Changes in Upper Airway Morphology after Le Fort I and Horse-shoe Osteotomies in Maxillary Protrusion

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  • SHIMAMINE TAKAHIRO
    Orthodontic Science, Graduate School, Tokyo Medical and Dental University
  • YONEMITSU IKUO
    Orthodontic Science, Graduate School, Tokyo Medical and Dental University
  • SHIBUTANI NAOKI
    Orthodontic Science, Graduate School, Tokyo Medical and Dental University
  • KOKETSU MISAKO
    Orthodontic Science, Graduate School, Tokyo Medical and Dental University
  • IMAI HARUKI
    Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Medical Center
  • FUJITA KOICHI
    Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Medical Center
  • OMURA SUSUMU
    Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Medical Center
  • ONO TAKASHI
    Orthodontic Science, Graduate School, Tokyo Medical and Dental University

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  • 骨格性上顎前突症患者に対する馬蹄形骨切り併用Le Fort I型骨切り術後における上部気道形態の変化

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Abstract

This study aimed to compare cephalometric changes in the upper airway morphology, including the hyoid bone position, after the conventional Le Fort I (LF) osteotomy, and an LF and horse-shoe osteotomies. Twenty-two patients diagnosed as having skeletal maxillary protrusion at the Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Medical Center, were included. They were divided into two groups as follows: 13 patients underwent LF and sagittal split ramus osteotomies (LF group); and 9 patients underwent LF, horse-shoe and sagittal split ramus osteotomies (HS group). The following linear variables were measured on lateral cephalometric radiographs taken before (T0), immediately after (T1), and 1 year after (T2) surgery: palatal pharyngeal space (PPS), the length from the posterior pharyngeal wall to the posterior nasal spine (PNS); superior posterior palatal space (SPPS), the length from the posterior pharyngeal wall to the middle point between the PNS and the lowest point of the soft palate; middle posterior palatal space (MPS), the length from the posterior pharyngeal wall to the lowest point of the soft palate; inferior posterior palatal space (IPS), the length from the posterior pharyngeal wall to the tongue passing the lowest point of the second cervical vertebra; epiglottic pharyngeal space (EPS), the length from the posterior pharyngeal wall to the tongue passing the front end of the epiglottis; S-H, the length from the lowest point of the hyoid bone to the Sella; and C3-H, the length from the lowest point of the hyoid bone to the lowest front point of the second cervical vertebra. Statistical analyses were performed using the Mann-Whitney U test. P values of <0.05 indicated statistical significance. SPPS and MPS decreased at T2 in the HS group. IPS and EPS increased at T1 in both groups but decreased at T2 in the HS group. S-H decreased at T1 in both groups and at T2 in the LF group. C3-H increased at T1 in both groups but decreased at T2 in the HS group. The anteroposterior diameter of the oropharynx was unchanged in the LF group because the tongue moved upward after the palate moved upward but changed in the HS group because the tongue moved backward and the oral volume decreased due to the absence of palatal segment movement. In conclusion, the anteroposterior diameter of the oropharynx decreased after backward and upward movements of the maxilla by LF and HS in the patients with skeletal maxillary protrusions.

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