Effect of Genioplasty on the Pharyngeal Airway Space Following Maxillomandibular Advancement Surgery

doi:10.1016/j.joms.2016.09.005

Journal of Oral and Maxillofacial Surgery

Volume 75, Issue 1, January 2017, Pages 189.e1-189.e12

https://doi.org/10.1016/j.joms.2016.09.005 Get rights and content

Purpose

To evaluate the effect of genioplasty on the size of the pharyngeal airway space (PAS) in a sample of patients without obstructive sleep apnea syndrome (OSAS) undergoing maxillomandibular advancement (MMA) surgery.

Materials and Methods

Lateral cephalometric radiographs of 52 patients who underwent orthognathic surgery for MMA were obtained before (T1) and after (T2) surgery. The radiographs were digitized and the anteroposterior dimensions of the PAS were measured at the nasopharynx, oropharynx, and hypopharynx levels. The sample was divided into 2 groups: MMA with genioplasty (n = 27; average age, 30.81 yr) and without genioplasty (n = 25; average age, 37.64 yr). Comparisons were made between T1 and T2 in patients with and without genioplasty. Horizontal and vertical changes of the maxilla, mandible, and chin were correlated to changes in the PAS.

Results

MMA resulted in an increased anteroposterior PAS at the 3 levels analyzed (P < .05), except in the hypopharynx, in cases without genioplasty (P = .141). When the groups with and without genioplasty were compared, there were no significant differences (P > .05) in the PAS. There was a statistically relevant correlation between horizontal mandibular change and the oropharynx (r = 0.484 and r = 0.509, respectively) and between vertical chin change and the hypopharynx (r = 0.434 and r = 0.455, respectively) for groups with and without genioplasty. There was a statistically relevant correlation between horizontal chin change and the hypopharynx (r = 0.586) for surgeries without genioplasty.

Conclusion

Considering the limitations inherent to retrospective study designs, the results suggested that MMA surgery, with and without advancement genioplasty, can promote immediate gains to the PAS. A larger gain was possible in the hypopharynx for MMA with genioplasty. MMA without genioplasty could represent a greater gain in the nasopharynx and oropharynx. Further studies should evaluate functional parameters in patients with OSAS to measure the possible benefits of this increase in the PAS.

Section snippets

Materials and Methods

This retrospective study was approved by the research ethics committee of the Federal University of Goiás (Goiânia, Goiás, Brazil; protocol number 234371).

Results

In total, 104 LCRs were taken, corresponding to the T1 and T2 examinations of 52 patients who underwent MMA surgery with or without advancement genioplasty (Table 1).

The difference in the average measurement of craniocervical angulation at the T1 and T2 examinations was −0.7° ± 1.3° for the group that underwent genioplasty surgery and 0.13° ± 1.57° for the group that did not undergo genioplasty. These differences in angulation showed no statistically significant differences (P > .05).

Discussion

The present study compared MMA with and without genioplasty advancement by analyzing LCRs. Genioplasty was performed to esthetically improve the anteroposterior position of the chin in a sample of patients without OSAS. However, the genioplasty surgery was expected to improve the PAS results, because the inclusion of the genial tubercles was performed for all cases and myotomy of the genioglossus musculature was not performed. The hypothesis of this study, that genioplasty would affect the PAS,

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Cited by (18)

Comparison of airway changes after maxillomandibular advancement with or without genial tubercle advancement in obstructive sleep apnea using cone-beam computed tomography
2022, American Journal of Orthodontics and Dentofacial Orthopedics
Citation Excerpt :
A single investigator (W.K) established landmarks and planes and then measured parameters of interest. The consistency of preoperative and postoperative head position was determined by the craniocervical inclination18,20,23; this is measured as the angle between the sella-nasion (SN) line and tangent line of the posterior border of the second cervical vertebra. The skull was reoriented to the Frankfort horizontal plane (FHP), and the midsagittal plane was placed through the incisive canal.
This study compared the airway changes of patients with obstructive sleep apnea (OSA) after maxillomandibular advancement (MMA) with or without genial tubercle advancement (GTA) using cone-beam computed tomography.
The authors retrospectively studied 26 patients with moderate to severe OSA who underwent MMA with or without GTA. Airway changes were determined from preoperative and postoperative 3-dimensional reconstructed cone-beam computed tomography images. The Wilcoxon signed rank test, Mann-Whitney U tests, and Spearman correlation coefficients were used in data analysis.
Airway was changed in all dimensions significantly after MMA with or without GTA. There was no significant difference in horizontal surgical changes between MMA and MMA with the GTA group. The mean increase in total airway volume was 66.8% for MMA alone and 74.7% for MMA with GTA (P = 0.39). Patients who underwent MMA had a larger percentage change of segmented upper airway volume than patients with MMA and GTA (106.6% vs 85.3%; P = 0.65). The group with MMA and GTA had a greater percentage change of segmented lower airway volume than the MMA alone group (80.1% vs 56.3%; P = 0.42).
Differences in airway changes between MMA alone and MMA with GTA were not statistically significant. Performing the GTA concomitantly with MMA may not cause greater improvement in the pharyngeal airway in patients with OSA compared with MMA alone.
Three-dimensional morphologic evaluation of the changes in the pharyngeal airway and hyoid bone after bimaxillary surgery in patients with skeletal Class III malocclusion with facial asymmetry: A preliminary study
2022, American Journal of Orthodontics and Dentofacial Orthopedics
Citation Excerpt :
In addition, in this study, because of the lack of sample size, the patients who go through genioplasty were not possibly excluded. Torres et al13 reported that genioplasty could affect the hypopharynx area. To discriminate these possible effects from genioplasty, menton and B-point movements were recorded separately.
The study aimed to evaluate the morphologic changes in the pharyngeal airway after bimaxillary surgery in skeletal Class III malocclusion patients with or without asymmetry. We also analyzed the correlation between positional changes in the menton, hyoid bone, and changes in the dimensions of the pharyngeal airway.
We included 32 patients with skeletal Class III malocclusion who underwent bimaxillary surgery. There were 16 subjects in the symmetry group (10 male, 6 female; mean age, 22.44 ± 5.14 years), and 16 in the asymmetry group (10 male, 6 female; mean age, 21.38 ± 4.62 years). Preoperative and postoperative (2 months after surgery) cone-beam computed tomography scans were taken and then analyzed by comparing postoperative changes in each group.
The anteroposterior lengths at the uvula level (P2L) and epiglottis level (P3L) were significantly decreased in the symmetry group. The P2L was also significantly decreased in the asymmetry group, and a difference in the P3L was observed. However, there was no significant change in the width at the uvula level (P2W) and epiglottis level (P3W) in the symmetry group. In contrast, in the asymmetry group, P2W and P3W were significantly decreased. The cross-sectional ratio was significantly decreased P2 (P2L/P2W) and P3 (P3L/P3W) in the symmetry group. However, a statistically significant decrease occurred only at P3 in the asymmetry group. Anteroposterior positional changes of the menton and P2L (r = −0.370; P <.05), P3L (r = −0.414; P <0.05), and P3L/P3W (r = −0.361; P <0.05) were correlated.
Differences in the morphologic features of the pharyngeal airway after bimaxillary surgery was observed in both the symmetry and asymmetry groups. Bimaxillary surgery with a mandibular setback in patients with skeletal Class III malocclusion worsened morbidity of the elliptical structure of the pharyngeal airway. However, it worsened less in the asymmetry group than in the symmetry group.
The correlation of maxillomandibular advancement and airway volume change in obstructive sleep apnea using cone beam computed tomography
2021, International Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
Muto et al.25 reported that an increase in cranio-cervical inclination of 10° increased the PAS at the base of the tongue by 4 mm. This limitation was controlled to an extent in the present study by using a difference in cranio-cervical inclination of less than 5° to standardize the head position23,25. The second limitation is that the stability of the postoperative airway change may vary according to the timing of the postoperative imaging.
The purpose of this retrospective study was to evaluate the correlation of maxillomandibular advancement (MMA) and airway volume changes in patients with obstructive sleep apnea (OSA), and to determine the surgical skeletal movements necessary to achieve an increase in total airway volume (TAV) of ≥70%. Thirty patients with OSA treated by MMA were evaluated. Pre- and postoperative cone beam computed tomography images were used to determine the horizontal distance and angular changes in surgical parameters and linear, area, and volumetric airway parameters. Postoperatively, the horizontal distance of surgical parameters (A-point, UI, B-point, pogonion, and menton) and craniofacial angulation (SNA and SNB) increased significantly, similar to total surface area, TAV, and minimum cross-sectional area of the airway (p < 0.0001). The total airway length decreased significantly (p < 0.0001). The mean increase in TAV was 67.2%. There were positive correlations between linear surgical changes and the percentage change in TAV. All surgical parameters were predictive of a change in TAV ≥70%. The optimal surgical change was 6 mm for A-point, 7.9 mm for UI, 7.6 mm for B-point, 11.2 mm for pogonion, and 10 mm for menton. In conclusion, maxillary advancement of less than 10 mm was adequate in this study to obtain an increase in the TAV of at least 70%.
Follow-up observation of patients with obstructive sleep apnea treated by maxillomandibular advancement
2020, American Journal of Orthodontics and Dentofacial Orthopedics
This study aimed to evaluate the follow-up observation of patients with obstructive sleep apnea treated with maxillomandibular advancement (MMA) procedure with or without genial tubercle advancement (GTA).
A total of 25 patients (mean age 37.1 ± 17.3 years) were included in the study. Cone-beam computed tomography scans were taken before treatment; after presurgical orthodontic treatment; immediately after MMA procedure; and follow-up visit. All Digital Imaging and Communications in Medicine files were analyzed using the Dolphin 3D Imaging software program (Dolphin Imaging and Management Solutions, Chatsworth, Calif) to determine the total airway volume (TAV), airway area (AA), and minimal cross-sectional area (MCA). Dolphin 3D voxel-based superimposition was used to determine the amount of skeletal advancement with MMA and changes after surgery.
Significant increase in TAV, AA, and MCA was found with MMA treatment (40.6%, 28.8%, and 56.4%, respectively, P <0.0001). Smaller but significant decrease in TAV, AA, and MCA was found during a follow-up visit (20.0%, 9.7%, and 26.8%, respectively, P <0.0001) giving a net increase of TAV, AA and MCA (35.8%, 27.1%, and 45.9%, respectively). No significant differences were found in any of the airway measurements with or without the GTA procedure. The average forward movements of the maxilla, mandible, and chin were 6.6 mm, 8.2 mm, and 11.4 mm, respectively. A relapse of less than 1 mm was found in each of the variables during the follow-up period. No correlation was found between the magnitudes of skeletal advancement and the change in oropharyngeal airway space (OPAS).
Significant increase in OPAS can be expected with MMA surgery with or without GTA procedure in patients diagnosed with obstructive sleep apnea. A partial loss in OPAS was found during the follow-up visit. The surgical movements were found to be stable, with less than 1 mm of relapse during the follow-up period, which was not clinically significant.
Orthognathic surgery for obstructive sleep apnea
2019, Seminars in Orthodontics
As the importance in the management of obstructive sleep apnea and other obstructive upper airway disease continues to increase, the effect of orthognathic surgery on the upper airway in correction of both dentofacial deformities and obstructive sleep apnea has become a prominent component of treatment planning in recent decades. Applied correctly, orthognathic surgery can have a dramatic and life-changing effect on decreasing nocturnal obstructions through expansion of the upper airway. Large advancements of the maxillomandibular complex allows for three-dimensional upper airway expansion to nocturnal obstruction that diminish the deleterious effects of obstructive sleep apnea. This paper will discuss the orthognathic surgical techniques that are essential in the treatment planning to achieve the desired results of relief of nocturnal upper airway obstructions.
Pharyngeal airway space changes after maxillomandibular advancement: a five-year retrospective study
2019, International Journal of Oral and Maxillofacial Surgery
The aim of this study was to compare the alterations in three regions of the airway—nasopharynx, oropharynx, and hypopharynx—in relation to the area of the midsagittal plane, volume, and minimal axial area after maxillomandibular advancement (MMA) surgery. Thirty patients who had undergone MMA surgery were evaluated at four time points: preoperative (T0), immediately postoperative (T1), 1 year postoperative (T2), and ≥5 years postoperative (T3). All measurements were performed using computed tomography, analyzed in Dolphin Imaging 11.0 Premium 3D software. The area in the midsagittal plane presented a mean increase of 22.0% between T0 and T3 (P < 0.001), with the highest increase in the oropharynx (24.1%, P < 0.001). The total volumetric increase at T3 was 16.7% (P < 0.001), with the highest increase in the nasopharynx (15.7%; P < 0.001). The lowest minimal axial area was found for the oropharynx at all time points, and the highest increase in minimal axial area was found for the nasopharynx (114.9%; P < 0.001). MMA surgery showed the highest increase in upper posterior airway between T0 and T1, and this was followed by a progressive reduction until T3, but with a statistically significant increase at T3 compared with T0 in all cases.

View all citing articles on Scopus

: This study was financially supported by the National Council for Scientific and Technological Development (project 486771/2012).

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Craniomaxillofacial deformities/cosmetic surgeryEffect of Genioplasty on the Pharyngeal Airway Space Following Maxillomandibular Advancement Surgery

Purpose

Materials and Methods

Results

Conclusion

Section snippets

Materials and Methods

Results

Discussion

J Oral Maxillofac Surg

Sleep Med Clin

Otolaryngol Head Neck Surg

Chest

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Sleep Med Rev

Int J Oral Maxillofac Surg

J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Craniomaxillofacial deformities/cosmetic surgery
Effect of Genioplasty on the Pharyngeal Airway Space Following Maxillomandibular Advancement Surgery