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3D Volumetric Analysis of Pharyngeal Airway of 50 Individuals Who Underwent Maxillary Advancement
Oral Abstract Track 2 OSA, ORTHOGNATHIC, TRAUMA October 2, 2015, 7:30 AM-9:30 AM
3D Volumetric Analysis of Pharyngeal Airway of 50 Individuals Who Underwent Maxillary Advancement E. S. Gonc¸ales: Bauru Dental School - S~ao Paulo University, V. Tieghi Neto, C. F. Palmieri Jr., G. E. Ghali Introduction: Dentofacial deformities (DFD) can be defined as defects in the growth and development of facial bones, mainly in the maxilla and mandible. It may affect the function or development of other structures, organs and related systems. Orthognathic surgery is the procedure of choice for the treatment of DFDs and it may affect some related systems such as the pharyngeal airway. Objective: The aim of this study was to evaluate, through a 3D retrospective analysis of cone beam computed tomographic images (CBCT), the changes in the dimensions of the pharyngeal airway space after maxillary advancement. Materials and Method: Pre- and postoperative 3D volumetric measurements were done with the use of CBCT and Dolphin Imaging 11.5 of 50 individuals who underwent isolated maxillary advancement by Le Fort I osteotomy. The data were analyzed by the ANOVA Test. Results: Preoperative and postoperative CBCTs of 50 individuals that underwent maxillary advancement by Le Fort I osteotomy were studied. Fourteen of them were male and 36 were female. The average age and the standard deviation (SD) at the time of the surgery was 24.82 (11.21) years old and the average and the standard deviation (SD) of the postoperative period was 57.24(43.19) days. The average maxillary advancement was 3.44mm and it was shown by the A-Na Perp (average of 2.75mm at the preoperative time and average of 6.19mm at the postoperative time) and by the SNA, being 78.880 at the preoperative time and 83.250 at the postoperative time. The average volume of the oropharyngeal airway space had a statistically significant increase of 4020.49mm3 and this increase seemed to be higher at the upper portion of the oropharyngeal airway between the Posterior Nasal Spine (PNS) and the Uvula (U). Conclusion: Isolated maxillary advancement increased the volume of the oropharyngeal airway space, what would benefit patients which the site of obstruction is located at that upper level (Fujita Type I). For Fujita type II patients, where the site of obstruction is located at the oropharynx and hypopharynx, which are the majority of the OSA patients, the bi-maxillary advancement would be a more appropriate procedure. e-22
References: 1. Gonc¸ales ES, Rocha JF, Gonc¸ales AG, Yaed u RY, Sant’Ana E. Computerized cephalometric study of the pharyngeal airway space in patients submitted to orthognathic surgery. J Maxillofac Oral Surg. 2014 Sep;13(3):253-8. doi: 10.1007/s12663-013-0524-5. Epub 2013 May 3. 2. Gonc¸ales ES, Duarte MA, Palmieri C Jr, Zakhary GM, Ghali GE. Retrospective analysis of the effects of orthognathic surgery on the pharyngeal airway space. J Oral Maxillofac Surg. 2014 Nov;72(11):2227-40. doi: 10.1016/j.joms.2014.04.006. Epub 2014 Apr 13.
Key Words: Orthognathic Surgery. Cone Beam Computed Tomographic. Pharyngeal Airway Space. Thanks to Fundac¸~ao de Amparo a Pesquisa do Estado de S~ao Paulo - FAPESP.
Maxillomandibular Advancement Surgery for Patients Who Are Refractory to CPAP: A Preliminary Report I. Makovey: University of Michigan Oral and Maxillofacial Surgery, A. Robinson S. Aronovich Purpose: This pilot study was conducted to determine the effectiveness of maxillomandibular advancement(MMA) in the treatment of patients with moderate to severe obstructive sleep apnea. We also investigated the predictive value of clinical, radiographic, and treatment-related variables on the success or failure of maxillomandibular advancement as a treatment for obstructive sleep apnea. Patients and Methods: The study sample included patients who presented to the University of Michigan refractory to CPAP clinic for treatment alternatives. We included patients with moderate to severe obstructive sleep apnea (AHI > 15) who underwent MMA with or without adjunctive procedures such as genioglossus advancement and uvulectomy. Patients who had predominant central apnea(s) or those with inadequate post-surgical data were excluded. Data collected from the patient’s chart review included clinical exam findings, nasopharyngoscopy, CBCT, and polysomnogram. The primary outcome variables were the AHI, minimal oxygen saturation (min SpO2), and percent time spent with oxygen saturation below 88% as measured on a polysomnogram preoperatively and 3-9 months postoperatively. The patient variables included in the study were age, BMI, neck circumference, relative tongue size, pre-op airway dimensions, change in airway dimensions, soft palate length, size of the advancement, and occlusal plane changes. Statistical Analysis: Descriptive statistics and ANOVA analysis were used to establish a correlation between the primary outcome variable (AHI) and patient variables. AAOMS 2015
3D Volumetric Analysis of Pharyngeal Airway of 50 Individuals Who Underwent Maxillary Advancement E. S. Gonc¸ales: Bauru Dental School - S~ao Paulo University, V. Tieghi Neto, C. F. Palmieri Jr., G. E. Ghali Introduction: Dentofacial deformities (DFD) can be defined as defects in the growth and development of facial bones, mainly in the maxilla and mandible. It may affect the function or development of other structures, organs and related systems. Orthognathic surgery is the procedure of choice for the treatment of DFDs and it may affect some related systems such as the pharyngeal airway. Objective: The aim of this study was to evaluate, through a 3D retrospective analysis of cone beam computed tomographic images (CBCT), the changes in the dimensions of the pharyngeal airway space after maxillary advancement. Materials and Method: Pre- and postoperative 3D volumetric measurements were done with the use of CBCT and Dolphin Imaging 11.5 of 50 individuals who underwent isolated maxillary advancement by Le Fort I osteotomy. The data were analyzed by the ANOVA Test. Results: Preoperative and postoperative CBCTs of 50 individuals that underwent maxillary advancement by Le Fort I osteotomy were studied. Fourteen of them were male and 36 were female. The average age and the standard deviation (SD) at the time of the surgery was 24.82 (11.21) years old and the average and the standard deviation (SD) of the postoperative period was 57.24(43.19) days. The average maxillary advancement was 3.44mm and it was shown by the A-Na Perp (average of 2.75mm at the preoperative time and average of 6.19mm at the postoperative time) and by the SNA, being 78.880 at the preoperative time and 83.250 at the postoperative time. The average volume of the oropharyngeal airway space had a statistically significant increase of 4020.49mm3 and this increase seemed to be higher at the upper portion of the oropharyngeal airway between the Posterior Nasal Spine (PNS) and the Uvula (U). Conclusion: Isolated maxillary advancement increased the volume of the oropharyngeal airway space, what would benefit patients which the site of obstruction is located at that upper level (Fujita Type I). For Fujita type II patients, where the site of obstruction is located at the oropharynx and hypopharynx, which are the majority of the OSA patients, the bi-maxillary advancement would be a more appropriate procedure. e-22
References: 1. Gonc¸ales ES, Rocha JF, Gonc¸ales AG, Yaed u RY, Sant’Ana E. Computerized cephalometric study of the pharyngeal airway space in patients submitted to orthognathic surgery. J Maxillofac Oral Surg. 2014 Sep;13(3):253-8. doi: 10.1007/s12663-013-0524-5. Epub 2013 May 3. 2. Gonc¸ales ES, Duarte MA, Palmieri C Jr, Zakhary GM, Ghali GE. Retrospective analysis of the effects of orthognathic surgery on the pharyngeal airway space. J Oral Maxillofac Surg. 2014 Nov;72(11):2227-40. doi: 10.1016/j.joms.2014.04.006. Epub 2014 Apr 13.
Key Words: Orthognathic Surgery. Cone Beam Computed Tomographic. Pharyngeal Airway Space. Thanks to Fundac¸~ao de Amparo a Pesquisa do Estado de S~ao Paulo - FAPESP.
Maxillomandibular Advancement Surgery for Patients Who Are Refractory to CPAP: A Preliminary Report I. Makovey: University of Michigan Oral and Maxillofacial Surgery, A. Robinson S. Aronovich Purpose: This pilot study was conducted to determine the effectiveness of maxillomandibular advancement(MMA) in the treatment of patients with moderate to severe obstructive sleep apnea. We also investigated the predictive value of clinical, radiographic, and treatment-related variables on the success or failure of maxillomandibular advancement as a treatment for obstructive sleep apnea. Patients and Methods: The study sample included patients who presented to the University of Michigan refractory to CPAP clinic for treatment alternatives. We included patients with moderate to severe obstructive sleep apnea (AHI > 15) who underwent MMA with or without adjunctive procedures such as genioglossus advancement and uvulectomy. Patients who had predominant central apnea(s) or those with inadequate post-surgical data were excluded. Data collected from the patient’s chart review included clinical exam findings, nasopharyngoscopy, CBCT, and polysomnogram. The primary outcome variables were the AHI, minimal oxygen saturation (min SpO2), and percent time spent with oxygen saturation below 88% as measured on a polysomnogram preoperatively and 3-9 months postoperatively. The patient variables included in the study were age, BMI, neck circumference, relative tongue size, pre-op airway dimensions, change in airway dimensions, soft palate length, size of the advancement, and occlusal plane changes. Statistical Analysis: Descriptive statistics and ANOVA analysis were used to establish a correlation between the primary outcome variable (AHI) and patient variables. AAOMS 2015