Changes in Head Posture, Hyoid Bone Position and Airway Dimensions After Orthognatic Surgery

  • Wanderson Roberto dos Santos Azevedo
  • Christiane Cavalcante Feitoza
  • Carlos Sanches Vargas Jr.
  • Karina Eiras Dela Coleta Pizzol

Abstract

Abstract: Mandibular/bimaxillary advancement surgery is described as a potential means of increasing the oropharyngeal airspace, provided a significant improvement in breathing capacity. Aim: To evaluate postural changes suffered in the positioning of the head and the hyoid bone, dentofacial deformity patients
undergoing orthognathic surgery with consequent dimensional changes of oropharyngeal airspace. Methods: We evaluated the archived records of patients with postoperative 6 months
minimum, being used as criteria for selecting individuals with dental class II malocclusion and facial Pattern II, jaw or maxilomandibular deficiency, patients undergoing orthodontic-surgical treatment
through mandibular advancement or of both bony bases, associated or not to genioplasty. Twenty-eight patients were part of the sample and were evaluated by means of lateral radiographs
in lateral standard digitized, in three distinct periods: pre-operative, immediate, postoperative period and late postoperative period (minimum 6 months). 12 linear measures and two angular cephalometric analysis were used in this research. Results: With the surgery, there was an average of mandibular advancement
6.76 mm, while remaining stable in the long-term follow-up period; the hyoid bone moved onward and upward, extending your movement in the post-operative. The cervical region presented
minimal movement of the head extension in the immediate post operative with almost total returns the position of the head in the post-operative. The surgical movement of oropharyngeal air space was in the same direction of the mandibular movement, but to a lesser extent (1.88 -2.76 mm). In the post-operative period was a late partial reduction of the diameter of the air space between 34-56% of gain, representing an apparent accommodation of this anatomical region soft tissue. Conclusion: Orthognathic surgery of mandibular advancement or bimaxillary promotes significant changes in aesthetics, in the position of the hyoid bone and upper airway dimensions, getting better quality of life to these patients.

References

1. Pizzol KEDC, Barbeiro RH, Coleta RD, Marcantonio E. [Evaluation of occlusal plane alteration in
Orthognathic Surgeries combined with rigid internal fixation in Class II skeletal facial standard
patients]. Rev Dental Press Ortod Ortop Facial. 2006;11(4):104-17. Portuguese.
2. Raffani M, Pisani C. Clinical and cone-beam computed tomography evaluation of the
three-dimensional increase in pharyngeal airway space following maxilla-mandibular
rotation-advancement for Class II – correction in patients without sleep apnoea (OSA).
J Craniomaxillofac Surg. 2013 Oct;41(7):552-7. doi: 10.1016/j.jcms.2012.11.022.
3. Ronchi P, Cinquini V, Ambrosoli A, Caprioglio A. Maxillomandibular advancement in obstructive sleep
apnea syndrome patients: a restrospective study on the sagittal cephalometric variables. J Oral
Maxillofac Res. 2013 Jul 1;4(2):e5. doi: 10.5037/jomr.2013.4205.
4. Coleta KED, Wolford LM, Gonçalves JR, Santos-Pinto A, Pinto LP, Cassano DS, et al.
Maxillo-Mandibular Counter-Clockwise Rotation and Mandibular Advancement with TMJ Concepts
Total Joint Prostheses: Part II Airway Changes and Stability. Int J Oral Maxillofac Surg. 2009
Mar;38(3):228-35. doi: 10.1016/j.ijom.2008.11.021.
5. Mishima K, Yamada T, Sugahara T. Evaluation of respiratory status and mandibular movement after
total temporomandibular joint replacement in patients with rheumatoid arthritis. Int J Oral Maxillofac
Surg. 2003 Jun;32(3):275-9.
6. Lee YJ, Park JT, Cha JY. Perioral soft tisuue evaluation of skeletal Class II Division 1: A lateral cephalometric
study. Am J Orthod Dentofacial Orthop. 2015 Sep;148(3):405-13. doi: 10.1016/j.ajodo.2015.03.033.
7. Opdebeeck MD, Bell WH, Eisenfeld J, Mishelevich D. Comparative study between the SFS and LFS
rotation as a possible morphogenic mechanism. Am J Orthod. 1978 Nov;74(5):509-21.
8. Gokce SM, Gorgulu S, Gokce HS, Bengi AO, Karacayli U, Ors F. Evaluation of pharyngeal airway space
changes after bimaxillary orthognathic surgery with a 3-dimensional simulation and modeling program.
Am J Orthod Dentofacial Orthop. 2014 Oct;146(4):477-92. doi: 10.1016/j.ajodo.2014.06.017.
9. Mehra P, Downie M, Pita M, Wolford LM. Pharyngeal airway space changes after counterclockwise
rotation of the maxillomandibular complex. Am J Orthod Dentofacial Orthop. 2001 Aug;120(2):154-9.
10. Islam S, Uwadiae, Ormiston IW. Orthognathic surgery in the management of obstructive sleep
apnoea: experience from maxillofacial surgery unit in the United Kingdom. Br J Oral Maxillofac Surg.
2014 Jul;52(6):496-500. doi: 10.1016/j.bjoms.2014.04.002.
11. Muto T, Yamazaki A, Takeda S, Kawakami J, Tsuji Y, Shibata T, et al. Relationship between the
pharyngeal airway space and craniofacial morphology, taking into account head posture. Int J Oral
Maxillofac Surg. 2006 Feb;35(2):132-6.
12. Jiang C, Yi Y, Jiang C, Fang S, Wang J. Pharyngeal airway space and hyoid bone positioning
after different orthognathic surgeries in skeletal Class II patients. J Oral Maxillofac Surg. 2017
Jul;75(7):1482-1490. doi: 10.1016/j.joms.2017.02.021.
13. Dela Coleta KE, Wolford LM, Gonçalves JR, Santos-Pinto A, Pinto LP, Cassano DS. Maxillo-mandibular counterclockwise
rotation and mandibular advancement with TMJ Concepts total joint prostheses: part I--skeletal and
dental stability. Int J Oral Maxillofac Surg. 2009 Feb;38(2):126-38. doi: 10.1016/j.ijom.2008.11.024.
14. Riepponen A, Myllykangas R, Savolainen J, Kilpeläinen P, Kellokoski J, Pahkala R. Changes in
posterior airway space and hyoid bone position after surgical mandibular advancement. Acta
Odontol Scand. 2017 Jan;75(1):73-78. doi: 10.1080/00016357.2016.1252851.
15. Bianchi FA, Gerbino G, Corsico M, Schellino E, Barla N, Verzè L, et al. Soft, hard-tissues and
pharyngeal airway volume changes following maxillomandibular transverse osteodistraction:
Computed tomography and three-dimensionsional laser scanner evaluation. J Craniomaxillofac Surg.
2017 Jan;45(1):47-55. doi: 10.1016/j.jcms.2016.10.005.
16. Carvalho ACGS. [Cephalometric and tridimensional avaliation of posterior airway space after
maxillomandibular advancement] [tese]. Araçatuba: Faculdade de Odontologia, Universidade
Estadual Paulista; 2011. Portuguese.
17. Zhao X, Liu Y, Gao Y. Three-dimensional upper-airway changes associated with various amounts
of mandibular advancement in awake apnea patients. Am J Orthod Dentofacial Orthop. 2008
May;133(5):661-8. doi: 10.1016/j.ajodo.2006.06.024.
18. Gonçalves JR, Buschang PH, Gonçalves DG, Wolford LM. Postsurgical stability of oropharyngeal
airway changes following counter-clockwise maxillo-mandibular advancement surgery. J Oral
Maxillofac Surg. 2006 May;64(5):755-62.
19. Wei S, ZhangY, Guo X, Yu W, Wang M, Yao K et al. Counterclockwise maxillomandibular
advancement: a choice for Chinese patients with severe obstrutive sleep apnea. Sleep Breath. 2017
Dec;21(4):853-860. doi: 10.1007/s11325-017-1484-7.
20. Li KK, Powel NB, Riley RW, Troell RJ, Guilleminault C. Long term results of maxillomandibular
advancement surgery. Sleep Breath. 2000;4(3):137-140.
21. Reiche-Fischel O, Wolford LM. Posterior airway space changes after double jaw surgery with
counter-clockwise rotation. AAOMS 78th Annual Meeting and Scientific Sessions. J Oral Maxillofac
Surg 1996;54:96.
22. Riley RW, Powell NB, Guilleminault C. Obstructive sleep apnea syndrome: a surgical protocol for
dynamic airway reconstruction. J Oral Maxillofac Surg. 1993 Jul;51(7):742-7; discussion 748-9.
23. Chung DH, Hatch JP, Dolce C, Van Sickels JE, Bays RA, Rugh JD. Positional change of the hyoid bone
after bilateral sagittal split osteotomy with rigid and wire fixation. Am J Orthod Dentofacial Orthop.
2001 Apr;119(4):382-9.
24. Gale A, Kilpeläinen PV, Laine-Alava MT. Hyoid bone position after surgical mandibular advancement.
Eur J Orthod. 2001 Dec;23(6):695-701.
25. Wessberg GA, Schendel SA, Epker BN. The role of suprahyoid myotomy in surgical advancement of
the mandible via sagittal split ramus osteotomies. J Oral Maxillofac Surg. 1982 May;40(5):273-7.
26. Winnberg A, Pancherz H,Westesson PL. Head posture and hyomandibular function in man. A
synchronized electromyographic and videofluorographic study of the open-close-clench cycle. Am J
Orthod Dentofacial Orthop. 1988 Nov;94(5):393-404.
27. Hedayati Z, Paknahad M, Zorriasatine F. Comparison of natural head position in different
anteroposterior malocclusions. J Dent (Tehran). 2013 May;10(3):210-20.
28. Phillips C, Snow MD, Turvey TA, Proffit WR. The effect of orthognathic surgery on head posture. Eur J
Orthod. 1991 Oct;13(5):397-403.
Published
2017-11-13
How to Cite
AZEVEDO, Wanderson Roberto dos Santos et al. Changes in Head Posture, Hyoid Bone Position and Airway Dimensions After Orthognatic Surgery. Brazilian Journal of Oral Sciences, [S.l.], p. e18030, nov. 2017. ISSN 1677-3225. Available at: <https://www.fop.unicamp.br/bjos/index.php/bjos/article/view/1326>. Date accessed: 20 july 2019. doi: https://doi.org/10.20396/bjos.v17i0.8652645.
Section
Original Research

Most read articles by the same author(s)