J Korean Assoc Oral Maxillofac Surg.  2015 Oct;41(5):224-231. 10.5125/jkaoms.2015.41.5.224.

Retrospective study on change in pharyngeal airway space and hyoid bone position after mandibular setback surgery

• On SW
• Han MW
• Hwang DY
• Song SI

• KMID: 2070435
• DOI: http://doi.org/10.5125/jkaoms.2015.41.5.224

Abstract

OBJECTIVES
The purpose of this study was to evaluate changes in the pharyngeal airway space and hyoid bone position after mandibular setback surgery with bilateral sagittal split ramus osteotomy (BSSRO) and to analyze the correlation between the amount of mandibular setback and the amount of change in pharyngeal airway space or hyoid bone position.
MATERIALS AND METHODS
From January 2010 to February 2013, a total of 30 patients who were diagnosed with skeletal class III malocclusion and underwent the same surgery (BSSRO) and fixation method in the Division of Oral and Maxillofacial Surgery, Department of Dentistry at the Ajou University School of Medicine (Suwon, Korea) were included in this study. Lateral cephalograms of the 30 patients were assessed preoperatively (T1), immediately postoperatively (T2), and 6 months postoperatively (T3) to investigate the significance of changes by time and the correlation between the amount of mandibular setback and the amount of change in the airway space and hyoid bone position.
RESULTS
Three regions of the nasopharynx, oropharynx, and hypopharynx were measured and only the oropharynx showed a statistically significant decrease (P<0.01). A significant posterior and inferior displacement of the hyoid bone was found 6 months after surgery (P<0.01). Analysis of the correlation between the amount of mandibular setback and the amount of final change in the airway space and hyoid bone position with Pearson's correlation showed no significant correlation.
CONCLUSION
In this study, the oropharynx significantly decreased after mandibular setback surgery, and changes in the surrounding structures were identified through posteroinferior movement of the hyoid bone during long-term follow-up. Therefore, postoperative obstructive sleep apnea should be considered in patients who plan to undergo mandibular setback surgery, and necessary modifications to the treatment plan should also be considered.

Keyword

Mandibular setback surgery; Pharyngeal airway space; Hyoid bone position; Obstructive sleep apnea

MeSH Terms

Dentistry
Follow-Up Studies
Humans
Hyoid Bone*
Hypopharynx
Malocclusion
Nasopharynx
Oropharynx
Osteotomy, Sagittal Split Ramus
Retrospective Studies*
Sleep Apnea, Obstructive
Surgery, Oral

Figure

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  Fig. 1 Parameters and landmarks used for cephalometry. Upper horizontal line: Frankfort horizontal plane, lower oblique line: mandibular plane, vertical line: Sella vertical plane. (S: Sella, N: nasion, Ba: basion, PNS: posterior nasal spine, ANS: anterior nasal spine, A: A point, P: the most inferior point of soft palate, Go: gonion, C3: third cervical vertebra, B: B point, Me: menton, H: hyoid bone)

• 

  Fig. 2 Measurement of the pharyngeal airway space. The airway space measurement was classified into three areas: the nasopharynx (Nph), oropharynx (Oph), and hypopharynx (Hph). (S: Sella, N: nasion, PNS: posterior nasal spine, ANS: anterior nasal spine, A: A point, P: the most inferior point of soft palate, Go: gonion, C3: third cervical vertebra, B: B point, Me: menton, H: hyoid bone)

• 

  Fig. 3 Measurement of hyoid bone position. The hyoid bone position was evaluated with 3 measuring items using the horizontal position (SV-Hy), vertical position (FH-Hy), and distance to the mandibular inferior border (Mn-Hy). (S: Sella, N: nasion, Ba: basion, PNS: posterior nasal spine, ANS: anterior nasal spine, A: A point, P: the most inferior point of soft palate, Go: gonion, C3: third cervical vertebra, Me: menton, H: hyoid bone)

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  Fig. 4 Measurement of SV-Pog. The vertical distance from the Sella vertical (SV) plane to the pogonion (Pog) was measured to evaluate recurrence. (S: Sella, N: nasion, Ba: basion, PNS: posterior nasal spine, ANS: anterior nasal spine, A: A point, P: the most inferior point of soft palate, Go: gonion, C3: third cervical vertebra, B: B point)

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