The structural change in the hyoid bone and upper airway after orthognathic surgery for skeletal class III anterior open bite patients using 3-dimensional computed tomography

Yoon-seob Lee; Hyoung-seon Baik; Kee-joon Lee; Hyung-seog Yu

doi:10.4041/kjod.2009.39.2.72

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Lee, Baik, Lee, and Yu: The structural change in the hyoid bone and upper airway after orthognathic surgery for skeletal class III anterior open bite patients using 3-dimensional computed tomography

Original Article

Korean Journal of Orthodontics

Korean Journal of Orthodontics 2009; 39(2): 72-82.

Published online: 30 April 2009

DOI: https://doi.org/10.4041/kjod.2009.39.2.72

The structural change in the hyoid bone and upper airway after orthognathic surgery for skeletal class III anterior open bite patients using 3-dimensional computed tomography

Yoon-seob Lee, DDS, MSD^a, Hyoung-seon Baik, DDS, MSD, PhD^b, Kee-joon Lee, DDS, MSD, PhD^c, Hyung-seog Yu, DDS, MSD, PhD^c

^aResident, Department of Orthodontics, College of Dentistry, Yonsei University, Korea.

^bProfessor, Department of Orthodontics, College of Dentistry, Oral Science Research Center, The Institute of Cranio-facial Deformity, Yonsei University, Korea.

^cAssociate Professor, Department of Orthodontics, College of Dentistry, Oral Science Research Center, The Institute of Cranio-facial Deformity, Yonsei University, Korea.

Corresponding author: Hyung-Seog Yu. Department of Orthodontics, College of Dentistry, Yonsei University, 134, Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea. +82 2 2228 3104; yumichael@yuhs.ac

Received 10 September 2008 Revised 20 February 2009 Accepted 23 February 2009

Abstract

Objective

The purpose of this study was to investigate the structural changes of the hyoid bone and upper airway after orthognathic surgery for skeletal class III anterior open bite patients, and make comparisons with normal occlusion.

Methods

Pre- and post-operative computed tomography (CT) examinations were performed on 12 skeletal class III anterior open bite patients who were treated with mandibular setback osteotomy. Using the V-works 4.0™ program, 3-dimensional images of the total skull, mandible, hyoid bone, and upper airway were evaluated.

Results

In the Class III openbite group, the hyoid bone were all positioned anteriorly, compared to the Normal group (p < 0.05). The angle between the hyoid plane and mandibular plane in the Class III openbite group before surgery was greater than in the Normal group (p < 0.05), and the difference increased after surgery (p < 0.01). In the Class III openbite group, the volume of the upper airway decreased after surgery (p < 0.001) and the volume of the upper airway was smaller than the Normal group before and after surgery (p < 0.001).

Conclusions

The narrow upper airway space in skeletal Class III openbite patients decreased after mandibular setback osteotomy. This may affect the post-surgical stability.

Keywords: Three-dimensional computed tomography (3D CT), Skeletal class III openbite, Hyoid bone, Upper airway

Figures and Tables

Fig 1

Procedure of 3D image reconstruction using V-works™ 4.0 (Cybermed, Seoul, Korea).

Fig 2

Nine landmarks used in this study. Na (Nasion), Most posterior point on the curvature between frontal bone and nasal bone in the midsagittal plane; P (prechiasmatic groove), vertical and transverse midpoint of prechiasmatic groove; Or (orbitale), lowest point on the infraorbital margin of each orbit; Po (porion, anatomical), highest midpoint on the roof of the external auditory meatus; B (B point), greatest concavity point on the anterior border of the symphysis; Me (menton), most inferior point on the symphysis of the mandible; Go2 (gonion2), midpoint of the posterior border of mandibular angle; H (hyoidale), most upper and superior point at the middle of the hyoid bone; Hs (hyoidale superioris), most upper and posterior point at the greater horn of hyoid bone.

Fig 3

Coordinate axis used in this study. A positive coordinate value indicates the front, superior, and left side of the patient, and a negative value indicates the opposite. Na (Nasion), Most posterior point on the curvature between frontal bone and nasal bone in the midsagittal plane.

Fig 4

Measurements of Hyoid bone. The 3-dimensional position of hyoid bone was obtained by measuring the distances between H point and Coronal, Midsagittal, and Horizontal planes. The angle between hyoid plane and horizontal, mandibular planes was obtained for the angular measurement. If the angle between hyoid plane and mandibular plane was more than 180°, a negative value was used and defined as reverse inclination. Five reference planes were used in this study. Horizontal plane, parallel to the FH plane, which was constructed on both sides of Po and left of Or, passing through Na; Midsagittal plane, perpendicular to the horizontal plane passing through Na and P; Coronal plane, at right angles to the horizontal and midsagittal plane passing through Na; Mandibular plane, constructed by Me and both sides of Go2; Hyoid plane, constructed by H and both sides of Hs.

Fig 5

Measurements of Airway space, Mandibular setback, PNS impaction. 3-dimensional reconstruction of upper airway was limited between C1 and C3. Mandibular setback was obtained by measuring the difference in the distance between Coronal plane and B point at pre-, post-surgery. PNS impaction was obtained by measuring the difference in the distance between Horizontal plane and PNS point at pre-, post-surgery. C1, lowest midpoint on the 1st cervical vertebrae; C3, lowest midpoint on the 3rd cervical vertebrae; B (B point), greatest concavity point on the anterior border of the symphysis; PNS (posterior nasal spine), the process formed by uniting the projecting ends of the posterior borders of the palatal process of the palatal bone; sBack, difference of mandibular set back at T₁ and T₂; pIMPACTION, difference of PNS.

Table 1

3-dimensional measurements and comparison of H (Hyoidale) between Class III openbite group at T1 and T2 and normal group (N)

^*p < 0.05; ^†p < 0.01; NS, not significant; Sig, significance; SD, standard deviation; H-Hori angle, angle of hyoid plane and horizontal plane; H-Mn angle, angle of hyoid plane and mandibular plane.

Table 2

Mean treatment changes of H (Hyoidale) and upper airway volume (airVol) in the Class III openbite group

^*p < 0.001; NS, not significant; H-Hori angle, angle of hyoid plane and horizontal plane; H-Mn angle, angle of hyoid plane and mandibular plane.

Table 3

Comparison of upper airway volume (airVol) between the Class III openbite group at T1 and T2 and normal group (N)

^*p < 0.001. Sig, significance; SD, standard deviation.

Table 4

Comparison of upper airway volume (airVol) in male and female between the Class III openbite group at T1 and normal group (N)

^*p < 0.05.

Table 5

Correlation between mandibular setback, PNS impaction and upper airway volume change in the Class III openbite group at T1 and T2

β, Linear regression coefficiency; NS, not significant; sBack, horizontal change of B point at T₁ and T₂; pIMPACTION, vertical change of PNS at T₁ and T₂.

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