EVALUATION OF SOFT TISSUE AND AIRWAY CHANGES IN PATIENTS UNDERGOING COMBINED ORTHODONTIC AND ORTHOGNATHIC SURGERY

Year 2021, Volume: 8 Issue: 2, 344 - 351, 31.08.2021

Elif Dilara Şeker Rabianur Baltacı Melike Polat Türker Yücesoy Gökmen Kurt

https://doi.org/10.15311/selcukdentj.644887

Abstract

Background: Combined orthodontic
treatment and orthognathic surgery lead to changes in soft tissues and airway.
Prediction of postoperative changes is important for treatment planning. The
aim of this study was to investigate the changes in hard-soft tissue, and
airway in patients undergoing class III orthognathic surgery. 

Methods: In this study, pre- and post-operative
cephalometric films of 18 patients with Class III malocclusion were included.
The maxillary impaction-advancement and mandibular setback were performed. Hard-soft
tissue and airway measurements on lateral cephalometric radiographs which were
taken immediately before surgery(T1) and at least 6 months after surgery(T2)
were performed using Dolphin and Planmeca Romexis softwares, respectively. The data
distribution was analysed using Shapiro Wilk test. Comparisons of the data were
analysed using Paired t-test and
Wilcoxon test.

Results: A statistically significant
increase in Sn'-LLS/LLS-Me' value and E plane-lower lip distance and a
significant decrease in E-plane-upper lip distance were observed. No
statistical differences were observed in other soft tissue parameters. A
significant increase in SNA°, ANB° and a significant decrease in SN-GoGn° were
observed. There was an increase in V-LPW value in airway evaluations, however,
no significant difference was found in other airway parameters.

Conclusıon: In the literature, it is
difficult to obtain evidence-based results due to the retrospective character
of the studies examining soft tissue and airway changes after orthognathic
surgery, non-standard methods and the wide range of surgical movements applied.
However, combined orthodontic treatment and orthognathic surgery have positive
effects on soft tissue and airway in terms of aesthetics and function.

Keywords

Orthodontics, orthognatic surgery, Angle Class III, cephalometry

SINIF III ORTOGNATİK CERRAHİ HASTALARINDA YUMUŞAK DOKU VE HAVA YOLU DEĞİŞİMLERİNİN DEĞERLENDİRİLMESİ

Abstract

Amaç: : Kombine ortodontik tedavi ve ortognatik cerrahi
yumuşak dokularda ve havayolunda değişikliklere neden olmakta olup, ameliyat
sonrası oluşacak değişimlerin öngörülmesi tedavi planlaması açısından
önemlidir. Bu çalışmanın amacı sınıf III ortognatik cerrahi geçiren hastaların
sert doku, yumuşak doku ve havayolu değişimlerinin incelenmesidir.

Gereç ve Yöntemler: Bu
retrospektif çalışmaya, 18 adet sınıf III hastanın pre-operatif ve
post-operatif lateral sefalometrik kayıtları dahil edilmiştir. Çalışmaya dahil
edilen hastalarda maksiller gömme ve ilerletme, mandibular geri alma işlemleri
uygulanmıştır. Hastalardan cerrahiden hemen önce(T1) ve cerrahiden en az 6 ay
sonra(T2) alınan lateral sefalometrik radyografiler üzerinde yumuşak doku
ölçümleri Dolphin programıyla, havayolu ölçümleri ise Planmeca Romexis
yazılımıyla yapılmıştır. Elde edilen verilerin dağılımı Shapiro Wilk Testi ile
incelenmiş olup, T1 ve T2 döneminde elde edilen normal dağılım gösteren
verilerin karşılaştırmaları için Paired t-test, normal dağılım göstermeyen
verilerin karşılaştırmaları için ise Wilcoxon testi kullanılmıştır.

Bulgular: Hastaların
T1 ve T2 dönemlerinde elde edilen verileri karşılaştırıldığında yumuşak dokuda
Sn'-LLS/LLS-Me' değerinde ve E düzlemi-alt dudak mesafesinde istatistiksel
olarak anlamlı artış, E düzlemi-üst dudak mesafesinde olarak anlamlı azalma
gözlenmiştir. Diğer yumuşak doku parametrelerinde farklılık gözlenmemiştir. Sert doku değerlendirmesinde,
SNA°, ANB° değerinde anlamlı
artış, SN-GoGn° açısında anlamlı azalma gözlenmiştir. Havayolu
değerlendirmelerinde V-LPW değerinde artış meydana gelirken diğer
parametrelerde anlamlı fark bulunamamıştır.

Sonuçlar: Literatürde
ortognatik cerrahi sonrası yumuşak doku ve havayolu değişimlerini inceleyen
çalışmaların retrospektif karakteri, yöntemlerin standart olmaması ve uygulanan
cerrahi hareket miktarının geniş bir aralıkta değişmesi nedeniyle kanıta dayalı
sonuçlar çıkarmak zordur. Bununla birlikte kombine ortodontik tedavi ve
ortognatik cerrahi yumuşak doku ve hava yolu üzerinde estetik ve fonksiyon
bakımından olumlu etkileri vardır.

Anahtar Kelimeler: Ortodonti, Ortognatik cerrahi, Angle Sınıf III, Sefalometri

Keywords

Ortodonti, Ortognatik cerrahi, Angle Sınıf III, sefalometri

References

• 1. Joss CU, Joss-Vassalli IM, Bergé SJ, Kuijpers-Jagtman AM. Soft tissue profile changes after bilateral sagittal split osteotomy for mandibular setback: a systematic review. J Oral Maxillofac Surg, 2010; 68: 2792-801.
• 2. Ulgen M. Anomaliler, sefalometri, etyoloji, büyüme ve gelişim, tanı, ortodonti. İstanbul: Yeditepe Üniversitesi Yayınları, 2000.
• 3. Lisboa C, Martins M, Ruellas A, Ferreira D, Maia L, Mattos C. Soft tissue assessment before and after mandibular advancement or setback surgery using three-dimensional images: systematic review and meta-analysis. Int J Oral Maxillofac Surg, 2018; 47: 1389-97.
• 4. Arnett GW, Jelic JS, Kim J, Cummings DR, Beress A, Worley Jr CM, et al. Soft tissue cephalometric analysis: diagnosis and treatment planning of dentofacial deformity. Am J Orthod Dentofacial Orthop, 1999; 116 :239-53.
• 5. Epker BN, Fish LC, Stella JP. Dentofacial deformities: integrated orthodontic and surgical correction: Mosby St. Louis, 1986.
• 6. Ricketts RM. Esthetics, environment, and the law of lip relation. Am J Orthod Dentofacial Orthop, 1968; 54: 272-89.
• 7. Degerliyurt K, Ueki K, Hashiba Y, Marukawa K, Nakagawa K, Yamamoto E. A comparative CT evaluation of pharyngeal airway changes in class III patients receiving bimaxillary surgery or mandibular setback surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2008; 105 :495-502.
• 8. Samman N, Mohammadi H, Xia J. Cephalometric norms for the upper airway in a healthy Hong Kong Chinese population. Hong Kong Med J, 2003; 9: 25-30.
• 9. Malkoc S, Usumez S, Nur M, Donaghy CE. Reproducibility of airway dimensions and tongue and hyoid positions on lateral cephalograms. Am J Orthod Dentofacial Orthop, 2005; 128: 513-6.
• 10. Linder-Aronson S. Adenoids. Their effect on mode of breathing and nasal airflow and their relationship to characteristics of the facial skeleton and the dentition. A biometric, rhino-manometric and cephalometro-radiographic study on children with and without adenoids. Acta Otolaryngol Suppl, 1970; 265: 1-132.
• 11. Kerr W, Ten Have T. Changes in soft tissue profile during the treatment of Class III malocclusion. Br J Orthod, 1987; 14: 243-9.
• 12. Storms A-S, Miclotte A, Grosjean L, Cadenas de Llano-Pérula M, Alqerban A, Fieuws S, et al. Short-term hard and soft tissue changes after mandibular advancement surgery in Class II patients: a retrospective cephalometric study. Eur J Orthod, 2017; 39: 567-76.
• 13. Rosen HM. Aesthetic perspectives in jaw surgery: Springer Science & Business Media, 2012.
• 14. Kiliçoĝlu H, Kirliç Y. Profile changes in patients with Class III malocclusions after Delaire mask therapy. Am J Orthod Dentofacial Orthop, 1998; 113: 453-62.
• 15. Chew MT, Sandham A, Wong HB. Evaluation of the linearity of soft-to hard-tissue movement after orthognathic surgery. Am J Orthod Dentofacial Orthop, 2008; 134: 665-70.
• 16. Yamamoto S, Miyachi H, Fujii H, Ochiai S, Watanabe S, Shimozato K. Intuitive facial imaging method for evaluation of postoperative swelling: a combination of 3-dimensional computed tomography and laser surface scanning in orthognathic surgery. J Oral Maxillofac Surg, 2016; 74: 2506.e1-.e10.
• 17. Osorio F, Perilla M, Doyle DJ, Palomo JM. Cone beam computed tomography: an innovative tool for airway assessment. Anesth Analg, 2008; 106: 1803-7.
• 18. Ngan D, Kharbanda OP, Geenty JP, Darendeliler M. Comparison of radiation levels from computed tomography and conventional dental radiographs. Aust Orthod J, 2003; 19: 67-75.
• 19. Silva MAG, Wolf U, Heinicke F, Bumann A, Visser H, Hirsch E. Cone-beam computed tomography for routine orthodontic treatment planning: a radiation dose evaluation. Am J Orthod Dentofacial Orthop, 2008; 133: 640.e1-.e5.
• 20. Marsan G, Kuvat SV, Oztas E, Cura N, Susal Z, Emekli U. Oropharyngeal airway changes following bimaxillary surgery in Class III female adults. J Craniomaxillofac Surg, 2009; 37: 69-73.
• 21. Joss CU, Vassalli IM, Thüer UW. Stability of soft tissue profile after mandibular setback in sagittal split osteotomies: a longitudinal and long-term follow-up study. J Oral Maxillofac Surg, 2008; 66: 1610-6.
• 22. Mobarak KA, Krogstad O, Espeland L, Lyberg T. Factors influencing the predictability of soft tissue profile changes following mandibular setback surgery. Angle Orthod, 2001; 71: 216-27.
• 23. Altug-Atac AT, Bolatoglu H, Memikoglu UT. Facial soft tissue profile following bimaxillary orthognathic surgery. Angle Orthod, 2008; 78: 50-7.
• 24. Stella JP, Streater MR, Epker BN, Sinn DP. Predictability of upper lip soft tissue changes with maxillary advancement. J Oral Maxillofac Surg, 1989; 47: 697-703.
• 25. Ksiezycki-Ostoya BK, McCollum AG, Becker PJ, editors. Sagittal soft-tissue changes of the lower lip and chin associated with surgical maxillary impaction and consequent mandibular autorotation. Semin Orthod, 2009; 15: 185.
• 26. Wenzel A, Williams S, Ritzau M. Changes in head posture and nasopharyngeal airway following surgical correction of mandibular prognathism. The European Journal of Orthodontics. 1989;11(1):37-42.
• 27. 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. Am J Orthod Dentofacial Orthop, 2007; 131: 372-7.
• 28. Aydemir H, Memikoğlu 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.
• 29. Pereira-Filho VA, Castro-Silva LM, de Moraes M, Gabrielli MFR, Campos JADB, Juergens P. Cephalometric evaluation of pharyngeal airway space changes in class III patients undergoing orthognathic surgery. J Oral Maxillofac Surg, 2011; 69: 409-15.
• 30. Cakarne D, Urtane I, Skagers A. Pharyngeal airway sagittal dimension in patients with Class III skeletal dentofacial deformity before and after bimaxillary surgery. Stomatol, 2003; 5: 13-6.