The Assessment of Upper Airway Volume Changes Following Bimaxillary Advancement Surgery: A Radiological Evaluation in the Supine Position at Multiple Intervals

TL;DR

This study shows that bimaxillary advancement surgery significantly increases upper airway volume over time, with the largest changes observed six months after the procedure.

Contribution

The study provides new evidence that upper airway volume increases significantly over time following bimaxillary advancement surgery.

Findings

Upper airway volume significantly increased six months after surgery compared to pre-surgery measurements.

The upper airway volume remained larger six months post-surgery than immediately after surgery.

Statistically significant differences in upper airway volume were observed across all measurement intervals.

Abstract

Background: Bimaxillary surgeries (BiMax) are an essential part of the craniomaxillofacial specialty. The osteotomies and subsequent spatial rearrangement of the maxilla and the mandible enable the correction of facial deformities, asymmetry, and malocclusion. Moreover, the movements performed during the procedure affect the morphology of surrounding soft tissues, including the upper airway (UA). Objectives: The objective of this study was to radiologically assess the potential volumetric alterations of the UA in the supine position at various intervals following BiMax advancement surgeries. Methods: A group of 31 patients who underwent BiMax advancement surgery were included in the study. Medical computed tomography (CT) of the head and neck region was performed 2 weeks preoperatively, 1 day postoperatively, and 6 months postoperatively. The UA volumes were calculated and analyzed based on the acquired Digital Imaging and Communications in Medicine (DICOM) files using different software applications. The sella-nasion-A point (SNA) and sella-nasion-B point (SNB) angles were evaluated to measure the achieved maxillomandibular advancement. Results: When comparing the volume of the UA before surgery, post-surgery, and 6 months post-surgery, the p-value was <0.001, indicating statistically significant differences in UA volume between the successive examinations. A statistically significant difference was found between UA volume before surgery and 6 months post-surgery and between UA volume after surgery and 6 months post-surgery, with the obtained p-values being <0.001 and 0.001, respectively. A significantly larger UA volume was observed 6 months post-surgery (mean ± SD: 27.3 ± 7.3) compared to the volume before surgery (mean ± SD: 22.2 ± 6.4), as well as 6 months post-surgery compared to the volume assessed shortly after surgery (mean ± SD: 24.2 ± 7.3). Conclusions: BiMax advancement surgeries result in the significant enlargement of the UA. The volume of the UA does not diminish immediately following the procedure and is not constant; it increases significantly during the postoperative observation period.

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