Evaluation of the Effect of Orthognathic Surgery on Cervical Lordosis and Head Posture in Class III Patients

Year 2025, Volume: 4 Issue: 3, 51 - 58, 23.09.2025

Seçil Çubuk , Burak Ok , Gaye Mısırlıoğlu , Gündüz Can Gürlek , Burak Bayram

Abstract

Objective: This study aimed to evaluate the effects of orthognathic surgery on cervical lordosis and head posture in patients with Class III skeletal deformity.
Materials and Methods: A retrospective analysis was conducted on 19 Class III patients who underwent bimaxillary orthognathic surgery and 18 control subjects with skeletal Class I relationship. Preoperative and minimum two-month postoperative lateral cephalograms were assessed. Cervical spine curvature was measured using the Cobb method for CV1–CV2, CV3–CV7, and CV1–CV7 angulations. Statistical comparisons were made using the Mann-Whitney U test, and measurement reliability was confirmed via intraclass correlation coefficients.
Results: Significant improvements were observed in cephalometric indicators of skeletal Class III correction, including increased SNA and ANB angles, and improved Wits appraisal. While the CV1–CV7 angle increased by an average of 9.6 degrees, the change was not statistically significant (p = 0.702). No significant postoperative differences were found in cervical or head posture parameters, nor between the study and control groups (p > 0.05).
Conclusion: Although orthognathic surgery effectively corrected skeletal discrepancies in Class III patients, it did not result in significant short-term changes in cervical lordosis or head posture. The limited extent of mandibular setback in this cohort may have reduced its biomechanical impact on cervical spine alignment.

Keywords

Class 3 patients , Cervical lordosis , Head posture

Sınıf III hastalarda ortognatik cerrahinin servikal lordoz ve baş postürü üzerine etkisinin değerlendirilmesi

Abstract

Amaç: Bu çalışmanın amacı Sınıf III iskeletsel deformitesi olan hastalarda ortognatik cerrahinin servikal lordoz ve baş postürü üzerine etkilerini değerlendirmektir.
Gereç ve Yöntemler: Bimaksiller ortognatik cerrahi uygulanan 19 Sınıf III hasta ve iskeletsel Sınıf I ilişkiye sahip 18 kontrol olgusu üzerinde retrospektif bir analiz yapıldı. Ameliyat öncesi ve ameliyat sonrası en az iki aylık lateral sefalogramlar değerlendirildi. Servikal omurga eğriliği CV1-CV2, CV3-CV7 ve CV1-CV7 açılanmaları için Cobb yöntemi kullanılarak ölçüldü. İstatistiksel karşılaştırmalar Mann-Whitney U testi kullanılarak yapıldı ve ölçüm güvenilirliği sınıf içi korelasyon katsayıları ile doğrulandı.
Sonuçlar: İskeletsel Sınıf III düzeltmenin sefalometrik göstergelerinde, SNA ve ANB açılarında artış ve Wits değerlendirmesinde iyileşme dahil olmak üzere önemli gelişmeler gözlenmiştir. CV1-CV7 açısı ortalama 9.6 derece artarken, değişiklik istatistiksel olarak anlamlı değildi (p = 0.702). Servikal veya baş duruşu parametrelerinde ya da çalışma ve kontrol grupları arasında ameliyat sonrası anlamlı bir fark bulunmamıştır (p > 0.05).
Tartışma: Ortognatik cerrahi, Sınıf III hastalarda iskeletsel uyumsuzlukları etkili bir şekilde düzeltmesine rağmen, servikal lordoz veya baş postüründe kısa vadede önemli değişikliklere yol açmamıştır. Bu kohorttaki mandibular gerilemenin sınırlı olması, servikal omurga hizalanması üzerindeki biyomekanik etkisini azaltmış olabilir.

Keywords

Sınıf 3 hasta , Servikal lordoz , Baş postürü

References

• 1. Saccucci M, Tettamanti L, Mummolo S, Polimeni A, Festa F, Tecco S. Scoliosis and dental occlusion: a review of the literature. Scoliosis. 2011;6:15. http://dx.doi.org/ 10.1186/1748-7161-6-15.
• 2. D’Attilio M, Caputi S, Epifania E, Festa F, Tecco S. Evaluation of cervical posture of children in skeletal class I, II, and III. Cranio. 2005;23:219–28. http://dx.doi.org/10.1179/ crn.2005.031.
• 3. Smailiene_ D, Intiene_ A, Dobradziejute_ I, Kuleika G. Effect of treatment with twin- block appliances on body posture in class II malocclusion subjects: a prospective clinical study. Med Sci Monit. 2017;23:343–52. http://dx.doi.org/10.12659/msm.899088.
• 4. Solow B, Siersbaek-Nielsen S. Cervical and craniocervical posture as predictors of craniofacial growth. Am J Orthod Dentofacial Orthop. 1992;101:449–58. http://dx.doi.org/ 10.1016/0889-5406(92)70119-U.
• 5. Solow B, Skov S, Ovesen J, Norup PW, Wildschiødtz G. Airway dimensions and head posture in obstructive sleep apnea. Eur J Orthod . 1996;18:571–9. http://dx.doi. org/10.1093/ejo/18.6.571.
• 6. Kerbrat A, Schouman T, Decressain D, Rouch P, Attali V. Interaction between posture and maxillomandibular deformity: A systematic review. Int J Oral Maxillofac Surg. 2022;51(1):104–112.
• 7. Kulczynski, FZ, de Oliveira Andriola F, Deon PH, da Silva Melo DA, Pagnoncelli RM. Postural assessment in class III patients before orthognathic surgery. J Oral Maxillofac Surg. 2018;76(2):426-435.
• 8. Kulczynski FZ, de Oliveira Andriola F, Deon PH, da Silva Melo DA, Pagnoncelli RM. Postural assessment in class III patients before and after orthognathic surgery. Oral Maxillofac Surg. 2018;22:143–150.
• 9. de Oliveira Andriola F, Kulczynski FZ, Deon PH, da Silva Melo DA, Zanettini L MS, Pagnoncelli RM. Changes in cervical lordosis after orthognathic surgery in skeletal class III patients. J Craniofac Surg. 2018;29(6), e598-e603.
• 10. Zhou S, Yan J, Da H, Yang Y, Wang N, Wang W, Ding Y, Sun S. A correlational study of scoliosis and trunk balance in adult patients with mandibular deviation. PLoS One. 2013;8:e59929. http://dx.doi.org/10.1371/ journal.pone.0059929.
• 11. Nakashima A, Yamada T, Nakano H, Sugiyama G, Sugi T, Kamata YU, Sumida T, Mori Y. Jaw asymmetry may cause bad posture of the head and the spine—a prelim- inary study. J Oral Maxillofac Surg Med Pathol. 2018;30:242–6. http://dx.doi.org/ 10.1016/j. ajoms.2018.01.001.
• 12. Nakashima A, Nakano H, Yamada T, Inoue K, Sugiyama G, Kumamaru W, Nakajima Y, Sumida T, Yokoyama T, Mishima K, Mori Y. The relationship between lateral displacement of the mandible and scoliosis. Oral Maxillofac Surg. 2016;21:59–63. http://dx. doi.org/10.1007/s10006-016-0607-9.
• 13. Sinko K, Grohs JG, Millesi-Schobel G, Wat- zinger F, Turhani D, Undt G, Baumann A. Dysgnathia, orthognathic surgery and spinal posture. Int J Oral Maxillofac Surg 2006;35:312–7. http://dx.doi.org/10.1016/j. ijom.2005.09.009.
• 14. Lippold C, Danesh G, Hoppe G, Drerup B, Hackenberg L. Trunk inclination, pelvic tilt and pelvic rotation in relation to the craniofacial morphology in adults. Angle Orthod. 2007;77:29–35. http://dx.doi.org/10.2319/ 121205-434R.1.
• 15. Lippold C, Danesh G, Schilgen M, Drerup B, Hackenberg L. Relationship between thorac- ic, lordotic, and pelvic inclination and cra- niofacial morphology in adults. Angle Orthod 2006;76:779–85. http://dx.doi.org/ 10.1043/0003- 3219(2006)076[0779: RBTLAP]2.0.CO;2.
• 16. Lippold C, Danesh G, Schilgen M, Drerup B, Hackenberg L. Sagittal jaw position in rela- tion to body posture in adult humans—a rasterstereographic study. BMC Musculoskeletal Disorders. 2006;7:8. http://dx.doi. org/10.1186/1471-2474-7-8.
• 17. Kim MA, Kim BR, Youn JK, et al. Head posture and pharyngeal airway volume changes after bimaxillary surgery for mandibular prognathism. J Cranio Maxillofac Surg. 2014;42:531–535
• 18. 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. Eur J Orthod. 2000;22:383–394.
• 19. Aydemir H, Memikoglu U, Karasu H. Pharyngeal airway space, hyoid bone position and head posture after orthognathic surgery in Class III patients. Angle Orthod. 2012;82:993–1000.
• 20. Efendiyeva R, Aydemir H, Karasu H, et al. Pharyngeal airway space, hyoid bone position, and head posture after bimaxillary orthognathic surgery in Class III patients: long-term evaluation. Angle Orthod 2014;84:773–78.