Effect of Mandible and Maxilla Osteotomies on Velar, Oropharyngeal, and Hypopharyngeal Diameter

Publication date: Available online 11 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Christopher Vanderbeek, Yuan F. Liu, Zachary Reichert, Jayini Thakker, Tolbin Collett, Jared C. Inman

Abstract

Purpose

In the literature, there is a lack of anatomic comparisons among maxillomandibular advancement (MMA) and other bony surgical treatments of obstructive sleep apnea (OSA). Therefore, we simulated these surgical procedures in cadavers to evaluate their ability to expand the posterior airway space (PAS).

Materials and Methods

The following bony advancement surgeries were performed on each of nine cadavers: genioglossal advancement (GGA); genioplasty with advancement of the genioglossus, geniohyoid, and anterior digastric muscles (GPA); bilateral sagittal split osteotomy (BSSO); LeFort I maxillary advancement (LFMA); LeFort I maxillary anterior impaction osteotomy (LFAI); maxillomandibular advancement (MMA); maxillomandibular advancement with genioplasty (MMA+GPA); and maxillomandibular advancement with LeFort I anterior impaction osteotomy (MMA+LFAI). Bony advancements were performed at increasing distances and change in PAS anterior-posterior (AP) diameter was measured at the levels of the velum, oropharynx, and hypopharynx.

Results

Change in posterior airway spaces varied in a grossly linear fashion with advancement surgical maneuvers. GPA led to a greater increase in AP distance at the level of the oropharynx and hypopharynx compared to GGA. LFAI showed greater increase in AP distance at the velum compared to MMA. All maxillary movements showed greater AP expansion in the PAS at the velum compared to mandibular advancements.

Conclusions

Static AP expansion of the PAS at the level of the velum, oropharynx, and hypopharynx occurs in a roughly linear and predictable pattern with different bony surgical procedure used in OSA surgery. MMA alone and MMA+GPA had the overall greatest effect at all airway levels. GPA had greater effect on expansion of the oropharynx and hypopharynx when compared to GGA.

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