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

Yıl 2022, Cilt: 6 Sayı: 2, 58 - 66, 31.12.2022

Necip Fazıl Erdem , Yasemin Bahar Acar , Alanur Çiftçi Şişman

https://doi.org/10.29228/erd.27

Öz

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.

Anahtar Kelimeler

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

Öz

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.

Anahtar Kelimeler

orthognathic surgery, Le Fort I Osteotomy, Angle Class III

Kaynakça

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