Kongsong Wichuda, Rochanavibhata Sunisa, Changsiripun Chidsanu, Sinpitaksakul Phonkit, Chirakalwasan Naricha
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Pathum Wan, Bangkok, 10330, Thailand.
Department of Orthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
Head Face Med. 2025 May 10;21(1):37. doi: 10.1186/s13005-025-00517-6.
To compare the effects of mandibular setback surgery on the upper airway and sleep quality using two approaches: the surgery-first approach (SFA) and the conventional orthognathic approach (COA).
A prospective, comparative clinical study was conducted in 20 patients, with 10 in each group undergoing isolated mandibular setback surgery. Three-dimensional upper airway analysis using cone-beam computed tomography and sleep quality assessments through questionnaires and sleep studies were performed preoperatively (T0), within 1 month postoperatively (T1), and six months postoperatively (T2).
The SFA group demonstrated greater mandibular setback and rotational changes compared to the COA group. Both groups exhibited postoperative reductions in airway volume and minimum cross-sectional area, with no significant intergroup differences. Significant differences in the change in airway length in the upper airway segment (0.9 ± 1.0 mm for SFA vs. -1.2 ± 3.4 mm for COA, P = 0.002) and total airway length (3.3 ± 1.8 mm for SFA vs. -0.1 ± 2.3 mm for COA, P < 0.001) were observed at T2 compared to the preoperative period. Subjective and objective sleep parameters were comparable between the groups. Objective sleep quality initially worsened but improved over time.
Isolated mandibular setback surgery, whether performed using SFA or COA, resulted in comparable changes in upper airway dimensions and sleep quality.
The choice between SFA and COA for isolated mandibular setback surgery does not significantly influence surgical decision-making regarding upper airway changes and sleep quality.
采用两种方法比较下颌后缩手术对上气道和睡眠质量的影响：手术优先方法（SFA）和传统正颌方法（COA）。
对20例患者进行前瞻性比较临床研究，每组10例，均接受单纯下颌后缩手术。术前（T0）、术后1个月内（T1）和术后6个月（T2）采用锥形束计算机断层扫描进行三维上气道分析，并通过问卷和睡眠研究进行睡眠质量评估。
与COA组相比，SFA组下颌后缩和旋转变化更大。两组术后气道容积和最小横截面积均减小，组间无显著差异。与术前相比，T2时上气道段气道长度变化（SFA组为0.9±1.0mm，COA组为-1.2±3.4mm，P = 0.002）和总气道长度变化（SFA组为3.3±1.8mm，COA组为-0.1±2.3mm，P < 0.001）存在显著差异。两组间主观和客观睡眠参数相当。客观睡眠质量最初恶化，但随时间改善。
单纯下颌后缩手术，无论采用SFA还是COA，对上气道尺寸和睡眠质量的影响相当。
在单纯下颌后缩手术中，选择SFA还是COA对关于上气道变化和睡眠质量的手术决策没有显著影响。
