Upper airway changes following high oblique sagittal split osteotomy (HSSO)

Abstract

The aim of this study was to evaluate volumetric changes of the posterior airway space (PAS) following bimaxillary surgery using a high oblique sagittal split osteotomy (HSSO) of the mandibular ramus. The cone beam CTs of Class II and Class III patients taken before (T0) and 6-12 months after surgery (T1) were analyzed using 3D software (Mimics® Innovation Suite 18.0). The PAS was divided into three segments (superior, middle, inferior) by three planes parallel to the Frankfurt horizontal plane intersecting at the posterior nasal spine, the velum palatinum and the epiglottis. Total (TPAS) and partial volumes (SPAS = superior, MPAS = middle, IPAS = inferior) were calculated. For the 25 Class II patients, a highly significant increase (p<0.001) of the total, middle and inferior airway space (TPAS: +33.6%, MPAS: +43.1%, IPAS: +55.9%) was found, while the increase of the upper airway space was statistically not significant (+5.4%, p = 0.074). For the 28 Class III patients, the total, middle and inferior airway space increased statistically insignificantly (TPAS: +4.6%, p = 0.265, MPAS: +2.7%, p = 0.387, IPAS: +2.8%, p = 0.495), while the increase of the upper airway space was statistically significant (+9.7%, p = 0.010). Bimaxillary orthognathic surgery using the HSSO technique led to a significant increase of PAS for Class II patients and could conserve the PAS for Class III patients.

Keywords: Airway management; Orthognathic surgical procedures; Sagittal split ramus osteotomy.