Abstract
Introduction
Pharynx is a muscular organ with is sustained by craniofacial bones. It is divided into nasal, oral and hipopharynx, and can be considered as a tube that serves both respiratory and digestive systems. Its anatomical morphology permits that factors facilitate its obstruction, leading to the sleep apnea syndrome. One of the treatment consists of surgical mandibular advancement, increasing pharyngeal dimensions. The aim of this study was evaluate the cephalometric changes in the pharyngeal airway space after orthognathic surgery procedures for correction of mandibular prognathism.
Materials and Methods
Pre and post-operative cephalometric analysis was performed on 19 patients submitted to mandibular setback by mandibular bilateral sagittal split osteotomy associated with maxillary advancement by Le Fort I osteotomy, using the Dolphin Imaging 10.0 software.
Results
Results did not reveal statistically significant changes in the upper (nasopharyngeal), middle (oropharyngeal) and lower (hypopharyngeal) airway spaces, but showed increase in the nasal pharynx due the maxillary advancement and a lower position of the hyoid bone due the mandibular setback.
Discussion
Maxillomandibular orthognathic surgery for correction of mandibular prognathism does not seem to statistically significantly change the pharyngeal airway space, but it increases the maxillary airway.
Conclusion
It seems to be important to consider the double jaw surgery in cases of mandibular prognathism, aiming prevention of a possible reduction of whole upper airway.
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References
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. Am J Respir Crit Care Med 152:1673–1689
Thornton WK (1998) Should the dentist independently assess and treat sleep-disordered breathing? CDA J 26:599–608
Barsh LI (1998) Dentistry’s role in the recognition and treatment of sleep-breathing disorders: the need for cooperation with the medical community. CDA J 26:591–596
Robertson CJ (2000) The effect of long-term mandibular advancement on the hyoid bone and pharynx as it relates to the treatment of obstructive sleep apnoea. Aust Orthod J 16:157–166
Pae EK, Blasius JJ, Nanda R (2004) Heterogeneity in vertical positioning of the hyoid bone in relation to genioglossal activity in men. Angle Orthod 74:343–348
Houston WJB (1983) The analysis of errors in orthodontic measurements. Am Orthod 83:382–390
Gonçales ES (2010) Cirurgia Ortognática: Guia de orientação para portadores de deformidades Faciais esqueléticas. Santos Publisher Company, São Paulo, Brazil
Miyamoto K et al (1998) Mandibular posture during sleep in healthy adults. Arch Oral Biol 43:269–275
Bohlman ME, Haponick EF, Smith PL, Allen RP, Bleecker ER, Goldman SM (1983) CT demonstration of pharyngeal narrowing in adult obstructive sleep apnea. Am J Roentgenol 140:543–548
Riley RW, Powell NB, Guilleminault C (1987) Current surgical concepts for treating obstructive sleep apnea syndrome. J Oral Maxillofac Surg 45:149–157
Mehra P, Downe M, Pitta M, Wolford LM (2001) Pharyngeal airway space changes after counterclockwise rotation of the maxillomandibular complex. Am J Orthod Dentofacial Orthop 120:154–159
Li KK, Powell NB, Riley RW, Guilleminault C (2002) Distraction osteogenesis in adult obstructive sleep apnea surgery: a preliminary report. J Oral Maxillofac Surg 60:6–10
Nimkarn Y, Miles PG, Waite PD (1995) Maxillomandibular advancement surgery in obstructive sleep apnea syndrome patients: long-term surgical stability. J Oral Maxillofac Surg 53:1414–1418
Eggensperger N, Smolka K, Johner A, Rahal A, Thüer U, Iizuka T (2005) Long-term changes of hyoid bone and pharyngeal airway size following advancement of the mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 99:404–410
Eggensperger N, Smolka W, Luder J, Iizuka T (2006) Short and long-term skeletal relapse after mandibular advancement surgery. Int J Oral Maxillofac Surg 35:36–52
Yu LF, Pogrel MA, Ajayi M (1994) Pharyngeal airway changes associated with mandibular advancement. J Oral Maxillofac Surg 52:40–43
Gonçalves JR, Buschang PH, Gonçalves DG, Wolford LM (2006) Postsurgical stability of oropharyngeal airway changes following counter-clockwise maxillo-mandibular advancement surgery. J Oral Maxillofac Surg 64:755–762
Athanasiou AE, Toutontizakis N, Mavreas D, Ritzau M, Wenzel A (1991) Alterations of hyoid bone position and pharyngeal depth and their relationship after surgical correction of mandibular prognathism. Am J Orthod Dentofacial Orthop 100:259–265
Saitoh K (2004) Long-term changes in pharyngeal airway morphology after mandibular setback surgery. Am J Orthod Dentofacial Orthop 125:556–561
Sayinzu K, Isik F, Arun T (2006) Sagittal airway dimensions following maxillary protraction: a pilot study. Eur J Orthod 28:184–189
Saito K, Ono T, Mochida M, Ohyama K (2006) Changes in nasorespiratory function in association with maxillary distraction osteogenesis in subjects with cleft lip and palate. Cleft palate. Craniofacial J 43:75–83
Riley RW, Powell NB, Guilleminault C, Ware W (1987) Obstructive sleep apnea syndrome following surgery for mandibular prognathism. J Oral Maxillofac Surg 47:450–452
Achilleos S, Krogstad O, Lyberg T (2002) Surgical mandibular setback and changes in uvuloglossopharyngeal morphology and head posture: a short- and long-term cephalometric study in males. Eur J Orthod 22:383–394
Enacar A, Aksoy AÜ, Sençift Y, Haydar B, Aras K (1994) Changes in the hypopharyngeal airway space and in tongue and hyoid bone position following the surgical correction of the mandibular prognathism. Int J Adult Orthod Orthognath Surg 9:285–290
Liukkonen M, Vahatalo K, Peltomaki T, Tiekso J, Happonen RP (2002) Effect of mandibular setback surgery on the posterior airway size. Int J Adult Orthod Orthognath Surg 17:41–46
Turnbull NR, Battagel JM (2000) The effects of orthognathic surgery on pharyngeal airway dimensions and quality of sleep. J Orthod 27:235–247
Wickwire NA, White RP Jr, Proffit WR (1972) The effect of mandibular osteotomy on tongue position. J Oral Surg 30:184–190
Lye KW (2008) Effect of orthognathic surgery on the posterior airway space (PAS). Ann Acad Med Singapore 37:677–682
Kawakami M, Yamamoto K, Fugimoto M, Ohgi K, Inoue M, Kirita T (2005) Changes in tongue and hyoid positions, and posterior airway space following mandibular setback surgery. J Craniomaxillofac Surg 33:107–110
Chen F, Terada K, Hanada K, Saito I (2005) Predicting the pharyngeal airway space after mandibular setback surgery. J Oral Maxillofac Surg 63:1509–1514
Tselnik M, Pogrel MA (2000) Assessment of the pharyngeal airway space after mandibular setback surgery. J Oral Maxillofac Surg 58:282–285
Greco JM, Frohberg U, Van Sickels JE (1990) Long-term airway space changes after mandibular setback using bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg 19:103–105
Samman N, Mohammadi H, Xia J (2003) Cephalometric norms for the upper airway in a healthy Honk Kong Chinese population. Hong Kong Med J 9:25–30
Hochban W, Schürmann R, Brandenburg U, Conrad R (1996) Mandibular setback for surgical correction of mandibular hyperplasia—does it provoke sleep-related breathing disorders. Int J Oral Maxillofac Surg 25:333–338
Kollias I, Krogstad O (1999) Adult craniocervical and pharyngeal changes—a longitudinal cephalometric study between 22 and 42 years of age. Part I: Morphological craniocervical and hyoid bone changes. Eur J Orthod 21:333–344
Kollias I, Krogstad O (1999) Adult craniocervical and pharyngeal changes—a longitudinal cephalometric study between 22 and 42 years of age. Part II: Morphological uvulo-glossopharyngeal changes. Eur J Orthod 21:345–355
Paoli JR, Lauwers F, Cances V (2000) Upper airway changes after mandibular setback osteotomy. Concerns for obstructive sleep apnea. Rev Stomatol Chir Maxillofac 101:129–134
Ramesh BV, Vinod N, Murgesan K (2005) Pharyngeal airway changes following mandibular setback surgery. Indian J Dent Res 16:147–150
Folta R et al (2009) The impact of Le Fort I advancement and bilateral sagittal split osteotomy setback on ventilation during sleep. Int J Oral Maxillofac Surg 38:1036–1040
Folta R et al (2011) The influence of orthognathic surgery on ventilation during sleep. Int J Oral Maxillofac Surg 40:146–149
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 68:2431–2436
Jakobson 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 Dentofacial Orthop 139:369–376
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Gonçales, E.S., Rocha, J.F., Gonçales, A.G.B. et al. Computerized Cephalometric Study of the Pharyngeal Airway Space in Patients Submitted to Orthognathic Surgery. J. Maxillofac. Oral Surg. 13, 253–258 (2014). https://doi.org/10.1007/s12663-013-0524-5
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DOI: https://doi.org/10.1007/s12663-013-0524-5