Effects of Mandibular Setback with or Without Maxillary Advancement Osteotomies on Pharyngeal Airways: An Overview of Systematic Reviews

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2017 Oct 11

PMID 29016682

Citations 7

Authors

Su Keng Tan

Wai Keung Leung

Alexander Tin Hong Tang

Roger A Zwahlen

Affiliations

Soon will be listed here.

Abstract

Background: Mandibular setback osteotomies potentially lead to narrowing of the pharyngeal airways, subsequently resulting in post-surgical obstructive sleep apnea (OSA).

Objective: To summarize current evidence from systematic reviews that has evaluated pharyngeal airway changes after mandibular setback with or without concomitant upper jaw osteotomies.

Methodology: PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched with no restriction of language or date. Systematic reviews studying changes in pharyngeal airway dimensions and respiratory parameters after mandibular setback with or without concomitant upper jaw osteotomies have been identified, screened for eligibility, included and analyzed in this study.

Results: Six systematic reviews have been included. While isolated mandibular setback osteotomies result in reduced oropharyngeal airway dimensions, the reduction is lesser in cases with concomitant upper jaw osteotomies. Only scarce evidence exists currently to what happens to naso- and hypo-pharyngeal airways. There is no evidence for post-surgical OSA, even though some studies reported reduced respiratory parameters after single-jaw mandibular setback with or without concomitant upper jaw osteotomies.

Conclusion: Although mandibular setback osteotomies reduce pharyngeal airway dimensions, evidence confirming post-surgical OSA was not found. Nevertheless, potential post-surgical OSA should be taken into serious consideration during the treatment planning of particular orthognathic cases. As moderate evidence exists that double-jaw surgeries lead to less compromised post-surgical pharyngeal airways, they should be considered as the method of choice especially in cases with severe dentoskeletal Class III deformity.

Study Registration: PROSPERO (registration number: CRD42016046484).

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References

Kobayashi T, Funayama A, Hasebe D, Kato Y, Yoshizawa M, Saito C . Changes in overnight arterial oxygen saturation after mandibular setback. Br J Oral Maxillofac Surg. 2012; 51(4):312-8. DOI: 10.1016/j.bjoms.2012.07.004. View

Tan S, Leung W, Tang A, Zwahlen R . Letter to the editor on the article "Impact on the upper airway space of different types of orthognathic surgery for the correction of skeletal class III malocclusion: A systematic review and meta-analysis". Int J Surg. 2017; 45:156-157. DOI: 10.1016/j.ijsu.2017.03.083. View

Kim M, Kim B, Choi J, Youn J, Kim Y, Park Y . Three-dimensional changes of the hyoid bone and airway volumes related to its relationship with horizontal anatomic planes after bimaxillary surgery in skeletal Class III patients. Angle Orthod. 2013; 83(4):623-9. PMC: 8754032. DOI: 10.2319/083112-700.1. View

Sterne J, Sutton A, Ioannidis J, Terrin N, Jones D, Lau J . Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011; 343:d4002. DOI: 10.1136/bmj.d4002. View

Wang H, Wang J, Qi S, Cai Z, Li X . [Three-dimensional analysis of pharyngeal airway in skeletal Class III patients after sagittal split ramus osteotomy]. Zhonghua Kou Qiang Yi Xue Za Zhi. 2012; 47(4):221-4. DOI: 10.3760/cma.j.issn.1002-0098.2012.04.007. View

Hwang S, Chung C, Choi Y, Huh J, Kim K . Changes of hyoid, tongue and pharyngeal airway after mandibular setback surgery by intraoral vertical ramus osteotomy. Angle Orthod. 2009; 80(2):302-8. PMC: 8973233. DOI: 10.2319/040209-188.1. View

Indriksone I, Jakobsone G . The upper airway dimensions in different sagittal craniofacial patterns: a systematic review. Stomatologija. 2014; 16(3):109-17. View

Huang C, Hsu S, Chen Y . Systematic review of the surgery-first approach in orthognathic surgery. Biomed J. 2014; 37(4):184-90. DOI: 10.4103/2319-4170.126863. View

Samman N, Tang S, Xia J . Cephalometric study of the upper airway in surgically corrected class III skeletal deformity. Int J Adult Orthodon Orthognath Surg. 2002; 17(3):180-90. View

10.

Rosario H, Oliveira G, Freires I, Matos F, Paranhos L . Efficiency of bimaxillary advancement surgery in increasing the volume of the upper airways: a systematic review of observational studies and meta-analysis. Eur Arch Otorhinolaryngol. 2016; 274(1):35-44. DOI: 10.1007/s00405-016-4015-4. View

11.

Welch V, Petticrew M, Tugwell P, Moher D, ONeill J, Waters E . PRISMA-Equity 2012 extension: reporting guidelines for systematic reviews with a focus on health equity. PLoS Med. 2012; 9(10):e1001333. PMC: 3484052. DOI: 10.1371/journal.pmed.1001333. View

12.

He J, Wang Y, Hu H, Liao Q, Zhang W, Xiang X . Impact on the upper airway space of different types of orthognathic surgery for the correction of skeletal class III malocclusion: A systematic review and meta-analysis. Int J Surg. 2016; 38:31-40. DOI: 10.1016/j.ijsu.2016.12.033. View

13.

Shea B, Grimshaw J, Wells G, Boers M, Andersson N, Hamel C . Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007; 7:10. PMC: 1810543. DOI: 10.1186/1471-2288-7-10. View

14.

Jakobsone G, Neimane L, Krumina G . Two- and three-dimensional evaluation of the upper airway after bimaxillary correction of Class III malocclusion. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 110(2):234-42. DOI: 10.1016/j.tripleo.2010.03.026. View

15.

Nakagawa F, Ono T, Ishiwata Y, Kuroda T . Morphologic changes in the upper airway structure following surgical correction of mandibular prognathism. Int J Adult Orthodon Orthognath Surg. 1999; 13(4):299-306. View

16.

Foltan R, Hoffmannova J, Pavlikova G, Hanzelka T, Klima K, Horka E . The influence of orthognathic surgery on ventilation during sleep. Int J Oral Maxillofac Surg. 2010; 40(2):146-9. DOI: 10.1016/j.ijom.2010.10.006. View

17.

Riley R, POWELL N, Guilleminault C, Ware W . Obstructive sleep apnea syndrome following surgery for mandibular prognathism. J Oral Maxillofac Surg. 1987; 45(5):450-2. DOI: 10.1016/0278-2391(87)90016-4. View

18.

Deeks J, Dinnes J, DAmico R, Sowden A, Sakarovitch C, Song F . Evaluating non-randomised intervention studies. Health Technol Assess. 2003; 7(27):iii-x, 1-173. DOI: 10.3310/hta7270. View

19.

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009; 6(7):e1000100. PMC: 2707010. DOI: 10.1371/journal.pmed.1000100. View

20.

Demetriades N, Chang D, Laskarides C, Papageorge M . Effects of mandibular retropositioning, with or without maxillary advancement, on the oro-naso-pharyngeal airway and development of sleep-related breathing disorders. J Oral Maxillofac Surg. 2010; 68(10):2431-6. DOI: 10.1016/j.joms.2010.02.033. View