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The Effects of Multidisciplinary Treatment in a Skeletal Class III Patient on Posterior Airway Space and Respiratory Function

Year 2014, Volume: 41 Issue: 1 - Volume: 41 Issue: 1, 29 - 40, 01.02.2014

Abstract

Objective: To evaluate the cephalometric, oropharyngeal airway volume, respiratory function during sleep and pulmonary functions changes in a severe Class-III patient undergoing bimaxillary orthognatic surgery. Method: A 19-year-old male patient referred for treatment with complaint inability to incise food and unaesthetic profile. Cephalometric evaluation revealed a significant Class-III skeletal discrepancy ANB= -15º with a negative overjet of 12mm. Computed tomography CT Aquilion 64, Toshiba Medical Systems, Otawara, Japan scans were obtained to determine the surgery and a stereolithographic model SLA was created preoperatively using SimPlant Materialise, Belgium software. According to the SLA planning, maxilla was advanced 10mm with LeFort-I downfracture, mandible was positioned back 13mm with BSSO. Cephalometric analyses, pulmonary function tests PFT , and a 1-night sleep study for full polysomnography PSG were performed before and repeated after 6 months to surgery. Results: Maxillary advancement and mandibular setback revealed an occlusion with a Class I molar and canine relationship. The overbite and overjet relationships were ideal and facial esthetic appearance was improved as a result of the reduction in the lower third of the face height in accordance with cephalometry. The PSG, PFT and cephalometric alterations indicated an enlargement in oropharyngeal volume, better airflow and improved sleep quality Conclusion: A large amount of mandibular setback might inhibit biological adaption and cause sleep-disordered breathing. Therefore, it might be better to consider mandibular set back with maxillary advance that does not reduce the airway for patients with skeletal Class-III malocclusions. The patient gained an appropriate facial aesthetics and oral function using multidisciplinary approach.

References

  • Stellzig-Eisenhauer A, Lux CJ,Schuster G. Treatment decision in adult patients with Class III malocclusion: Orthodontic therapy or orthognathic surgery? Am J Orthod Dentofacial Orthop. 2002;122: 27-38.
  • Guyer E, Ellis E, McNamara JA Jr, Beh- rents R. Components of Class III malocclusion in juveniles and adolescents. Angle Orthod. 1986;56:7-30.
  • Battagel JM. The aetiological factors in Class III malocclusion. Eur J Orthod. 1993;15:347- 70.
  • Arnett GW, Bergman RT. Facial keys to orthodontic diagnosis and treatment planning. Part I. Am J Orthod Dentofacial Orthop 1993;103:299- 312.
  • Arnett GW, Bergman RT. Facial keys to orthodontic diagnosis and treatment planning. Part II. Am J Orthod Dentofacial Orthop 1993;103:395- 411.
  • Dwyer PW. Orthodontic and orthognathic surgical correction of a severe Class III malocclu- sion. Am J Orthod Dentofacial Orthop 1998;113:125-32.
  • Gokce SM, Gorgulu S, Gokce HS, Bengi O, Sabuncuoglu F, Ozgen F, Bilgic H. Changes in pos- terior airway space, pulmonary function and sleep quality, following bimaxillary orthognathic surgery. Int J Oral Maxillofac Surg. 2012; 41:820–829.
  • Tselnik M, Pogrel MA. Assessment of the pharyngeal airway space after mandibular setback surgery. J Oral Maxillofac Surg. 2000;58:282–285.
  • Chen F, Terada K, Hua Y, Saito I. Effects of bimaxillary surgery and mandibular setback sur- gery on pharyngeal airway measurements in pati- ents with Class III skeletal deformities. Am J Ort- hod Dentofacial Orthop. 2007;131: 372–377.
  • Foltán R, Hoffmannová J, Donev F, Vlk M, Sedy J, Kufa R, Bulik O. The impact of Le Fort I advancement and bilateral sagittal split osteotomy setback on ventilation during sleep. Int J Oral Maxillofac Surg. 2009;38:1036–1040.
  • Rivera SM, Hatch JP, Dolce C, Bays RA, Van Sickels JE, Rugh JD. Patients’ own reasons and patient-perceived recommendations for orthog- nathic surgery. Am J Orthod Dentofacial Orthop. 2000;118:134–140.
  • Ölmez H, Sağdıç D, Bengi AO, ùengün O. İskeletsel sınıf III olgularda ortognatik cerrahi ( İki olgu nedeniyle).Türk Ortodonti Dergisi. 1994; 7: 213-219.
  • Demetriades N, Chang DJ, Laskarides C, Papageorge M. Effects of mandibular retropositio- ning, with or without maxillary advancement, on the oro-naso-pharyngeal airway and development of sleep-related breathing disorders. J Oral Maxillo- fac Surg 2010;68:2431-2436.
  • Soncul M, Bamber MA. Evaluation of fa- cial soft tissue changes with optical surface scan af- ter surgical correction of class III deformities. J Oral Maxillofac Surg. 2004;62: 1331–1340.
  • Kajikawa Y. Changes in soft tissue profile after surgical correction of skeletal class III malocc- lusion. J Oral Surg. 1979;37:167–174.
  • Meral O, Gürton Ü, Ölmez H, Bengi AO, Sağdıç D. İskeletsel sınıf III olgularda tek çene ve çift çene ortognatik cerrahi uygulamalarını takiben yumuşak doku değişimlerinin karşılaştırılması. Türk Ortodonti Dergisi. 2000;13(3):150-157.
  • Tüzün A, Uzun K, Yüksekol İ, Taş D. İleri dönem karaciğer hastalığında solunum fonksiyonla- rının değerlendirilmesi. Solunum. 2001;3:117-120.
  • Lange NE, Mulholland M, Kreider ME. Spirometry don’t blow it Chest 2009;136: 608– 614.
  • Kitagawara K, Kobayashi T, Goto H, Yo- kobayashi T, Kitamura N, Saito C. Effects of man- dibular setback surgery on oropharyngeal airway and arterial oxygen saturation. Int J Oral Maxillofac Surg 2008;37:328–333.
  • Turnbull NR, Battagel JM. The effects of orthognathic surgery on pharyngeal airway dimen- sions and quality of sleep. J Orthod. 2000;27:235– 247.

İskeletsel sınıf III olguda multidisipliner tedavinin arka hava yolu ve solunum fonksiyonlarına etkisi

Year 2014, Volume: 41 Issue: 1 - Volume: 41 Issue: 1, 29 - 40, 01.02.2014

Abstract

Amaç: ùiddetli iskeletsel Sınıf-III’e sahip bir olguda bimaksiller ortognatik cerrahi sonrası sefaalometrik, orofarengeal hava yolu, uyku sırasında solunum fonksiyonları ve akciğer fonksiyonlarında meydana gelen değişikliklerin incelenmesi. Metod: 19 yaşındaki erkek hasta estetik olmayan profil ve lokmaları çiğneyememe şikayeti ile tedavi için başvurdu. Sefalometrik inceleme sonucunda 12 mm’lik negative overjet ile birlikte belirgin bir iskeletsel Sınıf-III bozukluk ANB=15 º tespit edildi. Cerrahi planlaması amacıyla bilgisayarlı tomografi görüntüleri alındı ve operasyon öncesi SimPlant Materialise, Belgium programı kullanılarak bir stereolitografik model SLA oluşturuldu. SLA planlamasına göre, maksilla, LeFort-I osteotomisi ile 10mm ilerletildi; mandibula BSSO ile 13mm geriye alındı. Cerrahi öncesi ve cerrahiden 6 ay sonra sefalometrik analiz, solunum fonksiyon testi SFT ve tam polisomnografi PSG içeren 1 gecelik uyku çalışması analizleri yapıldı. Bulgular: Maksiller ilerletme ve mandibular setback operasyonu sonucu, Sınıf-I molar ve kanin ilişkisine sahip bir okluzyon elde edildi. Overbite ve overjet ilişkisi ideal hale getirildi ve sefalometrik analizle uyumlu olacak şekilde, alt yüz yüksekliğindeki azalmanın bir sonucu olarak fasiyal estetik görünüm iyileştirildi. PSG, SFT ve sefalometrik değişimler, orofarengeal hacimde artış, daha iyi hava akımı ve uyku kalitesinde iyileşme olduğunu ortaya koydu. Sonuç: Fazla miktarda yapılan mandibular setback operasyonu, biyolojik adaptasyonu engelleyebilmekte ve uyku solunum bozukluklarına yol açabilmektedir. Bu sebeple, iskeletsel Sınıf-III malokluzyonlu hastalarda, hava yolunu azaltmayan maksiller ilerletme ile birlikte mandibular set back uygulaması düşünülmesi daha iyi olacaktır. Hasta, multidisipliner bir yaklaşımla uygun bir estetik ve fonksiyon kazanmıştır

References

  • Stellzig-Eisenhauer A, Lux CJ,Schuster G. Treatment decision in adult patients with Class III malocclusion: Orthodontic therapy or orthognathic surgery? Am J Orthod Dentofacial Orthop. 2002;122: 27-38.
  • Guyer E, Ellis E, McNamara JA Jr, Beh- rents R. Components of Class III malocclusion in juveniles and adolescents. Angle Orthod. 1986;56:7-30.
  • Battagel JM. The aetiological factors in Class III malocclusion. Eur J Orthod. 1993;15:347- 70.
  • Arnett GW, Bergman RT. Facial keys to orthodontic diagnosis and treatment planning. Part I. Am J Orthod Dentofacial Orthop 1993;103:299- 312.
  • Arnett GW, Bergman RT. Facial keys to orthodontic diagnosis and treatment planning. Part II. Am J Orthod Dentofacial Orthop 1993;103:395- 411.
  • Dwyer PW. Orthodontic and orthognathic surgical correction of a severe Class III malocclu- sion. Am J Orthod Dentofacial Orthop 1998;113:125-32.
  • Gokce SM, Gorgulu S, Gokce HS, Bengi O, Sabuncuoglu F, Ozgen F, Bilgic H. Changes in pos- terior airway space, pulmonary function and sleep quality, following bimaxillary orthognathic surgery. Int J Oral Maxillofac Surg. 2012; 41:820–829.
  • Tselnik M, Pogrel MA. Assessment of the pharyngeal airway space after mandibular setback surgery. J Oral Maxillofac Surg. 2000;58:282–285.
  • Chen F, Terada K, Hua Y, Saito I. Effects of bimaxillary surgery and mandibular setback sur- gery on pharyngeal airway measurements in pati- ents with Class III skeletal deformities. Am J Ort- hod Dentofacial Orthop. 2007;131: 372–377.
  • Foltán R, Hoffmannová J, Donev F, Vlk M, Sedy J, Kufa R, Bulik O. The impact of Le Fort I advancement and bilateral sagittal split osteotomy setback on ventilation during sleep. Int J Oral Maxillofac Surg. 2009;38:1036–1040.
  • Rivera SM, Hatch JP, Dolce C, Bays RA, Van Sickels JE, Rugh JD. Patients’ own reasons and patient-perceived recommendations for orthog- nathic surgery. Am J Orthod Dentofacial Orthop. 2000;118:134–140.
  • Ölmez H, Sağdıç D, Bengi AO, ùengün O. İskeletsel sınıf III olgularda ortognatik cerrahi ( İki olgu nedeniyle).Türk Ortodonti Dergisi. 1994; 7: 213-219.
  • Demetriades N, Chang DJ, Laskarides C, Papageorge M. Effects of mandibular retropositio- ning, with or without maxillary advancement, on the oro-naso-pharyngeal airway and development of sleep-related breathing disorders. J Oral Maxillo- fac Surg 2010;68:2431-2436.
  • Soncul M, Bamber MA. Evaluation of fa- cial soft tissue changes with optical surface scan af- ter surgical correction of class III deformities. J Oral Maxillofac Surg. 2004;62: 1331–1340.
  • Kajikawa Y. Changes in soft tissue profile after surgical correction of skeletal class III malocc- lusion. J Oral Surg. 1979;37:167–174.
  • Meral O, Gürton Ü, Ölmez H, Bengi AO, Sağdıç D. İskeletsel sınıf III olgularda tek çene ve çift çene ortognatik cerrahi uygulamalarını takiben yumuşak doku değişimlerinin karşılaştırılması. Türk Ortodonti Dergisi. 2000;13(3):150-157.
  • Tüzün A, Uzun K, Yüksekol İ, Taş D. İleri dönem karaciğer hastalığında solunum fonksiyonla- rının değerlendirilmesi. Solunum. 2001;3:117-120.
  • Lange NE, Mulholland M, Kreider ME. Spirometry don’t blow it Chest 2009;136: 608– 614.
  • Kitagawara K, Kobayashi T, Goto H, Yo- kobayashi T, Kitamura N, Saito C. Effects of man- dibular setback surgery on oropharyngeal airway and arterial oxygen saturation. Int J Oral Maxillofac Surg 2008;37:328–333.
  • Turnbull NR, Battagel JM. The effects of orthognathic surgery on pharyngeal airway dimen- sions and quality of sleep. J Orthod. 2000;27:235– 247.
There are 20 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Sıla Mermut Gökçe This is me

Serkan Görgülü This is me

Korhan Gider This is me

Ümit Karaçaylı This is me

Gökhan Serhat Duran This is me

Publication Date February 1, 2014
Published in Issue Year 2014 Volume: 41 Issue: 1 - Volume: 41 Issue: 1

Cite

Vancouver Gökçe SM, Görgülü S, Gider K, Karaçaylı Ü, Duran GS. İskeletsel sınıf III olguda multidisipliner tedavinin arka hava yolu ve solunum fonksiyonlarına etkisi. EADS. 2014;41(1):29-40.