A Modified Cosmetic Genioplasty Can Affect Airway Space Positively in Skeletal Class II Patients: Studying Alterations of Hyoid Bone Position and Posterior Airway Space

Does Aesthetic Osseous Genioplasty Impact Upper Airway Volume?

BACKGROUND

Although maxillomandibular advancement is the treatment of choice for obstructive sleep apnea syndrome (OSAS) in the presence of underlying maxillomandibular complex hypoplasia, there is still a gap in the literature regarding the impact of genioplasty upon upper airway volume (UAV).

OBJECTIVES

The aim of this study was to evaluate the impact of isolated osseous genioplasty upon UAV.

METHODS

A retrospective analysis of all patients subjected to isolated osseous genioplasty between July 2015 and July 2022 was conducted. Cone-beam computed tomography was performed preoperatively and postoperatively to assess the chin and hyoid 3-dimensional (3D) spatial position and UAV changes after surgery.

RESULTS

A total of 44 patients were included in the study. Regarding surgical movements of the chin, almost all patients received a sagittal movement (n = 42; 39 forward and 3 backward), while in 8 patients a vertical movement (5 upward and 3 downward) was applied, and in 6 patients the chin was centered. Statistically significant increases in total UAV (P = .014) and at the level of the oropharynx (P = .004) were observed. Specifically, chin centering, upward and forward movements enlarged the oropharynx volume (P = .006, .043 and .065, respectively). Chin advancement enlarged the hypopharynx volume (P = .032), as did upward movement of the hyoid bone (P < .001).

CONCLUSIONS

Results of the study suggest that aesthetic osseous genioplasty impacts the UAV: each 3D spatial chin movement differently impacts the upper airway by enlarging or narrowing it. However, further studies addressing the apnea-hypopnea index are required to assess its effectiveness in treating OSAS.

LEVEL OF EVIDENCE: 4

Long-term airway evolution after orthognathic surgery: Systematic Review

Orthognathic surgery is a procedure that consists of correcting the abnormalities of the maxilla, mandible or both. Maxillary movements have a direct effect on the upper airways. For this reason, in the preoperative period, bone movements should be carefully analyzed and planned to avoid causing any damages to the airways. The goal of this study was to discuss the long-term evolution of the airways after orthognathic surgery. In order to do that, a search was performed through the databases PubMed, Virtual Health Library (VHL) and Scopus, using the acronym PICO strategy and a guiding question to conduct the search. Through the keywords and boolean operators "and" and "or" we found 930 articles. After reading the titles, abstracts and application of inclusion and exclusion criteria, we had 21 articles that were studied in their integrity. At the end of the selection, only 8 studies were included in the review. The postoperative evaluations from the selected studies showed that the airways suffered variations, independently of the patient's facial pattern. In addition, the airways tend to return to initial volumes, but none of the included studies obtained a complete return to the initial airways, even 6 years after surgery. Therefore, more studies with controlled methodologies should be conducted in order to have a better understanding of the airways and their changes.