The impact of Le Fort I advancement and bilateral sagittal split osteotomy setback on ventilation during sleep

Abstract The impact of orthognathic surgery for class III malocclusion on ventilation during sleep was examined using a comparison of pre- and post-surgical respiratory parameters. 21 patients with both maxillary hypoplasia and mandibular excess underwent Le Fort I osteotomy and advancement together...

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Bibliographic Details
Published in:International journal of oral and maxillofacial surgery 2009-10, Vol.38 (10), p.1036-1040
Main Authors: Foltán, R, Hoffmannová, J, Donev, F, Vlk, M, Šedý, J, Kufa, R, Bulik, O
Format: Article
Language:English
Subjects:
Adult
Airway Obstruction - etiology
Airway Remodeling
Airway Resistance
Biological and medical sciences
Cephalometry
Dentistry
Female
Humans
Male
Malocclusion, Angle Class III - surgery
Mandible - surgery
Medical sciences
orthognathic surgery
Orthognathic Surgical Procedures - adverse effects
Orthopedic surgery
Osteotomy - adverse effects
Osteotomy, Le Fort - adverse effects
Otorhinolaryngology. Stomatology
Pneumology
Polysomnography
Pulmonary Ventilation
Respiratory system : syndromes and miscellaneous diseases
Sleep Apnea, Obstructive - etiology
sleep apnoea
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
upper airways
ventilation
Young Adult
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Summary:Abstract The impact of orthognathic surgery for class III malocclusion on ventilation during sleep was examined using a comparison of pre- and post-surgical respiratory parameters. 21 patients with both maxillary hypoplasia and mandibular excess underwent Le Fort I osteotomy and advancement together with bilateral sagittal split osteotomy (BSSO) setback. Respiratory parameters, ECG and position of the body were monitored before surgery and postoperatively after the fixation removal (mean 8.5 months). Average Le Fort I advancement was 4.44 mm, BSSO setback was 4.96 mm. Generally, the orthognathic procedure worsened breathing function during sleep, as reflected in significant increase of index of flow limitations and decrease in oxygen saturation. The posterior airways space decreased to 75% of its original volume, the distance between mandibular plane and hyoid bone increased to 133%. The results indicate that bimaxillary surgery for class III malocclusion increased upper airway resistance. A young person would probably be able to balance such a decline in respiratory function using different adaptive mechanisms, but the potential impact of orthognathic surgery on the upper airways should be incorporated in a treatment plan.
ISSN:0901-5027
1399-0020
DOI:10.1016/j.ijom.2009.06.001