Analysis of sagittal jaw movements and pharyngeal airway changes in skeletal Class Ⅱ patients following bimaxillary surgery

doi:10.19438/j.cjoms.2025.02.005

Abstract

Abstract: PURPOSE: To explore the relationship between jaw movements and changes in pharyngeal airway morphology and volume by studying the preoperative and postoperative jaw movements and pharyngeal airway alterations in skeletal Class Ⅱ patients undergoing bimaxillary surgery. METHODS: A total of 28 skeletal Class Ⅱpatients with maxillary protrusion and mandibular retrusion who received orthognath-orthodontic combined treatment in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2021 to June 2024 were selected. All patients underwent maxillary setback via Le Fort I osteotomy combined with mandibular advancement using bilateral sagittal split ramus osteotomy(BSSRO). The difference in sagittal movement of the mandible was defined by subtracting the maxillary retraction from the mandibular forward movement. According to the difference of sagittal movement of the mandible,the patients were divided into two groups: group A(n=14) with a sagittal movement difference > 0 mm, and group B (n=14) with a sagittal movement difference ≤; 0 mm. All patients received CT scans at the end of preoperative orthodontics (T0) and six months after orthognathic surgery(T1). The CT data were imported into Dolphin Imaging 11.9 software to measure pharyngeal airway morphological parameters and jaw movements. Statistical analysis was performed using SPSS 29.0 software package. RESULTS: In group A, the sagittal movement difference was positively and linearly correlated with oropharyngeal airway volume. In group B, the sagittal movement difference had a nonlinear relationship with oropharyngeal airway volume. When the sagittal movement difference was less than -1.24 mm(R²=0.8225, P< 0.05), -1.02 mm(R²=0.6670, P< 0.05), -1.34 mm(R²=0.7717, P< 0.05), and -1.17 mm(R²=0.7332, P< 0.05), the total pharyngeal airway volume, nasopharyngeal airway volume, oropharyngeal airway volume, and hypopharyngeal airway volume decreased, respectively. CONCLUSIONS: In skeletal ClassⅡ patients undergoing maxillary setback combined with mandibular advancement, when the amount of maxillary setback exceeds the amount of mandibular advancement by more than 1 mm, there is significant reduction in pharyngeal airway volume. Therefore, for skeletal Class Ⅱ patients with a predisposition to pharyngeal airway narrowing, the treatment plan should be appropriately adjusted to mitigate airway risks.;

Key words: Skeletal Class Ⅱ malocclusion, Orthognathic surgery, Pharyngeal airway space, Sagittal jaw movements

CLC Number:

R782.2

WU Jia-qing, SHEN Ai-li, QIAN Yi-feng, LIU Jia-qiang. Analysis of sagittal jaw movements and pharyngeal airway changes in skeletal Class Ⅱ patients following bimaxillary surgery[J]. China Journal of Oral and Maxillofacial Surgery, 2025, 23(2): 129-136.

References

[1] Neelapu BC, Kharbanda OP, Sardana HK, et al.Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: a systematic review and meta-analysis of cephalometric studies[J]. Sleep Med Rev, 2017, 31: 79-90.
[2] Kaur S, Rai S, Kaur M.Comparison of reliability of lateral cephalogram and computed tomography for assessment of airway space[J]. Niger J Clin Pract,2014, 17(5): 629-636.
[3] Ceylan I, Oktay H.A study on the pharyngeal size in different skeletal patterns[J]. Am J Orthod Dentofacial Orthop, 1995, 108(1): 69-75.
[4] Jiang YY.Correlation between hyoid bone position and airway dimensions in Chinese adolescents by cone beam computed tomography analysis[J]. Int J Oral Maxillofac Surg, 2016, 45(7): 914-921.
[5] Cheng JH, Hsiao SY, Chen CM, et al.Relationship between hyoid bone and pharyngeal airway in different skeletal patterns[J]. J Dent Sci, 2020, 15(3): 286-293.
[6] da Costa ED, Roque-Torres GD, Brasil DM, et al. Correlation between the position of hyoid bone and subregions of the pharyngeal airway space in lateral cephalometry and cone beam computed tomography[J]. Angle Orthod, 2017, 87(5): 688-695.
[7] Kawamata A, Fujishita M, Ariji Y, et al.Three-dimensional computed tomographic evaluation of morphologic airway changes after mandibular setback osteotomy for prognathism[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2000, 89(3): 278-287.
[8] Santagata M, Tozzi U, Lamart E, et al.Effect of orthognathic surgery on the posterior airway space in patients affected by skeletal Class Ⅲ malocclusion[J]. J Maxillofac Oral Surg, 2015, 14(3): 682-686.
[9] Craig CE.The skeletal patterns characteristic of Class Ⅰ and Class Ⅱ, division I malocclusions in norma lateralis[J]. Angle Orthod, 1951, 21(1): 44-56.
[10] Jiang C, Yi Y, Jiang C, et al.Pharyngeal airway space and hyoid bone positioning after different orthognathic surgeries in skeletal Class Ⅱ patients[J]. J Oral Maxillofac Surg, 2017, 75(7): 1482-1490.
[11] Lee JY, Kim YI, Hwang DS, et al.Effect of maxillary setback movement on upper airway in patients with Class Ⅲ skeletal deformities: cone beam computed tomographic evaluation[J]. J Craniofac Surg, 2013, 24(2): 387-391.
[12] Mehra P, Downie M, Pita MC, et al.Pharyngeal airway space changes after counterclockwise rotation of the maxillomandibular complex[J]. Am J Orthod Dentofacial Orthop, 2001, 120(2): 154-159.
[13] 向明丽. 功能矫治治疗对骨性Ⅱ类下颌后缩患者气道影响的系统评价和meta分析[D].重庆: 重庆医科大学,2019.
Xiang ML.A systematic review and meta-analysis of the effect of functional correction on airway in patients with osteogenic Class Ⅱ mandibular retraction[D]. Chongqing: Chongqing Medical University, 2019.
[14] Park SB, Kim YI, Son WS, et al.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[J]. Int J Oral Maxillofac Surg, 2012, 41(1): 87-93.
[15] Hong JS, Oh KM, Kim BR, et al.Three-dimensional analysis of pharyngeal airway volume in adults with anterior position of the mandible[J]. Am J Orthod Dentofacial Orthop, 2011, 140(4): e161-e169.
[16] Mattos CT, Vilani GN, Sant'Anna EF, et al. Effects of orthognathic surgery on oropharyngeal airway: a meta-analysis[J]. Int J Oral Maxillofac Surg, 2011, 40(12): 1347-1356.
[17] Hsieh YJ, Chen YC, Chen YA, et al.Effect of bimaxillary rotational setback surgery on upper airway structure in skeletal Class Ⅲ deformities[J]. Plast Reconstr Surg, 2015, 135(2): 361e-369e.
[18] Brunetto DP, Velasco L, Koerich L, et al.Prediction of 3-dimensional pharyngeal airway changes after orthognathic surgery: a preliminary study[J]. Am J Orthod Dentofacial Orthop, 2014, 146(3): 299-309.
[19] Chang MK, Sears C, Huang JC, et al.Correlation of airway volume with orthognathic surgical movement using cone-beam computed tomography[J]. J Oral Maxillofac Surg, 2015, 73(12 Suppl): S67-S76.
[20] Zou Y, Yang R, Yeweng SJ, et al.MSCT 3D analysis of nasopharyngeal airway after Le Fort I maxillary setback surgeries[J]. J Craniofac Surg, 2024, 35(3): 869-873.
[21] Vos W, De Backer J, Devolder A, et al.Correlation between severity of sleep apnea and upper airway morphology based on advanced anatomical and functional imaging[J]. J Biomech, 2007, 40(10): 2207-2213.
[22] Resnick CM, Middleton JK, Calabrese CE, et al.Retropalatal cross-sectional area is predictive of obstructive sleep apnea in patients with syndromic craniosynostosis[J]. Cleft Palate Craniofac J, 2020, 57(5): 560-565.
[23] Wang YC, Ko EW, Huang CS, et al.The inter-relationship between mandibular autorotation and maxillary Le Fort I impaction osteotomies[J]. J Craniofac Surg, 2006, 17(5): 898-904.
[24] Chung C, Lee Y, Park KH, et al.Nasal changes after surgical correction of skeletal Class Ⅲ malocclusion in Koreans[J]. Angle Orthod, 2008, 78(3): 427-432.
[25] Rosen HM.Lip-nasal aesthetics following Le Fort I osteotomy[J]. Plast Reconstr Surg, 1988, 81(2): 171-182.
[26] Degerliyurt K, Ueki K, Hashiba Y, et al.A comparative CT evaluation of pharyngeal airway changes in Class Ⅲ patients receiving bimaxillary surgery or mandibular setback surgery[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2008, 105(4): 495-502.
[27] Kim JS, Kim JK, Hong SC, et al.Pharyngeal airway changes after sagittal split ramus osteotomy of the mandible: a comparison between genders[J]. J Oral Maxillofac Surg, 2010, 68(8): 1802-1806.
[28] Jakobsone G, Stenvik A, Sandvik L, et al.Three-year follow-up of bimaxillary surgery to correct skeletal Class Ⅲ malocclusion: stability and risk factors for relapse[J]. Am J Orthod Dentofacial Orthop, 2011, 139(1): 80-89.
[29] Pirilä-Parkkinen K, Löppönen H, Nieminen P, et al.Validity of upper airway assessment in children: a clinical, cephalometric, and MRI study[J]. Angle Orthod, 2011, 81(3): 433-439.
[30] Hong JS, Park YH, Kim YJ, et al.Three-dimensional changes in pharyngeal airway in skeletal Class Ⅲ patients undergoing orthognathic surgery[J]. J Oral Maxillofac Surg, 2011, 69(11): e401-e408.
[31] Sutthiprapaporn P, Tanimoto K, Ohtsuka M, et al.Positional changes of oropharyngeal structures due to gravity in the upright and supine positions[J]. Dentomaxillofac Radiol, 2008, 37(3): 130-135.
[32] Pae EK, Lowe AA, Sasaki K, et al.A cephalometric and electromyographic study of upper airway structures in the upright and supine positions[J]. Am J Orthod Dentofacial Orthop, 1994, 106(1): 52-59.
[33] Muto T, Takeda S, Kanazawa M, et al.The effect of head posture on the pharyngeal airway space(PAS)[J]. Int J Oral Maxillofac Surg, 2002, 31(6): 579-583.