Impact of bone-anchored maxillary protraction on the quality of life of subjects with complete unilateral cleft lip and palate.

INTRODUCTION: This study aimed to evaluate the influence of bone-anchored maxillary protraction (BAMP) on the oral health-related quality of life (OHRQOL) in subjects with complete unilateral cleft lip and palate (UCLP) and moderate-to-severe maxillary deficiency. METHODS: A longitudinal observational study was conducted with a sample of 20 patients (13 males, 7 females) aged 10-14 years (mean age, 11.8 years) with Goslon 3, 4, and 5. To assess the patient's perception of their OHRQOL, the Quality of Life Questionnaire for Orthosurgical Patients was administered in 2 stages: after the installation of the protraction plates (T1) and 18 months after the protraction therapy started (T2). The questionnaire was composed of 4 domains, distributed over 22 questions: social aspects, facial esthetics, oral function, and awareness of facial deformity. RESULTS: The treatment protocol improved the OHRQOL in 75% of the patients who presented UCLP. The domain social aspects of the deformity were the only one that showed a significant difference from T1 to T2 and indicated an improvement in self-esteem. The girls had worse OHRQOL than boys at T1, which was statistically significant only for the domains of social aspects of deformity and awareness of deformity. After BAMP therapy, the effect size indicated a larger change in OHRQOL in girls than in boys. CONCLUSIONS: BAMP therapy positively impacted the OHRQOL and self-esteem of patients with UCLP during adolescence.

Early orthognathic surgery with postsurgical bone-anchored retention in unilateral cleft lip and palate: A case report.

We present a case report of early Le Fort I osteotomy with maxillary advancement retained postoperatively by Class III elastics anchored on miniplates in a growing patient with complete unilateral cleft lip and palate (UCLP). A 14-year-old boy who underwent orthognathic surgery at the pubertal growth spurt was presented. During surgery, Bollard miniplates were installed in the posterior region of the maxilla and in the anterior region of the mandible. Class III elastics anchored on miniplates were used at night (8-10 h) starting 60 days after surgery. The force of the elastics progressively increased from 100 g to 250 g. The elastics were replaced daily. The positive overjet remained stable over 15 months of postoperative follow-up. Maxillary advancement was adequately retained using Bollard miniplates and the facial profile remained stable until the end of facial growth.

Influence of bone-anchored maxillary protraction on secondary alveolar bone graft status in unilateral complete cleft lip and palate.

INTRODUCTION: Our objective was to evaluate the effects of bone-anchored maxillary protraction (BAMP) on the status of the secondary alveolar bone graft in patients with unilateral complete cleft lip and palate (UCLP). METHODS: The experimental group (EG) comprised 26 patients with UCLP, mean age of 11.9 years, submitted to secondary alveolar bone grafting (SABG) with recombinant bone morphogenetic protein, and BAMP therapy, using miniplate-borne Class III intermaxillary elastics. Cone beam computed tomography (CBCT) examinations were taken 6 months after SABG and before BAMP (T1) and after 18 months of BAMP therapy (T2). The control group (CG) was composed of 24 patients with UCLP submitted only to SABG with recombinant bone morphogenetic protein or autogenous bone from iliac crest without BAMP therapy, matched by initial age and sex with the EG. In the CG, CBCT examinations were performed 6 months (T1) and 12 months (T2) after SABG surgery. CBCT axial sections were analyzed using Garib scores in both time points. Intra- and intergroup comparisons were performed using Wilcoxon and Mann-Whitney tests, respectively (P <0.05). RESULTS: No intergroup differences were found at T1 and T2. The EG showed significant improvement of graft status from T1 to T2 at the cervical and middle levels of the alveolar cleft. No significant interphase differences were found for graft scores in the CG. CONCLUSIONS: Despite loads of intermaxillary elastics applied to the maxilla, no harm to the grafted alveolar bone was observed after BAMP therapy in patients with UCLP.

Bone-anchored maxillary protraction in unilateral cleft lip and palate: a cephalometric appraisal.

OBJECTIVES: The aim of this study was to evaluate the cephalometric outcome of bone-anchored maxillary protraction (BAMP) in individuals with unilateral complete cleft lip and palate (UCLP). MATERIAL AND METHODS: The experimental group (EG) comprised 23 individuals (17 males and 6 females) with UCLP and a mean age of 11.7 years. At least 6 months after secondary alveolar bone grafting, Bollard miniplates were installed in the posterior region of the maxilla and in the anterior region of the mandible. Class III elastics were recommended to be worn for 24 hours/day for a mean time of 18 months. Cone beam computed tomography (CBCT) was obtained before (T1) and after treatment (T2). The control group (CG) consisted of 23 individuals with UCLP matched by initial age and gender with the EG and without any orthopaedic or surgical intervention performed between T1 and T2. The interval between T1 and T2 observations was 18 months for both groups. Twenty-one cephalometric variables were analysed. Intra- and intergroup comparisons were performed using paired and independent t-tests, respectively (P < 0.05). RESULTS: BAMP caused a greater maxillary protrusion (SNA) and a greater decrease of Class III maxillomandibular discrepancy (ANB and Wits appraisal) compared with the CG. BAMP also caused a counterclockwise rotation of the occlusal plane (Occ Plane to FH) and an improvement in the molar relationship compared with controls. CONCLUSIONS: BAMP therapy demonstrated a significant orthopaedic maxillary protraction and an improvement in the Class III skeletal pattern in UCLP.

Bone-anchored maxillary protraction in a patient with complete cleft lip and palate: A case report.

Sagittal maxillary deficiency is frequently observed in patients with operated unilateral complete cleft of the lip and palate. Treatment for moderate to severe Class III malocclusion usually relies on LeFort I surgery for maxillary advancement after the end of growth. This case report describes bone-anchored maxillary protraction in a 10-year-old white boy with unilateral complete cleft of the lip and palate. His interarch relationship was diagnosed as GOSLON index 5 before treatment with a negative overjet of 3.2 mm. The orthopedic traction was started 4 months after secondary alveolar bone graft surgery and before comprehensive orthodontic treatment. Class III elastics were used full time for 18 months. After treatment, the interarch relationship was GOSLON index 1 with a positive overjet. The SNA angle increased by 6.50° and A-Na Perp increased by 3.8 mm, leading to marked improvement in facial convexity (+14.6°). No posterior rotation of the mandible occurred with a slight closure of the gonial angle. Visualization of 3-dimensional color-coded maps showed an overall forward maxillary displacement. The bone-anchored maxillary protraction results for this patient are a promising orthopedic therapy for patients with unilateral complete cleft of the lip and palate, with the advantage of achieving much earlier improvement of facial esthetics and functional occlusion, compared with LeFort I surgery at skeletal maturity.

Bone-anchored maxillary protraction therapy in patients with unilateral complete cleft lip and palate: 3-dimensional assessment of maxillary effects.

INTRODUCTION: The aim of this study was to 3-dimensionally assess the treatment outcomes of bone-anchored maxillary protraction (BAMP) in patients with unilateral cleft lip and palate. METHODS: The cleft group comprised 24 patients with unilateral cleft lip and palate and Class III malocclusion with mean initial and final ages of 11.8 and 13.2 years, respectively. The noncleft group comprised 24 noncleft patients with Class III malocclusion with mean initial and final ages of 11.9 and 12.9 years, respectively. Cone-beam computed tomography examinations were performed before and after BAMP therapy in both groups and superimposed at the cranial base. Three-dimensional displacements of maxillary landmarks were quantified and visualized with color-coded maps and semitransparent superimpositions. The t test corrected for multiple testing (Holm-Bonferroni method), and the paired t test was used for statistical comparison between groups and sides, respectively (P <0.05). RESULTS: BAMP produced anterior (1.66 mm) and inferior (1.21 mm) maxillary displacements in the cleft group with no significant differences compared with the noncleft group. The maxillary first molars of the cleft group showed significantly greater medial displacement than did those in the noncleft group. The zygoma showed significantly greater lateral displacement at the cleft side compared with the noncleft side. CONCLUSIONS: BAMP caused similar amounts of maxillary protraction in patients with and without unilateral cleft lip and palatem with discrete differences between the cleft side and the noncleft side.

Growth modification of the face: A current perspective with emphasis on Class III treatment.

A summary of the current status of modification of jaw growth indicates the following. 1. Transverse expansion of the maxilla is easy before adolescence, requires heavy forces to create microfractures during adolescence, and can be accomplished only with partial or complete surgical osteotomy after adolescence. Transverse expansion of the mandible or constriction of either jaw requires surgery. 2. Acceleration of mandibular growth in preadolescent or adolescent patients can be achieved, but slower than normal growth afterward reduces or eliminates a long-term increase in size of the mandible. Restraint of maxillary growth occurs with all types of appliances to correct skeletal Class II problems. For short-face Class II patients, increasing the face height during preadolescent or adolescent orthodontic treatment is possible, but it may make the Class II problem worse unless favorable anteroposterior growth occurs. For those with a long face, controlling excessive vertical growth during adolescence is rarely successful. 3. Attempts to restrain mandibular growth in Class III patients with external forces largely result in downward and backward rotation of the mandible. Moving the maxilla forward with external force is possible before adolescence; moving it forward and simultaneously restricting forward mandibular growth without rotating the jaw is possible during adolescence with intermaxillary traction to bone anchors. The amount of skeletal change with this therapy often extends to the midface, and the short-term effects on both jaws are greater than with previous approaches, but individual variations in the amount of maxillary vs mandibular response occur, and it still is not possible to accurately predict the outcome for a patient. For all types of growth modification, 3-dimensional imaging to distinguish skeletal changes and better biomarkers or genetic identification of patient types to indicate likely treatment responses are needed.

Three-dimensional analysis of maxillary changes associated with facemask and rapid maxillary expansion compared with bone anchored maxillary protraction.

INTRODUCTION: Our objectives in this study were to evaluate in 3 dimensions the growth and treatment effects on the midface and the maxillary dentition produced by facemask therapy in association with rapid maxillary expansion (RME/FM) compared with bone-anchored maxillary protraction (BAMP). METHODS: Forty-six patients with Class III malocclusion were treated with either RME/FM (n = 21) or BAMP (n = 25). Three-dimensional models generated from cone-beam computed tomographic scans, taken before and after approximately 1 year of treatment, were registered on the anterior cranial base and measured using color-coded maps and semitransparent overlays. RESULTS: The skeletal changes in the maxilla and the right and left zygomas were on average 2.6 mm in the RME/FM group and 3.7 mm in the BAMP group; these were different statistically. Seven RME/FM patients and 4 BAMP patients had a predominantly vertical displacement of the maxilla. The dental changes at the maxillary incisors were on average 3.2 mm in the RME/FM group and 4.3 mm in the BAMP group. Ten RME/FM patients had greater dental compensations than skeletal changes. CONCLUSIONS: This 3-dimensional study shows that orthopedic changes can be obtained with both RME/FM and BAMP treatments, with protraction of the maxilla and the zygomas. Approximately half of the RME/FM patients had greater dental than skeletal changes, and a third of the RME/FM compared with 17% of the BAMP patients had a predominantly vertical maxillary displacement.

Three-dimensional assessment of mandibular and glenoid fossa changes after bone-anchored Class III intermaxillary traction.

INTRODUCTION: Conventional treatment for young Class III patients involves extraoral devices designed to either protract the maxilla or restrain mandibular growth. The use of skeletal anchorage offers a promising alternative to obtain orthopedic results with fewer dental compensations. Our aim was to evaluate 3-dimensional changes in the mandibles and the glenoid fossae of Class III patients treated with bone-anchored maxillary protraction. METHODS: Twenty-five consecutive skeletal Class III patients between the ages of 9 and 13 years (mean age, 11.10 ± 1.1 year) were treated with Class III intermaxillary elastics and bilateral miniplates (2 in the infrazygomatic crests of the maxilla and 2 in the anterior mandible). The patients had cone-beam computed tomography images taken before initial loading and at the end of active treatment. Three-dimensional models were generated from these images, registered on the anterior cranial base, and analyzed by using color maps. RESULTS: Posterior displacement of the mandible at the end of treatment was observed in all subjects (posterior ramus: mean, 2.74 ± 1.36 mm; condyles: mean, 2.07 ± 1.16 mm; chin: mean, -0.13 ± 2.89 mm). Remodeling of the glenoid fossa at the anterior eminence (mean, 1.38 ± 1.03 mm) and bone resorption at the posterior wall (mean, -1.34 ± 0.6 mm) were observed in most patients. CONCLUSIONS: This new treatment approach offers a promising alternative to restrain mandibular growth for Class III patients with a component of mandibular prognathism or to compensate for maxillary deficiency in patients with hypoplasia of the midface. Future studies with long-term follow-up and comparisons with facemask and chincup therapies are needed to better understand the treatment effects.

Three-dimensional assessment of maxillary changes associated with bone anchored maxillary protraction.

INTRODUCTION: Bone-anchored maxillary protraction has been shown to be an effective treatment modality for the correction of Class III malocclusions. The purpose of this study was to evaluate 3-dimensional changes in the maxilla, the surrounding hard and soft tissues, and the circummaxillary sutures after bone-anchored maxillary protraction treatment. METHODS: Twenty-five consecutive skeletal Class III patients between the ages of 9 and 13 years (mean, 11.10 ± 1.1 years) were treated with Class III intermaxillary elastics and bilateral miniplates (2 in the infrazygomatic crests of the maxilla and 2 in the anterior mandible). Cone-beam computed tomographs were taken before initial loading and 1 year out. Three-dimensional models were generated from the tomographs, registered on the anterior cranial base, superimposed, and analyzed by using color maps. RESULTS: The maxilla showed a mean forward displacement of 3.7 mm, and the zygomas and the maxillary incisors came forward 3.7 and 4.3 mm, respectively. CONCLUSIONS: This treatment approach produced significant orthopedic changes in the maxilla and the zygomas in growing Class III patients.

Dentofacial effects of bone-anchored maxillary protraction: a controlled study of consecutively treated Class III patients.

INTRODUCTION: In this cephalometric investigation, we analyzed the treatment effects of bone-anchored maxillary protraction (BAMP) with miniplates in the maxilla and mandible connected by Class III elastics in patients with Class III malocclusion. METHODS: The treated sample consisted of 21 Class III patients consecutively treated with the BAMP protocol before the pubertal growth spurt (mean age, 11.10 ± 1.8 years) and reevaluated after BAMP therapy, about 1 year later. The treated group was compared with a matched control group of 18 untreated Class III subjects. Significant differences between the treated and control groups were assessed with independent-sample t tests (P <0.05). RESULTS: Sagittal measurements of the maxilla showed highly significant improvements during active treatment (about 4 mm more than the untreated controls), with significant protraction effects at orbitale and pterygomaxillare. Significant improvements of overjet and molar relationship were recorded, as well as in the mandibular skeletal measures at Point B and pogonion. Vertical skeletal changes and modifications in incisor inclination were negligible, except for a significant proclination of the mandibular incisors in the treated group. Significant soft-tissue changes reflected the underlying skeletal modifications. CONCLUSIONS: Compared with growth of the untreated Class III subjects, the BAMP protocol induced an average increment on skeletal and soft-tissue advancement of maxillary structures of about 4 mm, and favorable mandibular changes exceeded 2 mm.

Three-dimensional analysis of maxillary protraction with intermaxillary elastics to miniplates.

INTRODUCTION: Early Class III treatment with reverse-pull headgear generally results in maxillary skeletal protraction but is frequently also accompanied by unfavorable dentoalveolar effects. An alternative treatment with intermaxillary elastics from a temporary anchorage device might permit equivalent favorable skeletal changes without the unwanted dentoalveolar effects. METHODS: Six consecutive patients (3 boys, 3 girls; ages, 10-13 years 3 months) with Class III occlusion and maxillary deficiency were treated by using intermaxillary elastics to titanium miniplates. Cone-beam computed tomography scans taken before and after treatment were used to create 3-dimensional volumetric models that were superimposed on nongrowing structures in the anterior cranial base to determine anatomic changes during treatment. RESULTS: The effect of the intermaxillary elastic forces was throughout the nasomaxillary structures. All 6 patients showed improvements in the skeletal relationship, primarily through maxillary advancement with little effect on the dentoalveolar units or change in mandibular position. CONCLUSIONS: The use of intermaxillary forces applied to temporary anchorage devices appears to be a promising treatment method.

Bone-anchored maxillary protraction long-term outcomes in UCLP.

This case report presents a 12-year-old boy with unilateral complete cleft lip and palate and severe maxillary retrusion treated with bone-anchored maxillary protraction (BAMP) therapy followed by fixed appliances. The follow-up period extended until the end of growth. Initially, the patient demonstrated a Goslon 4 interarch relationship with an overjet of -3.5 mm and a Wits appraisal of -7.9 mm. Six months after the secondary alveolar bone graft, Bollard miniplates were fixed bilaterally at the infrazygomatic region in the maxilla and between the canines and lateral incisors in the mandible. Class III elastics were used bilaterally full time for 12 months. After treatment, the overjet increased 5.9 mm. Significant maxillary advancement (SNA +3.2°) and skeletal convexity improvement (NA-APo +12.4°) were observed. Retrusion of the anteroposterior position of the mandible was observed (SNB -2.1°). Comprehensive orthodontic treatment was performed after BAMP therapy with nighttime bone-anchored Class III elastics as active retention until the end of growth. Occlusion and facial esthetics were satisfactory at the end of orthodontic treatment and growth. Le Fort I surgery for maxillary advancement was not required. BAMP therapy demonstrated an adequate orthopedic outcome, preventing the need for orthognathic surgery in unilateral complete cleft lip and palate.

Modified miniplates for temporary skeletal anchorage in orthodontics: placement and removal surgeries.

PURPOSE: Skeletal anchorage systems are increasingly used in orthodontics. This article describes the techniques of placement and removal of modified surgical miniplates used for temporary orthodontic anchorage and reports surgeons' perceptions of their use. PATIENTS AND METHODS: We enrolled 97 consecutive orthodontic patients having miniplates placed as an adjunct to treatment. A total of 200 miniplates were placed by 9 oral surgeons. Patients and surgeons completed questionnaires after placement and removal surgeries. RESULTS: Fifteen miniplates needed to be removed prematurely. Antibiotics and anti-inflammatories were generally prescribed after placement but not after removal surgery. Most surgeries were performed with the patient under local anesthesia. Placement surgery lasted on average between 15 and 30 minutes per plate and was considered by the surgeons to be very easy to moderately easy. The surgery to remove the miniplates was considered easier and took less time. The patients' chief complaint was swelling, lasting on average 5.3 +/- 2.8 days after placement and 4.5 +/- 2.6 days after removal. CONCLUSIONS: Although miniplate placement/removal surgery requires the elevation of a flap, this was considered an easy and relatively short surgical procedure that can typically be performed with the patient under local anesthesia without complications, and it may be considered a safe and effective adjunct for orthodontic treatment.

Patients' and orthodontists' perceptions of miniplates used for temporary skeletal anchorage: a prospective study.

INTRODUCTION: Temporary skeletal anchorage is a relatively recent addition to orthodontic treatment. Surgical miniplates, modified with intraoral attachments, provide an alternative to miniscrews for skeletal anchorage. In this study, we wanted to determine patients' and providers' perceptions of miniplate use during orthodontic treatment. METHODS: Consecutive patients having miniplates placed as part of their treatment completed questionnaires about their experiences during surgery and orthodontic treatment. A total of 200 miniplates were placed for 97 patients. The 30 orthodontists treating these patients also completed questionnaires concerning miniplate success, handling complexity, and whether these devices simplified treatment. RESULTS: The success rate was 92.5%. The devices were well tolerated by the patients. After a year, 72% of the patients reported that they did not mind having the implant, and 82% said that the surgical experience was better than expected, with little or no pain. The most frequent problems were postsurgical swelling, lasting 5 days on average, and cheek irritation experienced initially by more than a third of the patients, but it lessened over time. The clinicians reported that these devices were easy to use and greatly simplified orthodontic treatment. CONCLUSIONS: Miniplates are well accepted by patients and providers and are a safe and effective adjunct for complex orthodontic treatments.

Maxillary molar distalization with miniplates assessed on digital models: a prospective clinical trial.

INTRODUCTION: The purpose of this prospective study was to evaluate the effects of maxillary molar distalization in patients treated with a miniplate skeletal anchorage system. METHODS: Thirty-one miniplates were placed on the infrazygomatic crests of 17 nongrowing patients consecutively selected for Class II treatment with skeletal anchorage. Three weeks after surgery, a 150-g force was applied to distalize the molars. No appliances were placed in the mandible. Models made before treatment and after molar distalization were scanned. Linear measurements were made on the digitized casts. Molar movement was measured on the superimposed maxillary arches before and after distalization, coregistered on the untreated mandibular models. RESULTS: A molar hyper Class I relationship was reached in all patients 7.0 +/- 2.0 months after miniplate loading. The maxillary molars were moved distally a mean distance of 3.27 +/- 1.75 mm. In patients without contact between the maxillary and the mandibular incisors, overjet decreased by 0.99 +/- 1.32 mm. Intermolar width increased by 2.78 +/- 1.38 mm. CONCLUSIONS: Maxillary molar distalization with miniplates for skeletal anchorage is an efficient, noncompliance-dependent, and predictable treatment modality for patients with Class II molar relationship.

Systematic review of the experimental use of temporary skeletal anchorage devices in orthodontics.

INTRODUCTION: Our aim was to review the experimental literature to determine what is known about functional and morphological tissue reactions around orthodontically loaded temporary skeletal anchorage devices. METHODS: The PubMed electronic database and the reference citations in published articles were searched to the end of April 2006. The inclusion criteria were animal studies about orthodontically loaded skeletal anchorage consisting of metallic bone plates or screw implants of 2.2 mm diameter or less. Data on healing time, force application, stability, side effects, and osseointegration were collected by 2 independent readers. RESULTS: Eight articles met the selection criteria. The healing times ranged from 0 to 12 weeks, and the amount of force varied from 25 to 500 g. Implant stability was generally achieved without severe side effects. Direct bone-screw contact was reported to be 10% to 58%, and osseointegration increased with loading time. Nevertheless, no significant difference in bone-screw contact was found between loaded and unloaded screw implants, or between tension and pressure sides of loaded implants. CONCLUSIONS: This review highlights some positive experimental findings that apply in clinical practice. However, questions concerning optimal force systems, surgical techniques and placement, and healing times remain. Future research should be well controlled and based on standardized protocols to test specific hypotheses.

Mandibular and glenoid fossa changes after bone-anchored maxillary protraction therapy in patients with UCLP: A 3-D preliminary assessment.

OBJECTIVE: To assess mandibular and glenoid fossa (GF) changes after bone-anchored maxillary protraction (BAMP) therapy in patients with unilateral complete cleft lip and palate (UCLP). MATERIALS AND METHODS: The cleft group (CG) comprised 19 patients with (mean initial age of 11.8 years). The noncleft group (NCG) comprised 24 patients without clefts (mean initial age of 11.7 years). Both groups had Class III malocclusion and were treated with BAMP therapy for 18 and 12 months, respectively. Cone-beam computed tomography (CBCT) exams were performed before and after treatment and superimposed on the anterior cranial fossa (ACF). Mandibular rotations and three-dimensional linear displacements of the mandible and GF were quantified. A t-test corrected for multiple testing (Holm-Bonferroni method) and a paired t-test were used to compare, respectively, the CG and NCG and cleft vs noncleft sides (P < .05). RESULTS: Immediately after active treatment, the GF was displaced posteriorly and laterally in both groups relative to the ACF. The overall GF changes in the CG were significantly smaller than in the NCG. Condylar displacement was similar in both groups, following a posterior and lateral direction. The gonial angle was displaced similarly posteriorly, laterally, and inferiorly in both groups. The intercondylar line rotated in opposite directions in the CG and NCG groups. In the CG, most changes of the GF and mandible were symmetrical. CONCLUSIONS: Overall GF and mandibular changes after BAMP therapy were similar in patients with and without clefts. The exception was the posterior remodeling of the GF that was slightly smaller in patients with UCLP.

Effect of Class III bone anchor treatment on airway.

OBJECTIVES: To compare airway volumes and minimum cross-section area changes of Class III patients treated with bone-anchored maxillary protraction (BAMP) versus untreated Class III controls. MATERIALS AND METHODS: Twenty-eight consecutive skeletal Class III patients between the ages of 10 and 14 years (mean age, 11.9 years) were treated using Class III intermaxillary elastics and bilateral miniplates (two in the infra-zygomatic crests of the maxilla and two in the anterior mandible). The subjects had cone beam computed tomographs (CBCTs) taken before initial loading (T1) and 1 year out (T2). Twenty-eight untreated Class III patients (mean age, 12.4 years) had CBCTs taken and cephalograms generated. The airway volumes and minimum cross-sectional area measurements were performed using Dolphin Imaging 11.7 3D software. The superior border of the airway was defined by a plane that passes through the posterior nasal spine and basion, while the inferior border included the base of the epiglottis to the lower border of C3. RESULTS: From T1 to T2, airway volume from BAMP-treated subjects showed a statistically significant increase (1499.64 mm(3)). The area in the most constricted section of the airway (choke point) increased slightly (15.44 mm(2)). The airway volume of BAMP patients at T2 was 14136.61 mm(3), compared with 14432.98 mm(3) in untreated Class III subjects. Intraexaminer correlation coefficients values and 95% confidence interval values were all greater than .90, showing a high degree of reliability of the measurements. CONCLUSION: BAMP treatment did not hinder the development of the oropharynx.