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Validation of a Finite Element Model for Clinical and Virtual Evaluation of the Changes in Airway Dimensions Following Class III Bimaxillary Orthognathic Surgery

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Abstract

Introduction

The aim of this study was to evaluate pharyngeal airway changes in adult skeletal Class III cases whose bimaxillary surgical treatments were planned with different amounts of maxillary and mandibular movement using lateral cephalometric radiographs and finite element analysis (FEA). Our null hypothesis was that bimaxillary orthognathic surgery in which maxillary forward movement (MF) is greater than mandibular backward movement (MB) will result in more expansion of the pharyngeal airway.

Materials and Methods

A total of 31 individuals (11 females, 20 males) with class III skeletal deformity were included in the study. Patients who underwent bimaxillary orthognathic surgery with greater maxillary advancement (MF > MB) were categorized in Group 1 (n = 15), and those with greater mandibular set-back (MB > MF) as Group 2 (n = 16). Changes in airway dimensions were evaluated from lateral cephalometric radiographs. In addition, FEA modeling was used to determine pharyngeal airway changes with 5 different MF/MB combinations performed in skeletal class III bimaxillary surgeries.

Results

Nasopharyngeal and oropharyngeal airway dimensions increased in direct proportion to the amount of MF. Hypopharyngeal volume decreased compared to preoperative value in direct proportion to the decrease in MB. According to the FEA models, total pharyngeal airway volume decreased when MF was less than or equal to MB, was nearly unchanged when MF was 2 mm greater than MB, and increased when MF was 4 mm greater than MB. The results of FEA and lateral cephalometric analysis were compatible.

Conclusion

Our results supported the null hypothesis. We concluded that when possible, planning slightly more maxillary advancement than mandibular set-back will not have an adverse impact on the airway. Although the skeletal deformity only causes forward displacement of the mandible, dividing the skeletal correction between the maxilla and mandible may be considered to avoid the risk to patients’ quality of life in terms of respiratory function.

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Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

FEA:

Finite element analysis

MF:

Maxillary forward

MB:

Mandibular backward

2D:

Two dimension

3D:

Three dimension

CBCT:

Cone beam computed tomography

SN:

Sella-Nasion Line

APL:

Nasopharyngeal and oropharyngeal anteroposterior length

LTW:

Oropharyngeal, nasopharyngeal and hypopharyngeal largest transverse width

CSA:

Cross sectional area

NPV:

Nasopharyngeal volume

HPV:

Hypopharyngeal volume

OPV:

Oropharyngeal volume

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Funding

This research was supported by Ankara University Scientific Research Projects Coordination. Project Number 16L0234004.

Author information

Authors and Affiliations

  1. Golbasi Oral and Dental Health Center, Ankara, Turkey

    Nagihan Ceylan Eser

  2. Department of Orthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey

    Can Arslan

  3. Department of Orthodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey

    Ayşe Tuba Altuğ

  4. Yeditepe Üniversitesi Diş Hastanesi, Bağdat Caddesi, Istanbul, 34728, Turkey

    Can Arslan

Authors
  1. Nagihan Ceylan Eser
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Contributions

CA and ATA carried out the study design, data collection, and statistical analysis and drafted the manuscript. CA and NCE treated the patients and acquired the data. NCE conceived the study and participated in its design, coordination, and manuscript writing. The authors read and approved the final manuscript.

Corresponding author

Correspondence to Can Arslan.

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All the authors that they have no conflict of interest.

Ethical Approval

Ethical approval of this study was obtained from Ankara University Faculty of Dentistry Clinical Research Ethics Committee (36290600/11).

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Ceylan Eser, N., Arslan, C. & Altuğ, A.T. Validation of a Finite Element Model for Clinical and Virtual Evaluation of the Changes in Airway Dimensions Following Class III Bimaxillary Orthognathic Surgery. J. Maxillofac. Oral Surg. 22, 217–225 (2023). https://doi.org/10.1007/s12663-022-01781-8

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  • DOI: https://doi.org/10.1007/s12663-022-01781-8

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