Two-Year Postoperative Upper Airway Cone-Beam Computed Tomographic Outcomes Based on a Verified Upper Airway Analysis Following Bimaxillary Orthognathic Surgery

Sirwan Fernandez Gurani; Gabriele Di Carlo; Jens Jørgen Thorn; Janne Ingerslev; Paolo Maria Cattaneo; Else Marie Pinholt

doi:10.1016/j.joms.2019.02.038

Two-Year Postoperative Upper Airway Cone-Beam Computed Tomographic Outcomes Based on a Verified Upper Airway Analysis Following Bimaxillary Orthognathic Surgery

J Oral Maxillofac Surg. 2019 Jul;77(7):1435-1445. doi: 10.1016/j.joms.2019.02.038. Epub 2019 Mar 5.

Authors

Sirwan Fernandez Gurani¹, Gabriele Di Carlo², Jens Jørgen Thorn³, Janne Ingerslev⁴, Paolo Maria Cattaneo⁵, Else Marie Pinholt⁶

Affiliations

¹ PhD Fellow, Department of Oral and Maxillofacial Surgery, Hospital of South West Denmark, Esbjerg; University of Southern Denmark, Faculty of Health Sciences, Institute of Regional Health Services Sciences, Esbjerg, Denmark. Electronic address: Sirwan.fernandez.gurani@rsyd.dk.
² Consultant, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy; Section of Orthodontics, Department of Dentistry and Oral Health, Faculty of Health Science, Aarhus University, Aarhus, Denmark.
³ Head of Department, Oral and Maxillofacial Surgery, Hospital of South West Denmark, Esbjerg, Denmark.
⁴ Senior Consultant, Department of Oral and Maxillofacial Surgery, Hospital of South West Denmark, Esbjerg, Denmark.
⁵ Associate Professor, Section of Orthodontics, Department of Dentistry and Oral Health, Faculty of Health Science, Aarhus University, Aarhus, Denmark.
⁶ Professor, University of Southern Denmark, Faculty of Health Sciences, Institute of Regional Health Services Sciences, Esbjerg; Department of Oral and Maxillofacial Surgery, Hospital of South West Denmark, Esbjerg, Denmark.

PMID: 30926544
DOI: 10.1016/j.joms.2019.02.038

Abstract

Purpose: Upper airway (UA) assessment after orthognathic surgery should rely on a verified method of UA analysis. Therefore, the authors applied a new validated UA evaluation method to determine the effect of bimaxillary surgery (BMS) on UA parameters and hyoid bone and epiglottis displacement evaluated immediately and 2 years after surgery.

Materials and methods: A retrospective cohort study was implemented of patients without obstructive sleep apnea who had undergone BMS for maxillomandibular deficiencies. A new validated UA cone-beam computed tomographic (CBCT) analysis, based on stable anatomic landmarks, was applied to CBCT scans acquired before initiation of treatment (T0), immediately after surgery (T1), and 2 years postoperatively (T2). A quality assessment was performed before analysis. The primary predictor variable consisted of time points during treatment (T0, T1 and T2), and UA volumes, cross-sectional area (CSA), and hyoid bone and epiglottis displacement were the outcome variables. Descriptive statistics and t test were performed and the P value was set at .05.

Results: Fifty patients (16 men and 34 women) with a mean age of 25.7 ± 8.2 years at time of surgery were included. CBCT scans were acquired at T0 (20 ± 9 months before surgery), T1 (14 ± 2 days after surgery), and T2 (30 ± 6 months after surgery). Immediately after surgery (T1 vs T0), BMS resulted in a statistically relevant UA volume increase of 26%. At 2-year follow-up (T2 vs T0), UA volume showed a statistically relevant increase by 20%. CSA increased by approximately 26 and 19% (P < .001) at T1 versus T0 and T2 versus T0, respectively. Two years after surgery, epiglottis displacement was 2 mm (P < .001) and hyoid bone displacement was 3 mm (P < .001) in a cranial direction and hyoid bone anterior displacement measured 3 mm (P < .001).

Conclusions: Based on an objective, standardized, and validated CBCT UA analysis, BMS was associated with increased UA volume and CSA measures evaluated immediately and 2 years after surgery.

MeSH terms

Adolescent
Adult
Cephalometry
Cone-Beam Computed Tomography*
Female
Humans
Male
Malocclusion, Angle Class III*
Maxilla
Orthognathic Surgery*
Orthognathic Surgical Procedures*
Pharynx
Retrospective Studies
Treatment Outcome
Young Adult