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Sınıf III Maloklüzyonun Cerrahi Düzeltiminde Farklı Maksillomandibuler Hareketlerin Üst Havayolu Anteroposterior Boyutları Üzerindeki Etkilerinin Karşılaştırılması

Yıl 2022, Cilt: 6 Sayı: 2, 58 - 66, 31.12.2022

Necip Fazıl Erdem Yasemin Bahar Acar Alanur Çiftçi Şişman

https://doi.org/10.29228/erd.27

Öz

Amaç: Sınıf III maloklüzyonun düzeltilmesi için farklı bimaksiller cerrahi planların üst hava yolunun ön-arka boyutlarına etkisini değerlendirmek.
Gereç ve Yöntem: Sınıf III düzeltimi için bimaksiller cerrahi ile tedavi edilen 59 birey (ortalama yaş: 23.11±1.85 yıl) dahil edildi. Ameliyat öncesi (T1) ve ameliyat sonrası (T2) lateral sefalogramlar analiz edilerek kafa kaidesi üzerinde çakıştırıldı. A ve B noktalarının yatay hareketlerinin miktarlarına göre 3 grup oluşturuldu. Grup-1: (n=21) B noktasının yer değiştirmesi A noktasından büyüktü. Grup-2: (n=13) A ve B noktalarının yer değiştirmeleri arasındaki fark ≤1mm idi. Grup-3: (n=25), A noktasının yer değiştirmesi B noktasından büyüktü. Ön-arka faringeal hava yolu boyutları (mm), arka(PAS), üst-arka(SPAS), orta(MAS), alt(IAS), epiglottik(EAS) hava yolu boşluklarında ölçüldü. Sınıf içi değerlendirme Paired sample t testi ve Wilcoxon testi ile yapıldı. Sefalometrik değişiklikler için sınıflar arası karşılaştırmalar ANOVA ve Tukey testi ile değerlendirilirken, hava yolu değişiklikleri için Welch ANOVA ve Kruskal-Wallis testleri yapıldı. Hava yolu parametrelerinin ikili karşılaştırmaları Bonferroni düzeltmeli Mann-Whitney u-testi ile yapıldı. Birincil yordayıcı ve sonuç değişkenleri arasındaki ilişkiyi değerlendirmek için Pearson korelasyon analizi yapıldı.
Sonuçlar: Maksiller yükseklik, palatal düzlem, SNA, SNB, ANB, Wits, N-Perp, maksiller derinlik toplam örnekte önemli ölçüde değişti. Mandibular düzlemdeki ve SNB'deki değişiklikler Grup-1'de daha yüksekti (p<0.05). SNA, N-PERP, maksiller derinlikteki değişiklikler Grup-3'te daha yüksekti (p<0.05). Toplam örnekte PAS (ortalama:2.44±2.21mm; medyan:2.17mm) ve SPAS (ortalama:1.07±2.31mm; medyan:1.14mm) oldukça anlamlı artış gösterdi. Grup-1'de İAS anlamlı olarak azaldı (ortalama: -1,98±3,68 mm; ortanca: -1,36 mm). Grup-2'de önemli bir faringeal değişiklik yoktu. Grup-3'te PAS (ortalama:3.03±2.20mm, ortanca:2.63mm) ve SPAS (ortalama:1.64±1.81mm, ortanca: 1,74mm) anlamlı olarak arttı. Toplam örnek, PAS ve SNA arasında anlamlı pozitif doğrusal zayıf ilişki ortaya koydu (r=0.335); IAS ve B noktası arasında (r=0.275). Grup-3'te PAS ve SNA ölçümleri arasında anlamlı pozitif doğrusal orta ilişki vardı (r=0.613).
Sonuç: Farklı kombinasyonlardaki maksillomandibular hareketler üst hava yolunun ön-arka boyutları üzerinde belirgin olarak farklı etkiler göstermiştir. Klinisyenler, hava yolu üzerindeki etkilerini göz önünde bulundurarak ameliyat planlamasını dikkatli bir şekilde yapmalıdır.

Anahtar Kelimeler

ortognatik cerrahi Angle Sınıf III Le Fort I Kesisi

Kaynakça

  • 1. Lowe AA, Ozbek MM, Miyamoto K, Pae EK, Fleetham JA. Cephalometric and demographic characteristics of obstructive sleep apnea: an evaluation with partial least squares analysis. Angle Orthod 1997;67:143-153. https://doi.org/10.1043/0003-3219(1997)067<0143:CADCOO>2.3.CO;2
  • 2. Kiliç N, Oktay H. Effects of rapid maxillary expansion on nasal breathing and some naso-respiratory and breathing problems in growing children: a literature review. Int J Pediatr Otorhinolaryngol. 2008;72:1595-1601. https://doi.org/10.1016/j.ijporl.2008.07.014.
  • 3. Germec-Cakan D, Taner T, Akan S. Uvulo-glossopharyngeal dimensions in non-extraction, extraction with minimum anchorage, and extraction with maximum anchorage. Eur J Orthod. 2011;33:515-520. https://doi.org/10.1093/ejo/cjq109.
  • 4. Kilinç AS, Arslan SG, Kama JD, Ozer T, Dari O. Effects on the sagittal pharyngeal dimensions of protraction and rapid palatal expansion in Class III malocclusion subjects. Eur J Orthod. 2008;30:61-66. https://doi.org/10.1093/ejo/cjm076.
  • 5. Muto T, Yamazaki A, Takeda S, Kawakami J, Tsuji Y, Shibata T, Mizoguchi I. Relationship between the pharyngeal airway space and craniofacial morphology, taking into account head posture. Int J Oral Maxillofac Surg. 2006;35:132-136. https://doi.org/10.1016/j.ijom.2005.04.022.
  • 6. Hasebe D, Kobayashi T, Hasegawa M, Iwamoto T, Kato K, Izumi N, Takata Y, Saito C. Changes in oropharyngeal airway and respiratory function during sleep after orthognathic surgery in patients with mandibular prognathism. Int J Oral Maxillofac Surg. 2011;40:584-592. https://doi.org/10.1016/j.ijom.2011.01.011.
  • 7. Hochban W, Schürmann R, Brandenburg U, Conradt R. Mandibular setback for surgical correction of mandibular hyperplasia--does it provoke sleep-related breathing disorders? Int J Oral Maxillofac Surg. 1996;25:333-338. https://doi.org/10.1016/s0901-5027(06)80024-x.
  • 8. Kawamata A, Fujishita M, Ariji Y, Ariji E. Three-dimensional computed tomographic evaluation of morphologic airway changes after mandibular setback osteotomy for prognathism. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89:278-287. https://doi.org/10.1016/s1079-2104(00)70089-8.
  • 9. Kitagawara K, Kobayashi T, Goto H, Yokobayashi T, Kitamura N, Saito C. Effects of mandibular setback surgery on oropharyngeal airway and arterial oxygen saturation. Int J Oral Maxillofac Surg. 2008;37:328-333. https://doi.org/10.1016/j.ijom.2007.12.005.
  • 10. Steegman R, Hogeveen F, Schoeman A, Ren Y. Cone beam computed tomography volumetric airway changes after orthognathic surgery: a systematic review. International Journal of Oral and Maxillofacial Surgery. 2022; https://doi.org/10.1016/j.ijom.2022.05.013 [Epub ahead of print] Available from: https://www.sciencedirect.com/science/article/pii/S0901502722002260
  • 11. Hwang S, Chung CJ, Choi YJ, Huh JK, Kim KH. Changes of hyoid, tongue and pharyngeal airway after mandibular setback surgery by intraoral vertical ramus osteotomy. Angle Orthod. 2010;80:302-308. https://doi.org/10.2319/040209-188.1.
  • 12. Azevêdo MS, Machado AW, Barbosa Ida S, Esteves LS, Rocha VÁ, Bittencourt MA. Evaluation of upper airways after bimaxillary orthognathic surgery in patients with skeletal Class III pattern using cone-beam computed tomography. Dental Press J Orthod. 2016;21:34-41. https://doi.org/10.1590/2177-6709.21.1.034-041.oar.
  • 13. Uesugi T, Kobayashi T, Hasebe D, Tanaka R, Ike M, Saito C. Effects of orthognathic surgery on pharyngeal airway and respiratory function during sleep in patients with mandibular prognathism. Int J Oral Maxillofac Surg. 2014;43:1082-1090. https://doi.org/10.1016/j.ijom.2014.06.010.
  • 14. Mochida M, Ono T, Saito K, Tsuiki S, Ohyama K. Effects of maxillary distraction osteogenesis on the upper-airway size and nasal resistance in subjects with cleft lip and palate. Orthod Craniofac Res. 2004;7:189-197. https://doi.org/10.1111/j.1601-6343.2004.00300.x.
  • 15. Burkhard JP, Dietrich AD, Jacobsen C, Roos M, Lübbers HT, Obwegeser JA. Cephalometric and three-dimensional assessment of the posterior airway space and imaging software reliability analysis before and after orthognathic surgery. J Craniomaxillofac Surg. 2014;42:1428-1436. https://doi.org/10.1016/j.jcms.2014.04.005.
  • 16. Jakobsone G, Neimane L, Krumina G. Two- and three-dimensional evaluation of the upper airway after bimaxillary correction of Class III malocclusion. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;110:234-242. https://doi.org/10.1016/j.tripleo.2010.03.026.
  • 17. Ryu HH, Kim CH, Cheon SM, Bae WY, Kim SH, Koo SK, Kim MS, Kim BJ. The usefulness of cephalometric measurement as a diagnostic tool for obstructive sleep apnea syndrome: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119:20-31. https://doi.org/10.1016/j.oooo.2014.07.537.
  • 18. Riley RW, Powell NB. Maxillofacial surgery and obstructive sleep apnea syndrome. Otolaryngol Clin North Am. 1990;23:809-826. https://doi.org/10.1016/S0030-6665(20)31254-8
  • 19. Mattos CT, Vilani GN, Sant'Anna EF, Ruellas AC, Maia LC. Effects of orthognathic surgery on oropharyngeal airway: a meta-analysis. Int J Oral Maxillofac Surg. 2011;40:1347-1356. https://doi.org/10.1016/j.ijom.2011.06.020.
  • 20. Hart PS, McIntyre BP, Kadioglu O, Currier GF, Sullivan SM, Li J, Shay C. Postsurgical volumetric airway changes in 2-jaw orthognathic surgery patients. Am J Orthod Dentofacial Orthop. 2015;147:536-546. https://doi.org/10.1016/j.ajodo.2014.12.023.
  • 21. Schwartz AR, Schubert N, Rothman W, Godley F, Marsh B, Eisele D, Nadeau J, Permutt L, Gleadhill I, Smith PL. Effect of uvulopalatopharyngoplasty on upper airway collapsibility in obstructive sleep apnea. Am Rev Respir Dis. 1992;145:527-532. https://doi.org/10.1164/ajrccm/145.3.527.
  • 22. Carlson DS, Ellis E 3rd, Dechow PC. Adaptation of the suprahyoid muscle complex to mandibular advancement surgery. Am J Orthod Dentofacial Orthop. 1987;92:134-143. https://doi.org/10.1016/0889-5406(87)90368-4.
  • 23. van der Vlis M, Dentino KM, Vervloet B, Padwa BL. Postoperative swelling after orthognathic surgery: a prospective volumetric analysis. J Oral Maxillofac Surg. 2014;72:2241-2247. https://doi.org/10.1016/j.joms.2014.04.026.

Comparison of Differential Maxillomandibular Movements on the Upper Airway in Anteroposterior Dimensions After Bimaxillary Surgery for Class III Correction

Yıl 2022, Cilt: 6 Sayı: 2, 58 - 66, 31.12.2022

Necip Fazıl Erdem Yasemin Bahar Acar Alanur Çiftçi Şişman

https://doi.org/10.29228/erd.27

Öz

Objective: To evaluate the effect of different surgery plans on anteroposterior dimensions of upper airway in bimaxillary surgery for correction of Class III malocclusion.
Materials and Methods: 59 subjects (mean age: 23.11±1.85years) treated with bimaxillary surgery for Class III correction were included. Preoperative (T1) and postoperative (T2) lateral cephalograms were traced and superimposed. 3 groups were formed according to different relative horizontal movements of A and B-points. Group-1: (n=21) displacement of B-point was greater than A-point. Group-2: (n=13) difference between displacements of A and B-points were ≤1mm. Group-3: (n=25), displacement of A-point was greater than B-point. Anteroposterior pharyngeal airway dimensions(mm) were measured at posterior(PAS), superoposterior(SPAS), middle(MAS), inferior(IAS), epiglottic(EAS) airway spaces. Intraclass evaluation was performed with Paired sample t-test and Wilcoxon’s test. Interclass comparisons were evaluated with ANOVA and Tukey test for cephalometric changes while Welch ANOVA and Kruskal-Wallis tests were performed for airway changes. Pairwise comparisons of airway parameters were made with Mann-Whitney u-test with Bonferroni correction. Pearson correlation analysis was performed to evaluate relationship between primary predictor and outcome variables.
Results: Maxillary-height, palatal-plane, SNA, SNB, ANB, Wits, N-Perp, maxillary-depth changed significantly in total sample. Changes in Mandibular-plane and SNB were higher in Group-1 (p<0.05). Changes in SNA, N-PERP, maxillary-depth were higher in Group-3 (p<0.05). In total sample, PAS (mean:2.44±2.21mm; median:2.17mm) and SPAS (mean:1.07±2.31mm; median:1.14mm) showed highly significant increase. In Group-1, IAS decreased significantly (mean:-1.98±3.68mm; median:-1.36mm). Group-2 had no significant pharyngeal changes. In Group-3, PAS (mean:3.03±2.20mm, median:2.63mm) and SPAS (mean:1.64±1.81mm, median: 1,74mm) increased significantly. Total sample revealed significant positive linear weak relationship between PAS and SNA (r=0.335); between IAS and B-point (r=0.275). Group-3 had significant positive linear moderate relationship existed between PAS and SNA measurements (r=0.613).
Conclusion: Differential maxillomandibular movements showed distinctly different effects on anteroposterior dimensions of upper airway. Clinicians should prepare surgery planning carefully, considering its effects on the airway.

Anahtar Kelimeler

orthognathic surgery Le Fort I Osteotomy Angle Class III

Kaynakça

  • 1. Lowe AA, Ozbek MM, Miyamoto K, Pae EK, Fleetham JA. Cephalometric and demographic characteristics of obstructive sleep apnea: an evaluation with partial least squares analysis. Angle Orthod 1997;67:143-153. https://doi.org/10.1043/0003-3219(1997)067<0143:CADCOO>2.3.CO;2
  • 2. Kiliç N, Oktay H. Effects of rapid maxillary expansion on nasal breathing and some naso-respiratory and breathing problems in growing children: a literature review. Int J Pediatr Otorhinolaryngol. 2008;72:1595-1601. https://doi.org/10.1016/j.ijporl.2008.07.014.
  • 3. Germec-Cakan D, Taner T, Akan S. Uvulo-glossopharyngeal dimensions in non-extraction, extraction with minimum anchorage, and extraction with maximum anchorage. Eur J Orthod. 2011;33:515-520. https://doi.org/10.1093/ejo/cjq109.
  • 4. Kilinç AS, Arslan SG, Kama JD, Ozer T, Dari O. Effects on the sagittal pharyngeal dimensions of protraction and rapid palatal expansion in Class III malocclusion subjects. Eur J Orthod. 2008;30:61-66. https://doi.org/10.1093/ejo/cjm076.
  • 5. Muto T, Yamazaki A, Takeda S, Kawakami J, Tsuji Y, Shibata T, Mizoguchi I. Relationship between the pharyngeal airway space and craniofacial morphology, taking into account head posture. Int J Oral Maxillofac Surg. 2006;35:132-136. https://doi.org/10.1016/j.ijom.2005.04.022.
  • 6. Hasebe D, Kobayashi T, Hasegawa M, Iwamoto T, Kato K, Izumi N, Takata Y, Saito C. Changes in oropharyngeal airway and respiratory function during sleep after orthognathic surgery in patients with mandibular prognathism. Int J Oral Maxillofac Surg. 2011;40:584-592. https://doi.org/10.1016/j.ijom.2011.01.011.
  • 7. Hochban W, Schürmann R, Brandenburg U, Conradt R. Mandibular setback for surgical correction of mandibular hyperplasia--does it provoke sleep-related breathing disorders? Int J Oral Maxillofac Surg. 1996;25:333-338. https://doi.org/10.1016/s0901-5027(06)80024-x.
  • 8. Kawamata A, Fujishita M, Ariji Y, Ariji E. Three-dimensional computed tomographic evaluation of morphologic airway changes after mandibular setback osteotomy for prognathism. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89:278-287. https://doi.org/10.1016/s1079-2104(00)70089-8.
  • 9. Kitagawara K, Kobayashi T, Goto H, Yokobayashi T, Kitamura N, Saito C. Effects of mandibular setback surgery on oropharyngeal airway and arterial oxygen saturation. Int J Oral Maxillofac Surg. 2008;37:328-333. https://doi.org/10.1016/j.ijom.2007.12.005.
  • 10. Steegman R, Hogeveen F, Schoeman A, Ren Y. Cone beam computed tomography volumetric airway changes after orthognathic surgery: a systematic review. International Journal of Oral and Maxillofacial Surgery. 2022; https://doi.org/10.1016/j.ijom.2022.05.013 [Epub ahead of print] Available from: https://www.sciencedirect.com/science/article/pii/S0901502722002260
  • 11. Hwang S, Chung CJ, Choi YJ, Huh JK, Kim KH. Changes of hyoid, tongue and pharyngeal airway after mandibular setback surgery by intraoral vertical ramus osteotomy. Angle Orthod. 2010;80:302-308. https://doi.org/10.2319/040209-188.1.
  • 12. Azevêdo MS, Machado AW, Barbosa Ida S, Esteves LS, Rocha VÁ, Bittencourt MA. Evaluation of upper airways after bimaxillary orthognathic surgery in patients with skeletal Class III pattern using cone-beam computed tomography. Dental Press J Orthod. 2016;21:34-41. https://doi.org/10.1590/2177-6709.21.1.034-041.oar.
  • 13. Uesugi T, Kobayashi T, Hasebe D, Tanaka R, Ike M, Saito C. Effects of orthognathic surgery on pharyngeal airway and respiratory function during sleep in patients with mandibular prognathism. Int J Oral Maxillofac Surg. 2014;43:1082-1090. https://doi.org/10.1016/j.ijom.2014.06.010.
  • 14. Mochida M, Ono T, Saito K, Tsuiki S, Ohyama K. Effects of maxillary distraction osteogenesis on the upper-airway size and nasal resistance in subjects with cleft lip and palate. Orthod Craniofac Res. 2004;7:189-197. https://doi.org/10.1111/j.1601-6343.2004.00300.x.
  • 15. Burkhard JP, Dietrich AD, Jacobsen C, Roos M, Lübbers HT, Obwegeser JA. Cephalometric and three-dimensional assessment of the posterior airway space and imaging software reliability analysis before and after orthognathic surgery. J Craniomaxillofac Surg. 2014;42:1428-1436. https://doi.org/10.1016/j.jcms.2014.04.005.
  • 16. Jakobsone G, Neimane L, Krumina G. Two- and three-dimensional evaluation of the upper airway after bimaxillary correction of Class III malocclusion. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;110:234-242. https://doi.org/10.1016/j.tripleo.2010.03.026.
  • 17. Ryu HH, Kim CH, Cheon SM, Bae WY, Kim SH, Koo SK, Kim MS, Kim BJ. The usefulness of cephalometric measurement as a diagnostic tool for obstructive sleep apnea syndrome: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119:20-31. https://doi.org/10.1016/j.oooo.2014.07.537.
  • 18. Riley RW, Powell NB. Maxillofacial surgery and obstructive sleep apnea syndrome. Otolaryngol Clin North Am. 1990;23:809-826. https://doi.org/10.1016/S0030-6665(20)31254-8
  • 19. Mattos CT, Vilani GN, Sant'Anna EF, Ruellas AC, Maia LC. Effects of orthognathic surgery on oropharyngeal airway: a meta-analysis. Int J Oral Maxillofac Surg. 2011;40:1347-1356. https://doi.org/10.1016/j.ijom.2011.06.020.
  • 20. Hart PS, McIntyre BP, Kadioglu O, Currier GF, Sullivan SM, Li J, Shay C. Postsurgical volumetric airway changes in 2-jaw orthognathic surgery patients. Am J Orthod Dentofacial Orthop. 2015;147:536-546. https://doi.org/10.1016/j.ajodo.2014.12.023.
  • 21. Schwartz AR, Schubert N, Rothman W, Godley F, Marsh B, Eisele D, Nadeau J, Permutt L, Gleadhill I, Smith PL. Effect of uvulopalatopharyngoplasty on upper airway collapsibility in obstructive sleep apnea. Am Rev Respir Dis. 1992;145:527-532. https://doi.org/10.1164/ajrccm/145.3.527.
  • 22. Carlson DS, Ellis E 3rd, Dechow PC. Adaptation of the suprahyoid muscle complex to mandibular advancement surgery. Am J Orthod Dentofacial Orthop. 1987;92:134-143. https://doi.org/10.1016/0889-5406(87)90368-4.
  • 23. van der Vlis M, Dentino KM, Vervloet B, Padwa BL. Postoperative swelling after orthognathic surgery: a prospective volumetric analysis. J Oral Maxillofac Surg. 2014;72:2241-2247. https://doi.org/10.1016/j.joms.2014.04.026.
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Diş Hekimliği
Bölüm Özgün Araştırmalar
Yazarlar

Necip Fazıl Erdem 0000-0002-5374-3233

Yasemin Bahar Acar 0000-0002-2243-7217

Alanur Çiftçi Şişman 0000-0002-3121-6467

Erken Görünüm Tarihi 18 Ekim 2022
Yayımlanma Tarihi 31 Aralık 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 6 Sayı: 2

Kaynak Göster

APA Erdem, N. F., Acar, Y. B., & Çiftçi Şişman, A. (2022). Comparison of Differential Maxillomandibular Movements on the Upper Airway in Anteroposterior Dimensions After Bimaxillary Surgery for Class III Correction. European Journal of Research in Dentistry, 6(2), 58-66. https://doi.org/10.29228/erd.27