Do patients treated with bimaxillary surgery have more stable condylar positions than those who have undergone single-jaw surgery?

PURPOSE: Because condylar positioning after sagittal split ramus osteotomy of the mandible has been known to affect postoperative skeletal stability, accurate positional assessment of the temporomandibular joint after orthognathic surgery is vital to maximize stability of the surgery. The purpose of this study was to evaluate condylar changes after single-jaw and double-jaw surgeries in mandibular prognathism patients by comparing 3-dimensional angular and positional changes of the condylar heads in groups of patients receiving combined maxillary posterior impaction and mandibular setback and those undergoing only mandibular setback surgeries. PATIENTS AND METHODS: We assessed condylar changes of patients who have been diagnosed with mandibular prognathism and underwent either bimaxillary surgery or isolated mandibular surgery at Kangdong Sacred Heart Hospital and SmileFuture Orthodontic Clinic, Seoul, South Korea, from August 2008 to February 2011. Condylar angulation, intercondylar distance, and amount of condylar displacement were examined based on the 3-dimensional reconstructed images. Preoperative and postoperative changes within each group were assessed by paired t test. Differences between the groups were determined by independent t test. RESULTS: A total of 43 skeletal Class III patients were included in this retrospective, multicenter study. After single-jaw surgery, condylar angulations in all dimensions did not change. In contrast, those who received double-jaw surgery showed forward rotation of 1.93° (P = .027) and medial rotation of 1.48° (P = .032) in the sagittal and axial planes, respectively. The mean distances of condylar displacements were 0.28 ± 0.44 mm in the single-jaw group and 0.31 ± 0.51 mm in the double-jaw group, but there was no statistically significant difference. CONCLUSIONS: Condylar angulations are more stable after sagittal split ramus osteotomy of the mandible as an isolated procedure than in combination with the posterior maxillary impaction in treatment of skeletal Class III malocclusion patients. Condylar displacements in both the single-jaw and double-jaw groups are clinically insignificant.

Three-dimensional changes in pharyngeal airway in skeletal class III patients undergoing orthognathic surgery.

PURPOSE: It has often been hypothesized that mandibular setback surgery causes narrowing of the pharyngeal airway. We examined whether the pharyngeal airway narrowed after orthognathic surgery in patients undergoing either mandibular setback surgery or bimaxillary surgery and whether the amount of narrowing of the pharyngeal airway was any different after mandibular setback surgery or bimaxillary surgery. MATERIALS AND METHODS: Cone-beam computed tomography scans were obtained for 21 patients who were assigned to either mandibular setback surgery or bimaxillary surgery. The anteroposterior dimension, lateral width, cross-sectional area, and volume of each subject's pharyngeal airway were measured before and after surgery. RESULTS: The pharyngeal airway showed significant narrowing after both mandibular setback surgery and bimaxillary surgery. The amount of change in the anteroposterior dimension and cross-sectional area on the posterior nasal spine plane and the length of the pharyngeal airway showed significant differences between the 2 groups. CONCLUSION: The amount of narrowing of the pharyngeal airway was smaller in patients undergoing bimaxillary surgery than in the patients undergoing mandibular setback surgery.

Three-dimensional analysis of pharyngeal airway volume in adults with anterior position of the mandible.

INTRODUCTION: The purpose of this study was to examine whether the pharyngeal airway volume in adults with skeletal Class III malocclusion is greater than in subjects with Class I occlusion and whether the pharyngeal airway volume correlated with facial morphology. METHODS: Cone-beam computed tomography scans were obtained from 60 subjects, who were assigned to 2 groups. The skeletal Class III malocclusion group consisted of 31 subjects (16 men, 15 women) who had planned on orthodontic treatment with orthognathic surgery. The Class I malocclusion group consisted of 29 subjects (14 men, 15 women). The pharyngeal airway volumes and areas were measured and compared with cephalometric variables. RESULTS: The cross-sectional areas of the lower part of the pharyngeal airway and the volume of the upper part of the pharyngeal airway were greater in skeletal Class III malocclusion patients than in Class I malocclusion patients. The volume of the upper part of the pharyngeal airway showed negative correlations with ANB angle and the Wits appraisal, and positive correlations with SNB, APDI, pogonion to N-perp, gonial angle, and FMA. CONCLUSIONS: The volume of the upper part of the pharyngeal space was greater in patients with skeletal Class III malocclusion, and the increased volume of the upper part of the pharyngeal airway showed significant correlations with measurements characterizing the anterior position of mandible.

Three-dimensional analysis of pharyngeal airway in preadolescent children with different anteroposterior skeletal patterns.

INTRODUCTION: In growing patients with skeletal discrepancies, early diagnosis, evidence-based explanations of etiology, and assessment of functional factors can be vital for the restoration of normal craniofacial growth and the stability of the treatment results. The aims of our study were to compare the 3-dimensional pharyngeal airway volumes in healthy children with a retrognathic mandible and those with normal craniofacial growth, and to investigate possible significant relationships and correlations among the studied cephalometric variables and the airway morphology in these children. METHODS: Three-dimensional airway volume and cross-sectional areas of 27 healthy children (12 boys, 15 girls; mean age, 11 years) were measured by using cone-beam computed tomography volume scans, and 2-dimensional lateral cephalograms were created and analyzed. The subjects were divided into 2 groups based on their ANB angles (group I: 2 degrees < or = ANB < or = 5 degrees ; group II: ANB >5 degrees ), and cephalometric variables, airway volumes, and cross-sectional measurements were compared. RESULTS: There were statistically significant differences in the following parameters: height of the posterior nasal plane (P <0.05), pogonion to nasion perpendicular distance (P <0.01), ANB angle (P <0.01), mandibular body length (P <0.01), facial convexity (P <0.01), and total airway volume (P <0.05). No statistically significant differences between the 2 groups were found in the cross-sectional area and the volumetric measurements of the various sections of the airway except for total airway volume, which had larger values in group I (P <0.05). CONCLUSIONS: The mean total airway volume, extending from the anterior nasal cavity and the nasopharynx to the epiglottis, in retrognathic patients was significantly smaller than that of patients with a normal anteroposterior skeletal relationship. On the other hand, differences in volume measurements of the 4 subregions of the airway were not statistically significant between the 2 groups.

Three-dimensional analysis of pharyngeal airway form in children with anteroposterior facial patterns.

OBJECTIVE: To test the null hypothesis that the form and size of the pharyngeal airways in preadolescents do not differ among various skeletal patterns. MATERIALS AND METHODS: Sixty healthy children (mean age, 11.79 ± 1.11 years) were divided into three groups by anteroposterior jaw relationships. Using cone-beam computed tomography, the inclination and the volume of the pharyngeal airway were measured and compared with craniocervical angles and cephalometric variables. RESULTS: Children with Class II malocclusion have a larger angle between the FH plane and midplane of the oropharyngeal airway (ang-OA) compared with children with Class I and III malocclusion (P < .01). Ang-OA was significantly correlated with craniocervical angle (ang-cc) and anteroposterior variables, mainly ANB angle, Pog-N perpendicular (P < .01). Airway volume had a positive correlation with facial depth (P < .01). CONCLUSION: Children with Class II malocclusion have more backward orientation and smaller volume of the pharyngeal airway than do children with Class I and III malocclusion. Inclination of the oropharyngeal airway might be a key factor in determining the form of the entire pharyngeal airway and is related to head posture.