Review Article

Airway cephalometric changes following mandibular setback surgery: A review

Abstract

Background and Aim: Mandibular setback surgery is one of the common treatments in patients with mandibular prognathism. In this surgery, the mandible is placed backward from its original position, and as a result, the soft tissue, tongue, and hyoid bone are slightly displaced, all of which can affect the dimensions of the airway. Given that these changes in the dimensions of the airway can lead to obstructive sleep apnea, it is important to examine these changes and their stability. In this regard, cephalometric radiography can be used, which haslowcost and dose in comparison to 3D radiographs, to examine changes in airway dimensions. The aim of this study was to evaluate the short-term and long-term changes in airway dimensions following mandibular steback surgery with the help of cephalometric radiography. Materials and Methods: The study was conducted by review method. Using the keywords ‘orthognathic surgery,’ ‘mandibular setback,’ ‘Malocclusion angle class III,’ ‘prognathism,’ ‘airway,’ ‘posterior airway space,’ ‘PAS,’ ‘pharyngeal space, ‘hypopharynx, a review of articles in PubMed and Embase databases, Google Scholar, and Cochrane databases was performed. The range of article searches was from 2000 to 2020. Conclusion: The results of studies showed that in the first 6 months after surgery, the dimensions of the airway decrease, but over time, due to the adaptation of the surrounding tissues and relapse after surgery, there is an improvement in the dimensions of the airway; Also, the study of index-related breathing disorders during sleep disorders during sleep showed that this surgery does not necessarily lead to obstructive sleep apnea. Keywords: Orthognathic surgery; Mandibular setback; Malocclusion angle class III; Prognathism;Airway; Posterior airway space; PAS; Pharyngeal space; Hypopharynx.
1. Veasey SC, Rosen IM. Obstructive sleep apnea in adults.New England Journal of Medicine. 2019 Apr 11;380(15):1442-9.
2. Osman AM, Carter SG, Carberry JC, Eckert DJ. Obstructive sleep apnea: current perspectives. Nature and science of sleep. 2018;10:21.
3. Mirhashemi AH, Arab S, Bahrami R. Orthodontics as a therapeutic tool for managing sleep apnea: A review. Journal of Craniomaxillofacial Research.2020 Oct 3:50-61.
4. Vitale GJ, Capp K, Ethridge K, Lorenzetti MS, Jeffrey M. Sleep Apnea and the Brain: Neurocognitive and Emotional Considerations. Journal of Sleep Disorders and Management. 2016;2(1):8-12.
5. Bayat M, Shariati M, Rakhshan V, Abbasi M, Fateh A, Sobouti F, Davoudmanesh Z. Cephalometric risk factors of obstructive sleep apnea. CRANIO®. 2017 Sep 3;35(5):321-6.
6. 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 RadiolEndod 89:278e287.
7. Turnbull NR, Battagel JM: The effects of orthognathic surgery on pharyngeal airwaydimensions and quality of sleep. J Orthod 27: 235e247.
8. Park SB, Kim YI, Son WS, Hwang DS, Cho BH: Cone-beam computed tomography
evaluation of short- and long-term airway change and stability after orthognathic surgery in patients with class III skeletal deformities: bimaxillary surgery and mandibular setback surgery. Int J Oral MaxillofacSurg 41: 87e93.
9. Schulz KF, Altman DG, Moher D, CONSORT Group: CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med24(8): 18.
10. Park JW, Kim NK, Kim JW, Kim MJ, Chang YI: Volumetric, planar, and linear analysisof pharyngeal airway change on computed tomography and cephalometry aftermandibular setback surgery. Am J OrthodDentofacialOrthop 138: 292e299.
11. Demetriades N, Chang DJ, Laskarides C, Papageorge M: Effects of mandibular retropositioning, with or without maxillary advancement, on the oro-nasopharyngeal airway and development of sleep-related breathing disorders.J Oral MaxillofacSurg 68: 2431e2436.
12. Gonçales ES, Duarte MAH, PalmieriJr C, Zakhary GM, Ghali GE: Retrospectiveanalysis of the effects of orthognathic surgery on the pharyngeal airway space.J Oral Maxillofac Surg.
13.Tselnik M, Pogrel MA. Assessment of the pharyngeal airway space after mandibular setback surgery.Journal of oral and maxillofacial surgery. 2000 Mar 1;58(3):282-5.
14. Achilleos S, Krogstad O, Lyberg T. Surgical mandibular setback and changes in uvuloglossopharyngeal morphology and head posture: a short-and long-term cephalometric study in males. The European Journal of Orthodontics. 2000 Aug 1;22(4):383-94.
15.Saitoh K. Long-term changes in pharyngeal airway morphology after mandibular setback surgery. American journal of orthodontics and dentofacial orthopedics. 2004 May 1;125(5):556-61.
16.Eggensperger N, Smolka W, Iizuka T. Long-term changes of hyoid bone position and pharyngeal airway size following mandibular setback by sagittal split ramus osteotomy. Journal of Cranio-Maxillofacial Surgery. 2005 Apr 1;33(2):111-7.
17.Chen F, Terada K, Hanada K, Saito I. Predicting the pharyngeal airway space after mandibular setback surgery. Journal of oral and maxillofacial surgery. 2005 Oct 1;63(10):1509-14.
18.Kawakami M, Yamamoto K, Fujimoto M, Ohgi K, Inoue M, Kirita T. Changes in tongue and hyoid positions, and posterior airway space following mandibular setback surgery. Journal of Cranio-Maxillofacial Surgery. 2005 Apr 1;33(2):107-10.
19.Chen F, Terada K, Hua Y, Saito I. Effects of bimaxillary surgery and mandibular setback surgery on pharyngeal airway measurements in patients with Class III skeletal deformities. American journal of orthodontics and dentofacial orthopedics. 2007 Mar 1;131(3):372-7.
20.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.The Angle orthodontist. 2010 Mar 1;80(2):302-8.
21.Park JW, Kim NK, Kim JW, Kim MJ, Chang YI. Volumetric, planar, and linear analyses of pharyngeal airway change on computed tomography and cephalometry after mandibular setback surgery. American journal of orthodontics and dentofacial orthopedics. 2010 Sep 1;138(3):292-9.
22.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. International journal of oral and maxillofacial surgery. 2011 Jun 1;40(6):584-92.
23.Kobayashi T, Funayama A, Hasebe D, Kato Y, Yoshizawa M, Saito C. Changes in overnight arterial oxygen saturation after mandibular setback. British Journal of Oral and Maxillofacial Surgery. 2013 Jun 1;51(4):312-8.
24. Engboonmeskul T, Leepong N, Chalidapongse P. Effect of surgical mandibular setback on the occurrence of obstructive sleep apnea. Journal of Oral Biology and Craniofacial Research. 2020 Oct 1;10(4):597-602.
Files
IssueVol 7, No 4 (Autumn 2020) QRcode
SectionReview Article(s)
Published2021-02-20
DOI https://doi.org/10.18502/jcr.v7i4.5553
Keywords
Orthognathic surgery; Mandibular setback; Malocclusion angle class III; Prognathism; Airway; Posterior airway space; PAS; Pharyngeal space; Hypopharynx

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Mirhashemi AH, Bahrami R, Niknami M. Airway cephalometric changes following mandibular setback surgery: A review. J Craniomaxillofac Res. 7(4):178-185.