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Objectives
To assess changes in the maxillary sinus (MS) and pharyngeal airway space (PAS) after bimaxillary orthognathic surgery using cone-beam computed tomography (CBCT).
Materials and Methods
The CBCT scans of 48 patients were divided into two groups: group 1: maxillary advancement and mandibular setback (n = 24); group 2: maxillomandibular ad...
Contexts in source publication
Context 1
... variables of MS were measured on both sides. In coronal reconstruction, MS areas were defined at the largest identifiable dimensions ( Figure 3A). In addition, a line was drawn from the highest to the lowest points of MS to determine the maximum height 22,23 ( Figure 3B). ...
Context 2
... coronal reconstruction, MS areas were defined at the largest identifiable dimensions ( Figure 3A). In addition, a line was drawn from the highest to the lowest points of MS to determine the maximum height 22,23 ( Figure 3B). In axial reconstruction, maximum lengths were defined as a line connecting the most anterior and posterior points of MS 2,23 ( Figure 4A) and, for the width, a line was drawn from the middle wall of the MS to the farthest lateral point, following the zygomatic arch ( Figure 4B). ...
Context 3
... variables of MS were measured on both sides. In coronal reconstruction, MS areas were defined at the largest identifiable dimensions ( Figure 3A). In addition, a line was drawn from the highest to the lowest points of MS to determine the maximum height 22,23 ( Figure 3B). ...
Context 4
... coronal reconstruction, MS areas were defined at the largest identifiable dimensions ( Figure 3A). In addition, a line was drawn from the highest to the lowest points of MS to determine the maximum height 22,23 ( Figure 3B). In axial reconstruction, maximum lengths were defined as a line connecting the most anterior and posterior points of MS 2,23 ( Figure 4A) and, for the width, a line was drawn from the middle wall of the MS to the farthest lateral point, following the zygomatic arch ( Figure 4B). ...
Citations
... Despite that, exists a weak scientific co-relation between subjective perception of symptoms and objective measurements [18]. The results of the present study agree with previous ones concerning statistically significant volume reduction in the maxillary sinuses after Le Fort1 advancement [19][20][21][22]. This outcome can be explained from the fact that in order to move maxilla in three dimensions it is necessary to separate it from the midface. ...
... Nocini et al. [17], observed that as the maxilla is moved anteriorly, there is a thickening in the posterior maxillary sinus wall. An additional etiology could be that the inflammatory changes produced after surgery, provoke a reduction in the maxillary sinuses volume [21]. The clinical implications after maxillary sinus reduction remain unknown [18], although these changes don´t seem to negatively affect the airway [20,23]. ...
The airway complex is modified by bimaxillary advancement surgery performed in patients suffering from obstructive sleep apnea (OSA). The aim of the present study is to analyse the volume of nasal and maxillary sinus after bimaxillary advancement surgery in patients suffering from OSA. The maxillary sinus and nasal complex of eighteen patients with OSA was measured through cone-beam computed tomography (CBCT) before and after they were treated with bimaxillary advancement surgery. Digital planning software was used to effectively measure the upper volume changes, as well as, statistical analysis of the results was performed.
Methods Eighteen patients were diagnosed with OSA the severity of which was measured by the apnea hypopnea index and were selected and submitted to preoperative and postoperative CBCT scans. Afterwards, datasets were uploaded into therapeutic digital planning software (Dolphin Imaging) to measure the volume of the right and left maxillary sinus and nasal and maxillary sinus complex. Statistically analysis between preoperative and postoperative measures was performed by Student t-test statistical analysis.
Results The paired t-test showed statistically significant volumetric reductions in the left maxillary sinus (p = 0.0004), right maxillary sinus (p < 0.0001) and nasal and maxillary sinus complex (p = 0.0009) after bimaxillary advancement surgery performed in patients suffering from OSA.
Conclusion The results showed that bimaxillary advancement surgery reduces the maxillary sinus volume as well as, the fossa nasal and sinus complex volume.
... Maxillo-mandibular advancement surgery in subjects with type II dentofacial deformity can produce augmentation in anatomical conditions in the oropharyngeal space when comparing to subjects with a type III dentofacial deformity treated with maxillary advancement and mandibular setback [14]. Several authors [15,16] indicated that the morphological changes in the airway of subjects with type III dentofacial deformity were negative after immediate postoperative evaluation of mandibular setback. ...
Citation: Ravelo, V.; Olate, G.; Unibazo, A.; de Moraes, M.; Olate, S.
... The method used in this research has been used in the past; the CBCT images from the diagnosis and follow up were used by superimposition with surface-based methods in the voxel and reference points [12] to perform comparison. This makes it easier to understand the clinical results and the stability of surgical movement [13]. In our study, we used the superimposition method with the base of the skull as a reference to evaluate the displacement of maxilla and mandible, which allows to confirm the real movement obtained after surgery. ...
Orthognathic surgery is used to modify anomalies in maxillomandibular position; this process can significantly affect the anatomy of the airway and cause functional changes. This study aims to define the impact of mandibular maxillary movement on the airway of subjects with dentofacial deformity. A retrospective study was conducted on subjects with Angle class II (CII group) and Angle class III (CIII group) dentofacial deformities. The subjects were treated by bimaxillary surgery; for all of them, planning was performed with software and 3D printing. Cone beam computed tomography (CBCT) was obtained 21 days before surgery and 6 months after surgery and was used for planning and follow-up with the same conditions and equipment. Was used the superimposition technique to obtain the maximum and minimum airway areas, and total airway volume. The data were analyzed with the Shapiro-Wilk test and Student’s t-test, while Spearman's test was used to correlate the variables, considering a value of p<0.05. Seventy-six subjects aged 18 to 55 years (32.38 ± 10.91) were included: 46 subjects were in CII group, treated with a maxillo-mandibular advancement, and 30 subjects were in the CIII group, treated with a maxillary advancement and a mandibular setback. In CII group, a maxillary advancement of +2.45 mm (±0.88) and a mandibular advancement of +4.25 mm (±1.25) were observed, with a significant increase in all the airway records. In the CIII group, a maxillary advancement of +3.42 mm (±1.25) and a mandibular setback of -3.62 mm (±1.18) was noted, with no significant changes in the variables measured for the airway (p>0.05). It may be concluded that maxillo mandibular advancement is an effective procedure to augment the airway area and volume in the CII group. On the other hand, in subjects with mandibular prognathism and Angle class III operated with the maxillary advancement and mandibular setback lower than 4 mm it is possible to not reduce the areas and volume in the airway.
... In Group 1, insignificant increases occurred in all PAS parameters following different amounts of surgical movement after MMA. Although there was some decrease in the long term (16,21), there were significant increases in the airway after MMA, and these increases were maintained in the long term (3,12,(22)(23)(24)(25)(26). It has also been reported that increases in PAS following MMA lead to improved postoperative polysomnography (PSG) recordings in OSA patients (27). ...
... Studies have also reported a significant increase (18,25) or decrease (8,14) in all PAS parameters after MAMS. In Lee et al.'s (14) study, the amount of skeletal movement was not stated, and a significant decrease was reported in the TV and UV parameters following MAMS. ...
... There are limited studies (12,25) comparing the effect of MMA and MAMS on PAS. Bin et al. (25) compared the effects of MAMS and MMA and reported that both methods did not adversely affect the PAS, similar to the present study. ...
Aim: To examine the pharyngeal airway space (PAS) changes in patients with skeletal Class III anomalies treated with two different bimaxillary surgery (BMS) techniques. Methodology: A total of 27 patients (15 females, 12 males) treated with BMS were divided into two groups: Group 1 (n=16, mean age: 20.67±2.82 years) consisted of patients who underwent maxillary-mandibular advancement (MMA), and Group 2 (n=11, mean age: 23.87±7.72 years) consisted of patients who underwent maxillary advancement and mandibular setback (MAMS). Cone-beam computed tomography (CBCT) records were taken immediately before (T1) and at least 5 months after (T2) BMS. To evaluate the postoperative PAS changes, the parameters of total volume (TV), upper volume (UV), lower volume (LV), and minimal axial area (Min-Ax) were evaluated using NemoCeph 10.4.2 software. Results: In Group 1, postoperative increases in the TV, NV, OV, and Min-Ax were determined as 4.5%, 6.6%, 3.07%, and 5.1%, respectively, but these increases were not statistically significant (p > 0.05). In Group 2, the following increases were determined: 10.4% in TV, 18.4% in NV, and 5.5% in OV. A postoperative decrease of 6.2% was determined for Min-Ax. These increases and decreases were not statistically significant (p > 0.05). There was no statistically significant difference between groups 1 and 2 in any pre- and postoperative parameters (p > 0.05). Conclusion: Neither of the BMS techniques caused any significant change in the PAS parameters. How to cite this article: Koç E, Akkurt A. Investigation of the effects of bimaxillary surgery on the pharyngeal airway space. Int Dent Res 2022;12(3):130-6. https://doi.org/10.5577/intdentres.2022.vol12.no3.4 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.
... Numerous studies investigated the impact of orthognathic procedures on the pharyngeal airway space in patients with class III abnormality. Although the majority of studies demonstrated a significant reduction in airway volume after single-jaw mandibular setback surgery [1,3,6,7], there are controversial reports about the effect of bimaxillary surgery [5,[8][9][10][11][12] with some studies indicating an increase [10] and others exhibiting decrease [4,9,12,13] or maintenance [11,[14][15][16] of airway volume following a combination of maxillary advancement and mandibular setback surgery. Furthermore, most studies included small sample sizes and focused on one or two groups of patients that underwent mandibular setback or bimaxillary surgery for correction of class III dysplasia, whereas the effect of maxillary advancement on airway space has not been sufficiently compared with the two other surgical modalities at the same settings. ...
... Numerous studies investigated the impact of orthognathic procedures on the pharyngeal airway space in patients with class III abnormality. Although the majority of studies demonstrated a significant reduction in airway volume after single-jaw mandibular setback surgery [1,3,6,7], there are controversial reports about the effect of bimaxillary surgery [5,[8][9][10][11][12] with some studies indicating an increase [10] and others exhibiting decrease [4,9,12,13] or maintenance [11,[14][15][16] of airway volume following a combination of maxillary advancement and mandibular setback surgery. Furthermore, most studies included small sample sizes and focused on one or two groups of patients that underwent mandibular setback or bimaxillary surgery for correction of class III dysplasia, whereas the effect of maxillary advancement on airway space has not been sufficiently compared with the two other surgical modalities at the same settings. ...
Objective
This study was conducted to compare changes in pharyngeal airway after different orthognathic procedures in subjects with class III deformity.
Methods
The study included CBCT scans of 48 skeletal class III patients (29 females and 19 males, mean age 23.50 years) who underwent orthognathic surgery in conjunction with orthodontic treatment. The participants were divided into three groups of 16, as follows: Group 1, mandibular setback surgery; group 2, combined mandibular setback and maxillary advancement surgery; and group 3, maxillary advancement surgery. CBCT images were taken 1 day before surgery (T0), 1 day (T1), and 6 months (T2) later. The dimensions of the velopharynx, oropharynx, and hypopharynx were measured in CBCT images.
Results
In all groups, there was a significant decrease in airway variables immediately after surgery, with a significant reversal 6 months later ( P < 0.05). In subjects who underwent maxillary advancement, the airway dimensions were significantly greater at T2 than the T0 time point ( P < 0.05), whereas in the mandibular setback and bimaxillary surgery groups, the T2 values were lower than the baseline examination ( P < 0.05). The alterations in airway variables were significantly different between the study groups ( P < 0.05).
Conclusions
The mandibular setback procedure caused the greatest reduction in the pharyngeal airway, followed by the bimaxillary surgery and maxillary advancement groups, with the latter exhibiting an actual increase in the pharyngeal airway dimensions. It is recommended to prefer a two-jaw operation instead of a mandibular setback alone for correction of the prognathic mandible in subjects with predisposing factors to the development of sleep-disordered breathing.
... 16 Contudo, ainda permanecem desconhecidas as implicações clínicas da diminuição do volume do seio maxilar. 17 Por outro lado, os estudos publicados apresentam uma grande heterogeneidade na sua amostra em termos de tipologia de cirurgia (bimaxilar ou unimaxilar) ou de movimentos cirúrgicos incluídos (bimaxilar, unimaxilar de avanço e/ou impactação do maxilar), o que pode traduzir -se num aumento do viés na avaliação do volume do seio maxilar. ...
Objetivos: A osteotomia de Le Fort I pode induzir alterações estruturais ou anatómicas nas
vias aéreas superiores, particularmente ao nível dos seios maxilares. O objetivo deste estudo foi comparar o volume dos seios maxilares antes e após a osteotomia de Le Fort I de
avanço.
Metódos: Neste estudo retrospetivo foram incluídos 19 doentes submetidos a tratamento
ortodôntico-cirúrgico com osteotomia de Le Fort I de avanço. As tomografias computorizadas de feixe cónico, pré-operatória (T0) e pós-operatória (T1), foram analisadas com recurso
ao software ITK-SNAP a fim de avaliar o volume dos seios maxilares. O teste t de Student
para amostras emparelhadas foi utilizado para avaliar o efeito da osteotomia de Le Fort I de
avanço no volume dos seios maxilares. Considerou-se um nível de significância de p
... CBCT were obtained using the i-Cat® Next Generation equipment (Imaging Sciences International, Hatfield, PA, USA), with 0.3-mm isometric voxel, field of view 17 × 23 cm, 120 Kvp, 3-8 mA. According to the protocol described previously in some studies [16][17][18][19], patients remained seated during scanning and were instructed to adopt the natural head position with the tongue and lips at rest, breathing lightly and avoiding swallowing during image acquisition. Chin and head support were used for initial positioning but were removed during the acquisition, as they could be confused with the soft tissues [17,18]. ...
... Intermediate splints were fabricated based on the virtual models that generated the computerized composite skull model [19]. According to the surgical protocol, patients were submitted to bimaxillary surgery (Le Fort I osteotomy and mandibular bilateral sagittal split osteotomy with or without genioplasty, following the modified CASS protocol) [20], using functionally stable fixation [18]. ...
... With the voxel-based superimposition in the Dolphin 3D software, the postoperative CBCT scans were approximated to preoperative CBCT scans using three landmarks on the neurocranium (glabella and right and left frontal zygomatic sutures) (Fig. 2a). Using the auto-superimposition tool, the cranial base (region not affected by surgery) was used as reference in the coronal, axial, and sagittal reconstructions [9,15,18,19,21] (Figs. 2b, c). ...
PurposeTo evaluate the accuracy of three-dimensional (3D) soft tissue prediction in bimaxillary orthognathic surgery.Methods
Cone-beam computed tomographs of 88 patients with class II (n = 46) and class III (n = 42) malocclusions, who underwent bimaxillary orthognathic surgery, were included in this retrospective study. 3D soft tissue prediction and postoperative outcome were compared by using ten landmarks of facial soft tissues. Patients’ sex and age were also assessed. Results were analyzed using a mixed model methodology (p < 0.05).ResultsThe success criterion adopted was a mean discrepancy of < 2 mm. Most mandibular landmarks indicated a tendency for underprediction with a downward direction in class II patients, with some values > 2 mm. In class III, there was overprediction with a downward direction for the mandibular landmarks, with values < 2 mm. More accurate results were found in female and older patients.Conclusions3D surgical planning showed clinically acceptable results for predicting soft tissues in patients undergoing bimaxillary orthognathic surgery, with more accurate results for class III patients. Although some differences were found when age and sex were interacted, a consistent association between these variables could not be stated. These results support the clinician, as accuracy can provide a strong guide to the surgeon when planning surgical orthodontic treatment.
... В других исследовани ях авторы не выявили статистически значимых различий объема ВДП до и после лечения при помощи RME, но доказали важность раннего начала лечения: чем младше пациенты, тем большее увеличение просвета ВДП можно получить [49]. При бимаксиллярной ортогнатической операции выявлено существенное изменение объемов дыхательных путей [50]. В большинстве случаев проблему обструкции дыхательных путей можно решить с помощью аденотонзиллэктомии, но в 20% случаев операция не приводит к исчезновению СОАС. ...
Due to the high mobility and variability of bone structures and soft tissues surrounding the upper respiratory tract, the exact boundaries for measuring and normalizing the size of the respiratory tract have not yet been determined. Studies have determined the relationship between the narrowing of the upper jaw and a decrease in the transverse dimensions of the airways, as well as a positive effect in changing the size of the airways after orthodontic treatment and/or orthognathic surgery. Nevertheless, the results of research in this area may differ greatly from different specialists, which indicates that the topic is poorly studied and it is necessary to continue and expand the range of scientific works to assess the state of the upper respiratory tract and their relationship with the orthodontic status.
... In surgeries involving the maxilla, maxillary sinuses are affected by the surgery and affect the course of surgery and precise knowledge of such structures with variable anatomy will be important. 3,4 Paranasal sinuses are also very important structures for closely related endoscopic sinus surgeries, endoscopic skull-base interventions like pituitary adenomas, anterior and middle skull-base meningiomas, craniopharyngiomas, surgical repair of (cerebrospinal fluid) CSF fistulas and osteotomies involving the maxilla such as Le Fort osteotomies. 3 Detailed preoperative investigation is crucial for patient selection and hence desired outcome. ...
... 7, 10-12 The same data were also widely investigated before and after different non-surgical and surgical interventions for various pathologic conditions. 4,8,[13][14][15][16][17][18] Changes in paranasal sinus morphologies are often varying degrees of hypoplasia, and it has been observed that the formal configurations are commonly preserved. This situation has been reported in genetic syndromes that cause growth center arrests, interval pressure alterations and osteonecrosis. ...
Introduction: The anatomy of the paranasal sinuses is important for many surgeon groups. The precise knowledge of such structures with variable anatomy will be important for the preservation of these structures and the management of complications in surgeries such as endoscopic sinus surgery and osteotomies involving the maxilla. Objective: The purpose of the present study is to investigate volumetric differences between ethmoid, sphenoid and maxillary sinus volumes in patients with maxillary deficiency requiring Le Fort osteotomy and healthy patients, by employing computed tomography imaging. Methods: Computed tomography scans of 120 patients (59 maxillary deficiency patients and 61 control patients) were included in the study. Images were processed, the paranasal sinuses were sculpted out from 3D images and measured. All measurements were taken twice by the same observers. The observers performed the study twice with an interval of 2 weeks to detect intra-observer variability. Results: Ethmoid and left and right maxillary sinus volumes were smaller in the Le Fort group, although no differences were observed for sphenoid sinus volumes. Conclusion: Paranasal sinus volumes varied between maxillary deficiency patients and control patients. This condition may be crucial for the surgeon operating in these areas and should be taken into consideration during surgeries.
Objective
In this study, we aimed to compare the efficiency of different osteotomy techniques for Lefort 1 osteotomy in an experimental caprine skull model.
Methods
Twelve caprine skulls were used for the study. Skulls were divided into 3 groups: (1) manual chisel group, (2) Lindemann bur group, and (3) piezo osteotomy group. Bilateral osteotomies were performed on each skull. Results were evaluated with three-dimensional computerized tomography scans and macroscopic observations of the mucosal tears and soft tissue.
Results
The mean length of the bone gap in the manual, Lindemann, and piezo groups was 4.8 (±0.7), 3.38 (±1.49), and 1.39 (±0.3) mm, respectively ( P < 0.05). The mean number of comminuted fractures in the manual, Lindemann, and piezo groups was 5.5 (±1.4), 1.6 (±0.3), and 0.6 (±0.5), respectively ( P < 0.05). Mucosal tearing and soft tissue damage based on subjective inspection observations were negligible in the piezo technique. Soft tissue and mucosal damage were observed significantly more in the manual chisel osteotomy method compared with the other 2 techniques.
Conclusion
We anticipate that piezo, which has started to be used in new application areas besides rhinoplasty, will continue to be used more widely, especially in reconstructive orthognathic surgery, due to the minimal damage it causes to tissues. With the long-term results, much healthier interpretations can be made.
