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Effects of combined orthodontic-orthognathic treatment for class II and III correction on posterior airway space

Comparison of mono- and bignathic osteotomies

Effekte kieferorthopädisch-kieferchirurgischer Kombinationsbehandlungen bei Klasse II und III auf den extrathorakalen Luftraum

Vergleich zwischen mono- und bignathen Osteotomien

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Abstract

Objectives

Comparison of treatment effects on the posterior airway space (PAS) in patients treated with combined orthodontic–orthognathic surgical treatment.

Methods

Pre- and postsurgical lateral cephalograms of 53 (34 females, 19 males) Caucasian patients were analyzed using a customized set of measurements. According to malocclusion (Class II or III) and surgical approach (either monognathic or bignathic), patients were allocated into four groups. PAS was assessed from cranial to caudal at six levels (P1–P6). Paired t tests were used for intragroup and t tests for independent samples for intergroup comparisons. Results were considered statistically significant at p < 0.05.

Results

In patients treated for Class II malocclusion, PAS retropalatally (P1 level) almost remained unchanged, whereas measurements at levels P2–P6 showed a mean increase ranging from approximately 2–5.5 mm. Significant changes were most pronounced in monognathic Class II patients (group 1) at levels P2–P4 with mean values ranging from approximately 3.7–5.5 mm. In patients treated for Class III malocclusion (groups 3 and 4), measurements at the P1 level almost remained unchanged in patients who underwent mandibular setback surgery (group 3), whereas the same measurements exhibited significant increase (>6 mm) in patients treated with bignathic surgery (group 4).

Conclusions

Bignathic surgery led to smaller changes of pharyngeal depth in Class II and III patients than monognathic surgery. Alterations of the PAS due to orthognathic surgery should be considered during orthodontic and presurgical treatment planning.

Zusammenfassung

Zielsetzung

Ziel dieser Studie war der Vergleich von Effekten der kieferorthopädisch-kieferchirurgischer Kombinationsbehandlung auf den extrathorakalen Luftraum.

Material und Methoden

Prä- und post-therapeutische Fernröntgenseitenaufnahmen von 53 (34 weibliche, 19 männliche) Patienten wurden kephalometrisch ausgewertet. In Abhängigkeit von der skelettalen Malokklusion (Klasse II oder III) und der/den durchgeführten Osteotomie/n (mono- oder bignath) wurden die Patienten 4 Studiengruppen zugewiesen. Der extrathorakale Luftraum wurde von kranial nach kaudal auf 6 Ebenen (P1 bis P6) bestimmt. Für Intragruppenvergleiche kamen gepaarte t-Tests, für Intergruppenvergleiche unabhängige t-Tests zur Anwendung. Eine statistische Signifikanz wurde bei p < 0,05 angenommen.

Ergebnisse

Bei Klasse-II-Patienten blieb der retropalatinale extrathorakale Luftraum (Ebene P1) nahezu unverändert, während die Messungen auf den Ebenen P2 bis P6 signifikante Vergrößerungen von etwa 2–5,5 mm aufwiesen. Signifikante Veränderungen waren am größten bei monognath operierten Klasse-II-Patienten (Gruppe 1) auf Level P2 bis P4 mit Werten von etwa 3,7–5,5 mm. Bei Klasse-III-Patienten (Gruppen 3 und 4) zeigten sich die Messungen bei Unterkieferrückverlagerung (Gruppe 3) auf der Ebene P1 nahezu unverändert, während die entsprechenden Messungen bei bignath operierten Patienten (Gruppe 4) eine signifikante Vergrößerung (>6 mm) aufwiesen.

Schlussfolgerungen

Bignathe Osteotomien führten zu geringeren Veränderungen des extrathorakalen Luftraumes bei Klasse-II- und -III-Patienten als monognathe Osteotomien. Die durch die orthognathe Chirurgie bedingten Auswirkungen auf den extrathorakalen Luftraum sollten sowohl bei der kieferorthopädischen als auch bei der prächirurgischen Behandlungsplanung berücksichtigt werden.

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Authors and Affiliations

  1. Department of Orthodontics, Saarland University, Universitätskliniken 56, 66424, Homburg/Saar, Germany

    Jan Hourfar, Gero Stefan Michael Kinzinger, Verena Maria Vehr & Jörg Alexander Lisson

  2. Practice and Department of Oral and Maxillofacial Surgery, Marienhospital, Aachen, Germany

    Hartmut Feifel

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  1. Jan Hourfar
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  2. Gero Stefan Michael Kinzinger
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  3. Hartmut Feifel
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  4. Verena Maria Vehr
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  5. Jörg Alexander Lisson
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Correspondence to Jörg Alexander Lisson.

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Jan Hourfar, G.S.M. Kinzinger, H. Feifel, V.M. Vehr, J.A. Lisson declare that they have no conflict of interest.

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Univ.-Prof. Dr. Jörg Alexander Lisson.

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Hourfar, J., Kinzinger, G.S.M., Feifel, H. et al. Effects of combined orthodontic-orthognathic treatment for class II and III correction on posterior airway space. J Orofac Orthop 78, 455–465 (2017). https://doi.org/10.1007/s00056-017-0101-5

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