Soft-Palate Changes After Orthognathic Surgery: A Three-Dimensional Assessment of Positioning and Morphology

TL;DR

This study uses 3D imaging to assess how orthognathic surgery affects the soft palate's position and shape over time, finding that certain surgical movements improve airway volume and morphology.

Contribution

The study introduces a 3D assessment of soft-palate changes after orthognathic surgery across multiple time points and surgical movement types.

Findings

Time significantly influenced most airway volume and mCSA parameters, except for mCSA-nasopharynx.

Groups 1 and 5 showed recurrence of oropharynx volume and mCSA at 12–36 months.

Maxillary counterclockwise rotation with posterior downward movement improved pharyngeal dimensions and soft-palate morphology.

Abstract

Background/Objectives: This study evaluated, by cone-beam computed tomography, the role of soft-palate morphology and positioning in upper airway volume and minimum cross-sectional area (mCSA) after orthognathic surgery at three time points: one week before surgery (T0); 4–6 months after surgery (T1); and 12–36 months after surgery (T2). Methods: Patients (N = 91) were divided into five groups according to maxillary surgical movement: 1: maxillary advancement; 2: maxillary advancement and counterclockwise rotation with anterior upward movement; 3: maxillary advancement and counterclockwise rotation with posterior downward movement; 4: maxillary advancement and clockwise rotation with anterior downward movement; and 5: maxillary advancement and clockwise rotation with posterior upward movement. Results: Time was an important predictor of change for almost all volume and mCSA parameters (p < 0.05), except for mCSA-nasopharynx (p = 0.114). Groups 1 and 5 showed recurrence of oropharynx volume and minimum cross-sectional area at 12–36 months, while Group 3 had 85% of vertical soft palate morphology and no oblique morphology at 12–36 months. Conclusions: Soft palate angulation did not change at any time or with any type of surgical movement. Maxillary counterclockwise rotation with posterior downward movement seems to be the preferred surgical movement of the maxilla to increase pharyngeal dimensions and improve soft-palate morphology.

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