy of stability and predictability in orthognathic surgery with rigid fixation: an update and extension. Head Face Med. 2007;3:21.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Wahl N. Orthodontics in 3 millennia. Chapter 13: the temporomandibular joint and orthognathic surgery. Am J Orthod Dentofac Orthop. 2007;131(2):263–7.

    Article  Google Scholar 

  10. Wahl N. Orthodontics in 3 millennia. Chapter 14: surgical adjuncts to orthodontics. Am J Orthod Dentofac Orthop. 2007;131(4):561–5.

    Article  Google Scholar 

  11. King EW. A roentgenographic study of pharyngeal growth. Angle Orthod. 1952;22(1):23–37.

    Google Scholar 

  12. Brodie AG. Anatomy and physiology of head and neck musculature. Am J Orthod. 1950;36(11):831–44.

    Article  CAS  PubMed  Google Scholar 

  13. Handelman CS, Osborne G. Growth of the nasopharynx and adenoid development from one to eighteeen years. Angle Orthod. 1976;46(3):243–59.

    CAS  PubMed  Google Scholar 

  14. Johnston C. Cephalometric changes in adult pharyngeal morphology. Eur J Orthod. 1999;21(4):357–62.

    Article  CAS  PubMed  Google Scholar 

  15. Kollias I. Adult craniocervical and pharyngeal changes - a longitudinal cephalometric study between 22 and 42 years of age. Part 1: morphological craniocervical and hyoid bone changes. Eur J Orthod. 1999;21(4):333–44.

    Article  CAS  PubMed  Google Scholar 

  16. Kim KWCJ, Kim CH. A cephalometric study on changes in hyoid bone, tongue and upper airway space according to skeletal change in persons with mandible prognathism after orthognathic surgery. J Korean Assoc Maxillofac Plast Recontr Surg. 2004;26:349–58.

    Google Scholar 

  17. Veena GC, Vivek AJ, Sudarshan GK, Jayagowri M. Orthognathic procedures and its effect on obstructive sleep apnea - a systematic review. Br Biomed Bull. 2014;2(4):765–74.

    Google Scholar 

  18. Kim N-R, Kim Y-I, Park S-B, Hwang D-S. Three dimensional cone-beam CT study of upper airway change after mandibular setback surgery for skeletal class III malocclusion patients. Kor J Orthodont. 2010;40(3):145.

    Article  Google Scholar 

  19. Park SB, Kim YI, Son WS, Hwang DS, Cho BH. Cone-beam computed tomography evaluation of short- and long-term airway change and stability after orthognathic surgery in patients with class III skeletal deformities: bimaxillary surgery and mandibular setback surgery. Int J Oral Maxillofac Surg. 2012;41(1):87–93.

    Article  CAS  PubMed  Google Scholar 

  20. J Oral Maxillofac Surg. 1987 May;45(5):450–2. Obstructive sleep apnea syndrome following surgery for mandibular prognathism. Riley RW, Powell NB, Guilleminault C, Ware W. PMID: 3471930 [Indexed for MEDLINE].

    Google Scholar 

  21. 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 Dentofac Orthop. 1991;100(3):259–65.

    Article  CAS  Google Scholar 

  22. Wickwire NA, White RP Jr, Proffit WR. The effect of mandibular osteotomy on tongue position. J Oral Surg. 1972;30(3):184–90.

    CAS  PubMed  Google Scholar 

  23. 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 Cranio-Maxillofac Surg. 2005;33(2):111–7.

    Article  Google Scholar 

  24. Enacar A, Aksoy AU, Sencift 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(4):285–90.

    CAS  PubMed  Google Scholar 

  25. Hochban W, Schürmann R, Brandenburg U. Mandibular setback for surgical correction of mandibular hyperplasia — does it provoke sleep-related breathing disorders? Int J Oral Maxillofac Surg. 1996;25(5):333–8.

    Google Scholar 

  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(3):180–90.

    PubMed  Google Scholar 

  27. Tselnik M, Pogrel MA. Assessment of the pharyngeal airway space after mandibular setback surgery. J Oral Maxillofac Surg. 2000;58(3):282–5.

    Article  CAS  PubMed  Google Scholar 

  28. 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 Cranio-Maxillofac Surg. 2005;33(2):107–10.

    Article  Google Scholar 

  29. Lee JY, Kim Y-I, Hwang D-S, Park S-B. Effect of maxillary setback movement on upper airway in patients with class III skeletal deformities. J Craniofac Surg. 2013;24(2):387–91.

    Article  PubMed  Google Scholar 

  30. Schwab RJ, Goldberg AN. UPPER AIRWAY ASSESSMENT. Otolaryngol Clin N Am. 1998;31(6):931–68.

    Article  CAS  Google Scholar 

  31. Grauer D, Cevidanes LSH, Proffit WR. Working with DICOM craniofacial images. Am J Orthod Dentofac Orthop. 2009;136(3):460–70.

    Article  Google Scholar 

  32. dos Reis ZIS, de Moraes LC, de Moura P, Ursi W. Assessment of pharyngeal airway space using cone-beam computed tomography. Dent Press J Orthod. 2010;15:150–8.

    Google Scholar 

  33. Iwasaki T, Hayasaki H, Takemoto Y, Kanomi R, Yamasaki Y. Oropharyngeal airway in children with class III malocclusion evaluated by cone-beam computed tomography. Am J Orthod Dentofac Orthop. 2009;136(3):318.e311–9.

    Article  Google Scholar 

  34. Abramson Z, Susarla S, Troulis M, Kaban L. Age-related changes of the upper airway assessed by 3-dimensional computed tomography. J Craniofac Surg. 2009;20(Suppl 1):657–63.

    Article  PubMed  Google Scholar 

  35. Cakarne DUI, Skagers A. Pharyngeal airway sagittal dimension in patients with class III skeletal dentofacial deformity before and after bimaxillary surgery. Stomatologija. 2003;5:13–6.

    Google Scholar 

  36. Chen F, Terada K, Hua Y, Saito I. Effects of bimaxillary surgery and mandibular setback surgery on pharyngeal airway measurements in patients with class III skeletal deformities. Am J Orthod Dentofac Orthop. 2007;131(3):372–7.

    Article  Google Scholar 

  37. Degerliyurt K, Ueki K, Hashiba Y, Marukawa K, Nakagawa K, Yamamoto E. A comparative CT evaluation of pharyngeal airway changes in class III patients receiving bimaxillary surgery or mandibular setback surgery. Oral Maxillofac Radiol. 2008;105(4):495–502.

    Google Scholar 

  38. Eggensperger N, Smolka K, Johner A, Rahal A, Thüer U, Iizuka T. Long-term changes of hyoid bone and pharyngeal airway size following advancement of the mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99(4):404–10.

    Article  PubMed  Google Scholar 

  39. Holmberg H, Linder-Aronson S. Cephalometric radiographs as a means of evaluating the capacity of the nasal and nasopharyngeal airway. Am J Orthod. 1979;76(5):479–90.

    Article  CAS  PubMed  Google Scholar 

  40. Hong J-S, Park Y-H, Kim Y-J, Hong S-M, Oh K-M. Three-dimensional changes in pharyngeal airway in skeletal class III patients undergoing orthognathic surgery. J Oral Maxillofac Surg. 2011;69(11):e401–8.

    Article  PubMed  Google Scholar 

  41. Jakobsone G, Stenvik A, Espeland L. The effect of maxillary advancement and impaction on the upper airway after bimaxillary surgery to correct class III malocclusion. Am J Orthod Dentofac Orthop. 2011;139(4):e369–76.

    Article  Google Scholar 

  42. Kitahara T, Hoshino Y, Maruyama K, In E, Takahashi I. Changes in the pharyngeal airway space and hyoid bone position after mandibular setback surgery for skeletal class III jaw deformity in Japanese women. Am J Orthod Dentofac Orthop. 2010;138(6):708.e701–10.

    Article  Google Scholar 

  43. Marşan G, Cura N, Emekli U. Changes in pharyngeal (airway) morphology in class III Turkish female patients after mandibular setback surgery. J Cranio-Maxillofac Surg. 2008;36(6):41–5.

    Google Scholar 

  44. Mattos CT, Vilani GNL, Sant’Anna EF, Ruellas ACO, Maia LC. Effects of orthognathic surgery on oropharyngeal airway: a meta-analysis. Int J Oral Maxillofac Surg. 2011;40(12):1347–56.

    Article  CAS  PubMed  Google Scholar 

  45. Muto T, Yamazaki A, Takeda S, Sato Y. Effect of bilateral sagittal split ramus osteotomy setback on the soft palate and pharyngeal airway space. Int J Oral Maxillofac Surg. 2008;37(5):419–23.

    Article  CAS  PubMed  Google Scholar 

  46. Nakagawa F, Ono T, Ishiwata Y, Kuroda T. Morphologic changes in the upper airway structure following surgical correction of mandibular prognathism. Int J Adult Orthodon Orthognath Surg. 1998;13(4):299–306.

    CAS  PubMed  Google Scholar 

  47. Saitoh K. Long-term changes in pharyngeal airway morphology after mandibular setback surgery. Am J Orthod Dentofac Orthop. 2004;125(5):556–61.

    Article  Google Scholar 

  48. Wenzel A, Williams S, Ritzau M. Changes in head posture and nasopharyngeal airway following surgical correction of mandibular prognathism. Eur J Orthod. 1989;11(1):37–42.

    Article  CAS  PubMed  Google Scholar 

  49. Lye KW. Effect of orthognathic surgery on the posterior airway space (PAS). Ann Acad Med Singap. 2008;37(8):677–82.

    PubMed  Google Scholar 

  50. Chung DH, Lee KS. A study on changes of airway, tongue, and hyoid position following orthognathic surgery. Korean J Orthod. 1998;28(4):487–98.

    Google Scholar 

  51. 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(5):552–4.

    Article  CAS  PubMed  Google Scholar 

  52. Ogawa T, Enciso R, Shintaku WH, Clark GT. Evaluation of cross-section airway configuration of obstructive sleep apnea. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol. 2007;103(1):102–8.

    Article  Google Scholar 

  53. Kitagawara K, Kobayashi T, Goto H, Yokobayashi T, Kitamura N, Saito C. Effects of mandibular setback surgery on oropharyngeal airway and arterial oxygen saturation. Int J Oral Maxillofac Surg. 2008;37(4):328–33.

    Article  CAS  PubMed  Google Scholar 

  54. Kim Y-I, Park S-B, Kim J-R. A study of upper airway dimensional change according to maxillary superior movement after orthognathic surgery. Korean J Orthod. 2008;38(2):121–32.

    Article  Google Scholar 

  55. Sarver DM, White RP, Proffit WR. Contemporary treatment of dentofacial deformity. St. Louis: Mosby; 2003.

    Google Scholar 

  56. Kim T, Baek S-H, Choi J-Y. Effect of posterior impaction and setback of the maxilla on retropalatal airway and velopharyngeal dimensions after two-jaw surgery in skeletal class III patients. Angle Orthod. 2015;85(4):625–30.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Powell N, Guilleminault C, Riley R, Smith L. Mandibular advancement and obstructive sleep apnea syndrome. Bullin europeen de physiopathologie respiratoire. 1983;19(6):607–10.

    CAS  Google Scholar 

  58. Zhao X, Liu Y, Gao Y. Three-dimensional upper-airway changes associated with various amounts of mandibular advancement in awake apnea patients. Am J Orthod Dentofac Orthop. 2008;133(5):661–8.

    Article  Google Scholar 

  59. Holty J-EC, Guilleminault C. Maxillomandibular advancement for the treatment of obstructive sleep apnea: a systematic review and meta-analysis. Sleep Med Rev. 2010;14(5):287–97.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthodontics, School of Dentistry, Pusan National University, Busan, South Korea

    Yong-Il Kim

  2. Department of Orthodontics, Saint Louis University, St. Louis, MO, USA

    Ki Beom Kim & Reza Movahed

  3. Private practice, St. Louis, MO, USA

    Reza Movahed

Authors
  1. Yong-Il Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ki Beom Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Reza Movahed
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Orthodontics, Saint Louis University Orthodontics, Saint Louis, MO, USA

    Ki Beom Kim

  2. Orthodontics, Saint Louis University Orthodontics, Saint Louis, MO, USA

    Reza Movahed

  3. Washington University in St. Louis School of Medicine, Saint Louis, MO, USA

    Raman K. Malhotra

  4. Otolaryngology-Head and Neck Surgery, University of Michigan–Ann Arbor, Ann Arbor, MI, USA

    Jeffrey J. Stanley

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kim, YI., Kim, K.B., Movahed, R. (2021). Orthognathic Surgical Considerations for Obstructive Sleep Apnea. In: Kim, K.B., Movahed, R., Malhotra, R.K., Stanley, J.J. (eds) Management of Obstructive Sleep Apnea. Springer, Cham. https://doi.org/10.1007/978-3-030-54146-0_21

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-54146-0_21

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-54145-3

  • Online ISBN: 978-3-030-54146-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation