Effects of orthognathic surgery on pharyngeal airway and respiratory function during sleep in patients with mandibular prognathism

• Published in: International journal of oral and maxillofacial surgery Vol. 43; no. 9; pp. 1082 - 1090
• Main Authors: Uesugi, T, Kobayashi, T, Hasebe, D, Tanaka, R, Ike, M, Saito, C
• Format: Journal Article
• Language: English
• Published: Denmark Elsevier Ltd 01-09-2014
• Subjects: Adolescent; Adult; Cone-Beam Computed Tomography; Dentistry; Female; Humans; jaw deformity; Male; Malocclusion, Angle Class III - diagnostic imaging; Malocclusion, Angle Class III - surgery; mandibular setback surgery; Middle Aged; Nasopharynx - diagnostic imaging; Nasopharynx - physiopathology; Nasopharynx - surgery; Orthognathic Surgical Procedures - methods; pharyngeal airway; Polysomnography - instrumentation; Postoperative Complications - physiopathology; Prognathism - surgery; Prospective Studies; Respiration; respiratory function during sleep; Sleep Wake Disorders - physiopathology; Surgery; Treatment Outcome; respiratory function during sleep; mandibular setback surgery; pharyngeal airway; jaw deformity; cone beam computed tomography
• ISSN: 0901-5027; 1399-0020
• DOI: 10.1016/j.ijom.2014.06.010

Abstract The aim of this study was to determine changes in overnight respiratory function and craniofacial and pharyngeal airway morphology following orthognathic surgery. The subjects were 40 patients in whom mandibular prognathism was corrected by orthognathic surgery: a one-jaw operation in 22 patients and a two-jaw operation in 18 patients. Morphological changes were studied using cone beam computed tomography immediately before surgery and at more than 6 months after surgery, and the apnoea–hypopnoea index (AHI) was measured with a portable polysomnography system. Pharyngeal airway volume was decreased significantly after surgery, especially in the one-jaw operation group. AHI was not changed significantly after surgery in either group, although AHI in one patient in the one-jaw operation group was increased to 19 events/h. There was no significant change in pharyngeal airway morphology in that patient, but he was obesity class 1 and was 54 years old. In conclusion, some patients who are obese, have a large amount of mandibular setback, and/or are of relatively advanced age may develop sleep-disordered breathing after mandibular setback; a two-jaw operation should therefore be considered in skeletal class III patients who have such risks because it decreases the amount of pharyngeal airway space reduction caused by mandibular setback surgery.