Postsurgical Stability of Oropharyngeal Airway Changes Following Counter-Clockwise Maxillo-Mandibular Advancement Surgery

Goncalves, Joao Roberto; Buschang, Peter H.; Goncalves, Daniela Godoi; Wolford, Larry M.

doi:10.1016/j.joms.2005.11.046

« Previous Next »Journal of Oral and Maxillofacial Surgery
Volume 64, Issue 5 , Pages 755-762, May 2006

Postsurgical Stability of Oropharyngeal Airway Changes Following Counter-Clockwise Maxillo-Mandibular Advancement Surgery

Joao Roberto Goncalves, DDS, PhD
- Assistant Professor, Orthodontics, UNESP—Paulista State University, Sao Paulo, Brazil; Formerly, Fellow, Oral and Maxillofacial Surgery, Baylor College of Dentistry, Texas A&M University System, Baylor University Medical Center, Dallas, TX.
Peter H. Buschang, PhD
- Professor and Director of Orthodontic Research, Department of Orthodontics and Center for Craniofacial Research and Diagnosis, Baylor College of Dentistry, Texas A&M University Health Science Center, Dallas, TX
Daniela Godoi Goncalves, DDS, MsC
- Graduate Student, Prosthodontics, UNESP—Paulista State University, Sao Paulo, Brazil
Larry M. Wolford, DMD
- Clinical Professor, Department of Oral and Maxillofacial Surgery, Baylor College of Dentistry, Texas A&M University Health Science Center; Private Practice, Baylor University Medical Center, Dallas, TX
- Address correspondence and reprint requests to Dr Wolford: 3409 Worth St, Suite 400, Dallas, TX 75246

Purpose

This study evaluated oropharyngeal airway changes and stability following surgical counter-clockwise rotation and advancement of the maxillo-mandibular complex.

Methods and Patients

Fifty-six adults (48 females, 8 males), between 15 and 51 years of age, were treated with Le Fort I osteotomies and bilateral mandibular ramus sagittal split osteotomies to advance the maxillo-mandibular complex with a counter-clockwise rotation. The average postsurgical follow-up was 34 months. Each patient’s lateral cephalograms were traced, digitized twice, and averaged to estimate surgical changes (T2-T1) and postsurgical changes (T3-T2).

Results

During surgery, the occlusal plane angle decreased significantly (8.6 ± 5.8°) and the maxillo-mandibular complex advanced and rotated counter-clockwise. The maxilla moved forward (2.4 ± 2.7 mm) at ANS and the mandible was advanced 13.1 ± 5.1 mm at menton, 10 ± 4.4 mm at point B, and 6.9 ± 3.7 mm at lower incisor edge. Postsurgical hard tissue changes were not statistically significant. While the upper oropharyngeal airway decreased significantly (4.2 ± 3.4 mm) immediately after surgery, the narrowest retropalatal, lowest retropalatal airway, and the narrowest retroglossal airway measurements increased 2.9 ± 2.7, 3.7 ± 3.2, and 4.4 ± 4.4 mm, respectively. Over the average 34 months postsurgical period, upper retropalatal airway increased 3.9 ± 3.7 mm, while narrowest retropalatal, lowest retropalatal airway, and narrowest retroglossal airway remained stable. Head posture showed flexure immediately after surgery (4.8 ± 5.9°) and extension postsurgically (1.6 ± 5.6°).

Conclusion

Maxillo-mandibular advancement with counter-clockwise rotation produces immediate increases in middle and lower oropharyngeal airway dimensions, which were constrained by changes in head posture but remain stable over the postsurgical period. The upper oropharyngeal airway space increased only on the longest follow-up.