SA2 - Is Airway Stable After a Big Counter-Clockwise Advancement?

Oral Abstract Presenter(s)

• 

  Jose S. Sifuentes-Cervantes, DDS, MS

  Fellow
  University of Michigan
  Ann arbor, Michigan

Co-Author(s)

• 

  Alejandro Martínez-Garza, DDS, MS

  Director
  UVA Institute
  Monterrey, Nuevo Leon, Mexico

Co-Author(s)

• 

  Omar A. Peña-Ruiz, DDS

  Non-categorical Intern
  Willis-Knighton Health, Oral and Maxillofacial Surgery Residency Program
  Shreveport, Louisiana
• RH

  Rubén Herrera-Atoche, DDS

  Dentist
  University of Yucatan
  Yucatan, Yucatan, Mexico
• LB

  Lucero S. Basulto-Lopez, P, DDS, MS

  Graduate
  University of Yucatan
  Yucatan, Yucatan, Mexico

Abstract:
Statement of the Problem: Airway expansion can be an adjunct benefit of orthognathic surgery.¹ One of the most feared post operative complications from this procedure is relapse. Relapse can be avoided by designing a surgical plan that flows accordingly to a natural soft tissue facial profile, and by providing adequate condylar stability with adequate fixation methods.^2,3 The purpose of this study is to determine if airway gains that resulted from big counterclockwise (CCW) maxillomandibular advancements are stable post operatively. The specific aims of this study are to quantify airway gains and to measure them postoperatively to determine their stability.
Materials and

Methods: The study design was a retrospective cohort study. The sample consisted in 24 patients (N–f24). All surgical plans were created taking in consideration the soft tissue profile keys to create a natural facial harmony. All patients were treated with a two-plate fixation technique. Cone Bean Computerized Tomographies (CBCT) were collected for all patients preop (T0), immediately postop (T1), at 3 months (T2), at 6 months (T3) and at 12 months(T4). Airway was measured in volume (mm3) and surface area (mm2). Analysis of variance (ANOVA) test was used to determine if the differences between the sets of measurements were statistically significant. A P value ( < .05) was considered statistically significant.

Results: The mean pogonion advancement was 18.53 mm. The mean preoperative airway volume was 11.99 ± 3.51 mm³, which increased to 20.21 mm³ postop (T1), and maintained stable throughout T2-T4. The mean airway volume gain was 8.22 mm³. The mean preoperative airway surface area was 99.94 ± 51.95 mm², which increased to 246.57 mm² postop (T1), and maintained stable throughout T2-T4. The mean airway area gain was 146.63 mm² (Figure 1). ANOVA test showed no statistically significant differences among the measurements regarding volume (P < .905) or surface area (P < .365) (Table 1).
Outcomes Data: CBCT analysis showed that airway increased substantially after performing a considerable CCW maxillomandibular advancement by planning to improve the soft tissue key facial features. Further CBCT imaging demonstrated that airway volumes and surface areas maintain stable in the postoperative phase with no signs of relapse. ANOVA test was used to determine if the differences between the volume and surface measurements are statistically significant, if there are no statistical associations it means that measurements didn’t vary remarkably.

Conclusion: Airway volume and surface area were stable through a 1-year postoperative period. Through this surgical plan strategy and two plate fixation methods, we found out that there are no significant airway changes. Longer follow-up periods would be valuable in the future to determine the long-term stability of airway in big CCW maxillomandibular advancements utilizing this surgical philosophy.

References

1. UPPER AIRWAY STABILITY AFTER BIMAXILLARY COUNTERCLOCKWISE SURGERY Garza, A. Martínez et al. International Journal of Oral and Maxillofacial Surgery, Volume 52, 115 – 116

2. Arnett GW, Bergman RT. Facial keys to orthodontic diagnosis and treatment planning. Part I. Am J Orthod Dentofacial Orthop. 1993 Apr;103(4):299-312. doi: 10.1016/0889-5406(93)70010-L. PMID: 8480695.

3. Arnett GW, Bergman RT. Facial keys to orthodontic diagnosis and treatment planning--Part II. Am J Orthod Dentofacial Orthop. 1993 May;103(5):395-411. doi: 10.1016/s0889-5406(05)81791-3. PMID: 8480709.
Table 1. ANOVA test for post operative measurements. Figure 1. Airway stability postoperatively.