Three dimensional cone-beam CT study of upper airway change after mandibular setback surgery for skeletal Class III malocclusion patients

Na-Ri Kim; Yong-Il Kim; Soo-Byung Park; Dae-Seok Hwang

doi:10.4041/kjod.2010.40.3.145

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Kim, Kim, Park, and Hwang: Three dimensional cone-beam CT study of upper airway change after mandibular setback surgery for skeletal Class III malocclusion patients

Original Article

Korean Journal of Orthodontics

Korean Journal of Orthodontics 2010; 40(3): 145-155.

Published online: 30 June 2010

DOI: https://doi.org/10.4041/kjod.2010.40.3.145

Three dimensional cone-beam CT study of upper airway change after mandibular setback surgery for skeletal Class III malocclusion patients

Na-Ri Kim, DDS, MSD^a, Yong-Il Kim, DDS, MSD^b, Soo-Byung Park, DDS, MSD, PhD^c, Dae-Seok Hwang, DDS, MSD, PhD^d

^aGraduate Student, Department of Orthodontics, School of Dentistry, Pusan National University, Korea.

^bClinical Assistant Professor, Department of Orthodontics, School of Dentistry, Pusan National University, Korea.

^cProfessor, Department of Orthodontics, School of Dentistry, Pusan National University, Korea.

^dClinical Assistant Professor, Department of Oral & Maxillofacial Surgery, School of Dentistry, Pusan National University, Korea.

Corresponding author: Soo-Byung Park. Department of Orthodontics, Pusan National University Hospital, Beomeo-ri, Mulgeum-eup, Yangsan 626-770, Korea. +82 55 360 5000; sbypark@pusan.ac.kr

Received 2 February 2010 Revised 9 April 2010 Accepted 12 April 2010

Abstract

Objective

Lateral cephalometric radiographs have been the main form of resource for assessing two dimensional anteroposterior airway changes. The purpose of this study was to evaluate the three dimensional volumetric change in the upper airway space in Class III malocclusion patients who underwent mandibular setback surgery.

Methods

Three dimensional cone-beam computed tomographs (CBCT) and their three dimensional reconstruction images were analyzed. The samples consisted of 20 adult patients (12 males and 8 females) who were diagnosed as skeletal Class III and underwent mandibular setback surgery. CBCTs were taken at 3 stages - Baseline (1.8 weeks before surgery), T1 (2.3 months after surgery), and T2 (1 year after surgery). Pharyngeal airway was separated according to the reference planes and reconstructed into the nasopharynx, the oropharynx and the hypopharynx. Measurements at Baseline, T1, and T2 were compared between groups.

Results

The result showed the volume of the pharyngeal airway decreased significantly 2.3 months after surgery (p < 0.001) and the diminished airway did not recover after 1 year post-surgery. The oropharynx was the most decreased area.

Conclusions

These findings suggest that mandibular setback surgery causes both short-term and long-term decrease in the upper airway space.

Keywords: Cone-beam computed tomography, Orthognathic surgery, Pharyngeal airway

Figures and Tables

Fig. 1

Three dimensional image and MPR (multiplanar projection reformat) overlay views of airways. A, Reference planes (PNS-Vp plane, CV1 plane, CV2 plane, CV4 plane); B, volumetric image at nasopharynx area; C, volumetric image at oropharynx area; D, volumetric image at hypopharynx area. PNS, Psterior nasal spine; Vp, the most posterior point of the ala of vomer; CV, cervical vertebrae.

Fig. 2

Measurement of mandibular position. Mandibular position was evaluated using anotomical B point at each time period.

Fig. 3

Mean pharyngeal volume change. Baseline, Before surgery; T1, 2.3 months after surgery; T2, 1 year after surgery.

Table 1

Means and standard deviations of volume of the whole-pharynx, nasopharynx, oropharynx and hypopharynx (unit: mm³)

Baseline, Before surgery; T1, 2.3 months after surgery; T2, 1 year after surgery.

Table 2

Comparison of volume changes of the whole-pharynx, nasopharynx, oropharynx and hypopharynx (unit: mm³)

^*p< 0.05; ^†p< 0.01; ^‡p< 0.001; NS, Not significant; Baseline, before surgery; T1, 2.3 months after surgery, T2, 1 year after surgery.

Table 3

Correlation analysis between mandibular setback amount and change of pharyngeal airway volume

p< 0.05; NS, not significant; Baseline, before surgery; T1, 2.3 months after surgery.

Table 4

Correlation analysis between skeletal relapse amount and change of pharyngeal airway volume.

p< 0.05; NS, not significant; T1, 2.3 months after surgery; T2, 1 year after surgery.

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