Mei Dong-Lan, Liu Li-Nan, Han Li-Chi
College of Stomatology, Dalian University, Dalian, Liaoning, 116622, China.
Hospital of General Hospital, Ningxia Medical University, Yinchuan, Ningxia, 750004, China.
Clin Oral Investig. 2025 Jan 22;29(1):73. doi: 10.1007/s00784-024-06105-3.
This study analyzed the differences in the upper airway of patients with skeletal Class III high-angle malocclusion with and without mandibular deviation, and further investigated whether there are differences in the changes in upper airway space after orthognathic surgery between the two groups.
15 patients with skeletal Class III high-angle malocclusion and mandibular deviation, and 15 patients without mandibular deviation were selected to explore the impact of mandibular deviation on the upper airway. Additionally, 16 patients with mandibular deviation undergoing orthodontic-orthognathic combined treatment, and 13 patients without mandibular deviation, were selected to investigate the differences in the changes in upper airway space after orthognathic surgery between the two groups.
In patients with skeletal Class III high-angle malocclusion, the deviation group showed significantly smaller sagittal diameter/maximum transverse diameter, cross-sectional area, volumes of oropharynx and hypopharynx, and total volume compared to the normal group, with all differences being statistically significant. After orthognathic surgery, the postoperative sagittal diameter/maximum transverse diameter of the oropharyngeal airway increased in the deviation group, while it decreased in the normal group. The postoperative reductions in cross-sectional area, volumes, and total volume of the oropharynx and hypopharynx were more pronounced in the normal group.
In patients with skeletal Class III high-angle malocclusion, mandibular deviation results in narrowing of the lower portion of the upper airway. The orthognathic surgical correction of mandibular deviation compensates to some extent for the reduction in the cross-sectional area and volume of the upper airway caused by the surgery itself.
For patients with skeletal Class III high-angle malocclusion with mandibular deviation, a thorough assessment of the upper airway should precede the selection of orthognathic surgery procedures. For patients with normal preoperative upper airway morphology, consideration may prioritize correction of facial aesthetics and occlusion. For patients with pre-existing narrow upper airways, as mandibular setback exacerbates narrowing and the compensatory effect of mandibular deviation correction on the airway is limited, it is suggested that these patients prioritize bimaxillary surgery or reduce the amount of mandibular setback to better promote postoperative respiratory function health.
本研究分析了有下颌偏斜和无下颌偏斜的骨性III类高角错牙合患者上气道的差异，并进一步探究两组患者正颌手术后上气道空间变化是否存在差异。
选取15例伴有下颌偏斜的骨性III类高角错牙合患者和15例无下颌偏斜的患者，以探究下颌偏斜对上气道的影响。此外，选取16例接受正畸-正颌联合治疗的下颌偏斜患者和13例无下颌偏斜的患者，以研究两组患者正颌手术后上气道空间变化的差异。
在骨性III类高角错牙合患者中，偏斜组的矢状径/最大横径、横截面积、口咽和下咽体积以及总体积均显著小于正常组，所有差异均具有统计学意义。正颌手术后，偏斜组口咽气道的术后矢状径/最大横径增加，而正常组则减小。正常组口咽和下咽的横截面积、体积及总体积的术后减小更为明显。
在骨性III类高角错牙合患者中，下颌偏斜导致上气道下部变窄。下颌偏斜的正颌手术矫正在一定程度上补偿了手术本身导致的上气道横截面积和体积的减小。
对于伴有下颌偏斜的骨性III类高角错牙合患者，在选择正颌手术方案之前应全面评估上气道。对于术前上气道形态正常的患者，可优先考虑矫正面部美观和咬合。对于术前上气道已狭窄的患者，由于下颌后缩会加剧狭窄且下颌偏斜矫正对气道的代偿作用有限，建议这些患者优先选择双颌手术或减少下颌后缩量，以更好地促进术后呼吸功能健康。
