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Airway Changes After Le Fort I Advancement: A Volumetric and Cross-Sectional Analysis
Thomas Ren
1, Yuri Zhang
1, Anahita Nimbalkar
1, Charbel Saad
1, Richard Redett
1, Robin Yang
1, Pasha Shakoori
1
1. Plastic Surgery, Johhs Hopkins School of Medicine, Hopewell Junction, NY, United States.
Introduction: The primary indication for Le Fort I osteotomy is correction of midface hypoplasia. Although maxillary advancement is expected to increase airway dimensions, there remains no consensus regarding its impact on the muscular pull, primarily of the superior pharyngeal constrictor and palatopharyngeal sphincter. This study evaluates the effect of Le Fort I advancement on airway volume and cross-sectional area.
Methods: An IRB-approved retrospective review was conducted of patients undergoing Le Fort I osteotomy at a tertiary care center from 2020 to 2023. Pre- and post-operative maxillofacial CT scans were reviewed to assess changes in oropharyngeal volume (cm3), and retropalatal and minimal cross-sectional area (mm3). Oropharyngeal volume was measured from the superior border of the epiglottis to the level of the posterior nasal spine. All scans were oriented to the Frankfort horizontal plane, and imaging analysis was performed using 3D Slicer.
Results: We analyzed 15 pre- and postoperative CT scans, including 11 male and 4 female patients, with a mean preoperative age of 27.3 years. Overall, oropharyngeal airway volume increased postoperatively by an average of 4.66 cm3 (33.4%,
p = 0.038). Among the cohort, 73% of patients (11/15) demonstrated increased airway volume (
p = 0.015), while 27% (4/15) showed a decrease (
p = 0.029). Minimal cross-sectional area increased in 53% (8/15) of patients (
p = 0.014) and decreased in 47% (7/15,
p = 0.153). Retropalatal cross-sectional area decreased in 53% (8/15) of patients (
p = 0.005) and increased in 47% (7/15,
p = 0.104).
Conclusion: We found Le Fort I osteotomy increased oropharyngeal airway volume overall, though nearly half of patients demonstrated postoperative reductions in cross-sectional area at the retropalatal level. These findings underscore the variability in airway response and the importance of individualized surgical planning. Further study is warranted to clarify the role of pharyngeal musculature in modulating these changes.
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