Sınıf III Maloklüzyonun Cerrahi Düzeltiminde Farklı Maksillomandibuler Hareketlerin Üst Havayolu Anteroposterior Boyutları Üzerindeki Etkilerinin Karşılaştırılması

Abstract

Amaç: Sınıf III maloklüzyonun düzeltilmesi için farklı bimaksiller cerrahi planların üst hava yolunun ön-arka boyutlarına etkisini değerlendirmek. Gereç ve Yöntem: Sınıf III düzeltimi için bimaksiller cerrahi ile tedavi edilen 59 birey (ortalama yaş: 23.11±1.85 yıl) dahil edildi. Ameliyat öncesi (T1) ve ameliyat sonrası (T2) lateral sefalogramlar analiz edilerek kafa kaidesi üzerinde çakıştırıldı. A ve B noktalarının yatay hareketlerinin miktarlarına göre 3 grup oluşturuldu. Grup-1: (n=21) B noktasının yer değiştirmesi A noktasından büyüktü. Grup-2: (n=13) A ve B noktalarının yer değiştirmeleri arasındaki fark ≤1mm idi. Grup-3: (n=25), A noktasının yer değiştirmesi B noktasından büyüktü. Ön-arka faringeal hava yolu boyutları (mm), arka(PAS), üst-arka(SPAS), orta(MAS), alt(IAS), epiglottik(EAS) hava yolu boşluklarında ölçüldü. Sınıf içi değerlendirme Paired sample t testi ve Wilcoxon testi ile yapıldı. Sefalometrik değişiklikler için sınıflar arası karşılaştırmalar ANOVA ve Tukey testi ile değerlendirilirken, hava yolu değişiklikleri için Welch ANOVA ve Kruskal-Wallis testleri yapıldı. Hava yolu parametrelerinin ikili karşılaştırmaları Bonferroni düzeltmeli Mann-Whitney u-testi ile yapıldı. Birincil yordayıcı ve sonuç değişkenleri arasındaki ilişkiyi değerlendirmek için Pearson korelasyon analizi yapıldı. Sonuçlar: Maksiller yükseklik, palatal düzlem, SNA, SNB, ANB, Wits, N-Perp, maksiller derinlik toplam örnekte önemli ölçüde değişti. Mandibular düzlemdeki ve SNB'deki değişiklikler Grup-1'de daha yüksekti (p<0.05). SNA, N-PERP, maksiller derinlikteki değişiklikler Grup-3'te daha yüksekti (p<0.05). Toplam örnekte PAS (ortalama:2.44±2.21mm; medyan:2.17mm) ve SPAS (ortalama:1.07±2.31mm; medyan:1.14mm) oldukça anlamlı artış gösterdi. Grup-1'de İAS anlamlı olarak azaldı (ortalama: -1,98±3,68 mm; ortanca: -1,36 mm). Grup-2'de önemli bir faringeal değişiklik yoktu. Grup-3'te PAS (ortalama:3.03±2.20mm, ortanca:2.63mm) ve SPAS (ortalama:1.64±1.81mm, ortanca: 1,74mm) anlamlı olarak arttı. Toplam örnek, PAS ve SNA arasında anlamlı pozitif doğrusal zayıf ilişki ortaya koydu (r=0.335); IAS ve B noktası arasında (r=0.275). Grup-3'te PAS ve SNA ölçümleri arasında anlamlı pozitif doğrusal orta ilişki vardı (r=0.613). Sonuç: Farklı kombinasyonlardaki maksillomandibular hareketler üst hava yolunun ön-arka boyutları üzerinde belirgin olarak farklı etkiler göstermiştir. Klinisyenler, hava yolu üzerindeki etkilerini göz önünde bulundurarak ameliyat planlamasını dikkatli bir şekilde yapmalıdır.

Keywords

• ortognatik cerrahi
• Angle Sınıf III
• Le Fort I Kesisi

Comparison of Differential Maxillomandibular Movements on the Upper Airway in Anteroposterior Dimensions After Bimaxillary Surgery for Class III Correction

Abstract

Objective: To evaluate the effect of different surgery plans on anteroposterior dimensions of upper airway in bimaxillary surgery for correction of Class III malocclusion. Materials and Methods: 59 subjects (mean age: 23.11±1.85years) treated with bimaxillary surgery for Class III correction were included. Preoperative (T1) and postoperative (T2) lateral cephalograms were traced and superimposed. 3 groups were formed according to different relative horizontal movements of A and B-points. Group-1: (n=21) displacement of B-point was greater than A-point. Group-2: (n=13) difference between displacements of A and B-points were ≤1mm. Group-3: (n=25), displacement of A-point was greater than B-point. Anteroposterior pharyngeal airway dimensions(mm) were measured at posterior(PAS), superoposterior(SPAS), middle(MAS), inferior(IAS), epiglottic(EAS) airway spaces. Intraclass evaluation was performed with Paired sample t-test and Wilcoxon’s test. Interclass comparisons were evaluated with ANOVA and Tukey test for cephalometric changes while Welch ANOVA and Kruskal-Wallis tests were performed for airway changes. Pairwise comparisons of airway parameters were made with Mann-Whitney u-test with Bonferroni correction. Pearson correlation analysis was performed to evaluate relationship between primary predictor and outcome variables. Results: Maxillary-height, palatal-plane, SNA, SNB, ANB, Wits, N-Perp, maxillary-depth changed significantly in total sample. Changes in Mandibular-plane and SNB were higher in Group-1 (p<0.05). Changes in SNA, N-PERP, maxillary-depth were higher in Group-3 (p<0.05). In total sample, PAS (mean:2.44±2.21mm; median:2.17mm) and SPAS (mean:1.07±2.31mm; median:1.14mm) showed highly significant increase. In Group-1, IAS decreased significantly (mean:-1.98±3.68mm; median:-1.36mm). Group-2 had no significant pharyngeal changes. In Group-3, PAS (mean:3.03±2.20mm, median:2.63mm) and SPAS (mean:1.64±1.81mm, median: 1,74mm) increased significantly. Total sample revealed significant positive linear weak relationship between PAS and SNA (r=0.335); between IAS and B-point (r=0.275). Group-3 had significant positive linear moderate relationship existed between PAS and SNA measurements (r=0.613). Conclusion: Differential maxillomandibular movements showed distinctly different effects on anteroposterior dimensions of upper airway. Clinicians should prepare surgery planning carefully, considering its effects on the airway.

Keywords

• orthognathic surgery
• Le Fort I Osteotomy
• Angle Class III

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