Evaluation of posterior airway space after setback surgery by simulation

  • Nazife Begum KaranEmail author
  • Sevil Kahraman
Original Article


The possible negative outcomes of mandibular setback surgery (MSS) on the upper airway (UA) have become an important issue in recent years. The purpose of the present study was to compare the different amounts of MSS and to confirm the accepted maximum amount of mandibular setback by using Computational Fluid Dynamics (CFD) method. An anatomically similar UA model was constructed from magnetic resonance images of a systemically healthy individual. Two out of six models were kept as control models and the remaining four models were created to represent MSS scenarios with different amounts to correct Class III skeletal abnormality. The airflow was assumed laminar, incompressible, and the surrounding soft tissue was assumed to be linear elastic. The sixth model that was representative of 15 mm of MSS showed statistically significant differences from the other models (p < 0.05). No significant differences were observed among other models in terms of all the parameters (p > 0.05). CFD has been recently used in researches by modeling the UA flow; however, to the best of our knowledge, none of the studies have proved the maximum limits of MSS amounts with this technique.

Graphical abstract


Mandibular setback Upper airway Finite element method Computational fluid dynamics 



The authors would like to thank Canan Erdogan and Aksel Fenerci for the technical writing assistance.

Compliance with ethical standards

Conflicts of interest and source of funding

The authors declare that they have no conflict of interest.

Supplementary material

11517_2018_1943_MOESM1_ESM.avi (1.2 mb)
Video 1 The simulation of the airflow. (AVI 1232 kb)


  1. 1.
    Demetriades N, Chang DJ, Laskarides C, Papageorge M (2010) 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 68:2431–2436CrossRefGoogle Scholar
  2. 2.
    Riley RW, Powell NB, Guilleminault C, Ware W (1987) Obstructive sleep apnea syndrome following surgery for mandibular prognathism. J Oral Maxillofac Surg 45:450–452CrossRefGoogle Scholar
  3. 3.
    Huang R, Li X, Rong Q (2013) Control mechanism for the upper airway collapse in patients with obstructive sleep apnea syndrome: a finite element study. Sci China Life Sci 56:366–372CrossRefGoogle Scholar
  4. 4.
    Kitagawara K, Kobayashi T, Goto H, Yokobayashi T, Kitamura N, Saito C (2008) Effects of mandibular setback surgery on oropharyngeal airway and arterial oxygen saturation. Int J Oral Maxillofac Surg 37:328–333CrossRefGoogle Scholar
  5. 5.
    Radhakrishnan H, Kassinos S (2009) CFD modeling of turbulent flow and particle deposition in human lungs. Conf Proc IEEE Eng Med Biol Soc 2009:2867–2870Google Scholar
  6. 6.
    Yu CC, Hsiao HD, Tseng TI, Lee LC, Yao CM, Chen NH et al (2012) Computational fluid dynamics study of the inspiratory upper airway and clinical severity of obstructive sleep apnea. J Craniofac Surg 23:401–405CrossRefGoogle Scholar
  7. 7.
    Jeong SJ, Kim WS, Sung SJ (2007) Numerical investigation on the flow characteristics and aerodynamic force of the upper airway of patient with obstructive sleep apnea using computational fluid dynamics. Med Eng Phys 29:637–651CrossRefGoogle Scholar
  8. 8.
    Degerliyurt K, Ueki K, Hashiba Y, Marukawa K, Nakagawa K, Yamamoto E (2008) 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 Endod 105:495–502CrossRefGoogle Scholar
  9. 9.
    Hong JS, Park YH, Kim YJ, Hong SM, Oh KM (2011) Three-dimensional changes in pharyngeal airway in skeletal class III patients undergoing orthognathic surgery. J Oral Maxillofac Surg 69:e401–e408CrossRefGoogle Scholar
  10. 10.
    Uesugi T, Kobayashi T, Hasebe D, Tanaka R, Ike M, Saito C (2014) Effects of orthognathic surgery on pharyngeal airway and respiratory function during sleep in patients with mandibular prognathism. Int J Oral Maxillofac Surg 43:1082–1090CrossRefGoogle Scholar
  11. 11.
    Chen F, Terada K, Hua Y, Saito I (2007) Effects of bimaxillary surgery and mandibular setback surgery on pharyngeal airway measurements in patients with class III skeletal deformities. Am J Orthod Dentofac Orthop 131:372–377CrossRefGoogle Scholar
  12. 12.
    Jakobsone G, Stenvik A, Espeland L (2011) The effect of maxillary advancement and impaction on the upper airway after bimaxillary surgery to correct class III malocclusion. Am J Orthod Dentofac Orthop 139:e369–e376CrossRefGoogle Scholar
  13. 13.
    Muto T, Takeda S, Kanazawa M, Yamazaki A, Fujiwara Y, Mizoguchi I (2002) The effect of head posture on the pharyngeal airway space (PAS). Int J Oral Maxillofac Surg 31:579–583CrossRefGoogle Scholar
  14. 14.
    Kawamata A, Fujishita M, Ariji Y, Ariji E (2000) Three-dimensional computed tomographic evaluation of morphologic airway changes after mandibular setback osteotomy for prognathism. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 89:278–287CrossRefGoogle Scholar
  15. 15.
    Jakobsone G, Neimane L, Krumina G (2010) Two- and three-dimensional evaluation of the upper airway after bimaxillary correction of class III malocclusion. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 110:234–242CrossRefGoogle Scholar
  16. 16.
    Lye KW (2008) Effect of orthognathic surgery on the posterior airway space (PAS). Ann Acad Med Singap 37:677–682PubMedGoogle Scholar
  17. 17.
    Partinen M, Guilleminault C, Quera-Salva MA, Jamieson A (1988) Obstructive sleep apnea and cephalometric roentgenograms. the role of anatomic upper airway abnormalities in the definition of abnormal breathing during sleep. Chest 93:1199–1205CrossRefGoogle Scholar
  18. 18.
    Zhao M, Barber T, Cistulli PA, Sutherland K, Rosengarten G (2013) Simulation of upper airway occlusion without and with mandibular advancement in obstructive sleep apnea using fluid-structure interaction. J Biomech 46:2586–2592CrossRefGoogle Scholar
  19. 19.
    Cheng S, Gandevia SC, Green M, Sinkus R, Bilston LE (2011) Viscoelastic properties of the tongue and soft palate using MR elastography. J Biomech 44:450–454CrossRefGoogle Scholar
  20. 20.
    Hasebe D, Kobayashi T, Hasegawa M, Iwamoto T, Kato K, Izumi N et al (2011) Changes in oropharyngeal airway and respiratory function during sleep after orthognathic surgery in patients with mandibular prognathism. Int J Oral Maxillofac Surg 40:584–592CrossRefGoogle Scholar
  21. 21.
    Kobayashi T, Funayama A, Hasebe D, Kato Y, Yoshizawa M, Saito C (2013) Changes in overnight arterial oxygen saturation after mandibular setback. Br J Oral Maxillofac Surg 51:312–318CrossRefGoogle Scholar
  22. 22.
    Burzdzius V. (2013) Effect of orthognathic surgery on the upper airway system. [dissertation]. Tampere University of TechnologyGoogle Scholar
  23. 23.
    Carrigy NB, Carey JP, Martin AR, Remmers JE, Zareian A, Topor Z et al (2016) Simulation of muscle and adipose tissue deformation in the passive human pharynx. Comput Methods Biomech Biomed Engin 19:780–788CrossRefGoogle Scholar
  24. 24.
    Obwegeser H (1964) The indications for surgical correction of mandibular deformity by the sagittal splitting technique. Br J Oral Surg 1:157–171CrossRefGoogle Scholar
  25. 25.
    Grauer D, Cevidanes LS, Styner MA, Ackerman JL, Proffit WR (2009) Pharyngeal airway volume and shape from cone-beam computed tomography: relationship to facial morphology. Am J Orthod Dentofac Orthop 136:805–814CrossRefGoogle Scholar
  26. 26.
    Li S, Shi H, Qü S, Hua Z, Dong X, Dong W (2002) The lingual region upper airway CT scan of obstructive sleep apnea patients. Zhonghua Kou Qiang Yi Xue Za Zhi 37:415–417 ChinesePubMedGoogle Scholar
  27. 27.
    Schwab RJ, Gupta KB, Gefter WB, Metzger LJ, Hoffman EA, Pack AI (1995) Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls. Am J Respir Crit Care Med 152(5 Pt 1):1673–1689CrossRefGoogle Scholar
  28. 28.
    Kuruppumullage DN (2010) Biomechanical models of human upper and tracheal airway functionality. [dissertation]. University of Central FloridaGoogle Scholar
  29. 29.
    Mylavarapu G, Murugappan S, Mihaescu M, Kalra M, Khosla S, Gutmark E (2009) Validation of computational fluid dynamics methodology used for human upper airway flow simulations. J Biomech 42:1553–1559CrossRefGoogle Scholar
  30. 30.
    Cheng GC, Koomullil RP, Ito Y, Shih AM, Sittitavornwong S, Waite PD (2014) Assessment of surgical effects on patients with obstructive sleep apnea syndrome using computational fluid dynamics simulations. Math Comput Simul 106:44–59CrossRefGoogle Scholar

Copyright information

© International Federation for Medical and Biological Engineering 2019

Authors and Affiliations

  1. 1.Department of Oral and Maxillofacial SurgeryRecep Tayyip Erdoğan UniversityRizeTurkey
  2. 2.Department of Oral and Maxillofacial SurgeryGazi UniversityAnkaraTurkey

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