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Nasopharyngeal Expansion in Counterclockwise Orthognathic Surgery
Louisa Darko
1, Nicole Nishime
*1, Ashtyn Moser
1, Derek M. Steinbacher
21Frank H. Netter MD School of Medicine at Quinnipiac University, New Haven, CT; 2West River Surgery Center, Guilford, CT
Background:Orthognathic surgery involving both jaws corrects skeletal deformities and can optimize airway volume and aesthetics. Maxillomandibular advancement with counterclockwise (CCW) rotation is shown to increase tongue-base airway space in class II patients, improving respiratory function and reducing CPAP use. However, its effects on Class III airway volume and nasal airway changes are less understood. This study analyzes changes in the nasopharyngeal airway space (NAS), posterior airway space (PAS), and nasal cavity following orthognathic surgery with CCW rotation, hypothesizing significant airway expansion across all patients.
Methods:Patients undergoing CCW orthognathic surgery with Class II-III patterns were included. Cone beam computed tomography scans were obtained pre- and postoperatively to measure volumetric and linear changes in the NAS, PAS, and nasal cavity. A paired t-test compared pre- and post-operative data.
Results:22 patients met inclusion criteria. Postoperative images were obtained at a mean of 6.2 months (range 5-60 weeks). In Class II patients (n=15), significant increases were found in NAS volume (p<0.001), PAS volume (p<0.001), PAS maximum linear (p<0.001), and PAS minimum linear (p<0.001). In Class III patients (n=7), NAS volume (p<0.001) and PAS minimum linear (p=0.042) significantly increased. PAS volume (p=0.826) and PAS maximum linear (p=0.919) changes were not significant. Nasal cavity volume changes were not significant for Class II (p=0.093) or Class III (p=0.902) patients.
Conclusion:CCW rotation in orthognathic surgery significantly increases both the NAS and PAS volumes. The increase in posterior NAS volume has not previously been reported or emphasized as a site for airway expansion and improvement. Not surprisingly, the anterior nasal cavity volume did not significantly increase and would benefit from future nasal reconstruction procedures. The nasopharyngeal and retropalatal region should be recognized as a site of obstruction that can be improved with CCW orthognathic movements.
Figure 1. Bar graphs comparing pre- and post-op mean volumetric and linear changes after orthognathic surgery with CCW rotation for class II and III patients.
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