• The korean journal of orthodontics
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• v.37 no.3 s.122
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• pp.192-203
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• 2007

Objective: The aim of this study was assessment of the relationship between airway space and facial morphology in Class III children with nasal obstruction. Methods: For this study, 100 Class III children (50 boys and 50 girls) were chosen. All subjects were refered to ENT, due to nasal obstruction. Airway space measurements and facial morphology measurements were measured on lateral cephalometric radiograph. Pearson correlation analysis was used to assess the relationship between airway space and facial morphology Results: Ramal height, SNA, SNB, PFH, FHR and facial plane angle were positively related to upper PAS, and sum of saddle angle, articular angle, and genial angle, SN-GoGn, Y-axis to SN and FMA negatively related to upper PAS. Genial angle, FMA were positively related to lower PAS, and articular angle, facial depth, PFH and FHR negatively related to lower PAS. PCBL, ramal height, Mn. body length, Mn. body length to ACBL, facial depth, facial length, PFH and AFH were positively related to tonsil size. Sum of saddle angle, articular angle, genial angle, facial length, AFH, FMA and LFH were positively related to tongue gap, and IMPA and overbite was negatively related to tongue gap. Upper PAS, related to size of adenoid tissue, was mainly related to posterior facial dimension following a vertical growth pattern of face and mandibular rotation. Lower PAS and tonsil size, related to anterior-posterior tongue base position, were significantly related to each other. Lower PAS was related to growth pattern of mandible, and tonsil size was related to size of mandible and horizontal growth pattern of face. Tongue gap was related to anterior facial dimension following a vertical growth pattern of face. Conclusion: Significant relationship exists between airway space and facial morphology.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.40
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• pp.33.1-33.11
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• 2018

Background: Bimaxillary orthognathic surgery with maxillomandibular setback is often accompanied by changes in airway space. We analyzed the changes in airway space before and after surgery and assessed their association with obstructive sleep apnea. Methods: This study is based on the cohort of 13 adult patients (9 males, 4 females, average age 23.85 years) who underwent bimaxillary orthognathic surgery with maxillomandibular setback. We performed computed tomography and portable polysomnography before and after the surgery to assess changes in airway space and Apnea-Hypopnea Index (AHI) values (total, supine, non-supine). Results: The oropharyngeal airway volume decreased by 29% after the surgery, which was statistically significant (p < .05). The upper airway volume and hypopharyngeal airway volume were decreased, but not significantly (4 and 19%, respectively). The changes in airway surface area were statistically significant at all levels examined (p < .05). Changes in the maximum anteroposterior width of the airway were also significant at all levels (p < .05). However, the changes in maximum lateral width were only statistically significant at C2 level (p < .05). AHI values were increased after the surgery but not significantly at any position. Conclusions: Although bimaxillary surgery with maxillomandibular setback significantly reduces the airway space, it does not affect AHI values or induce obstructive sleep apnea.

• The Journal of the Korean dental association
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• v.53 no.12
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• pp.926-934
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• 2015

Obstructive sleep apnea (OSA), most common respiratory disorder of sleep, is characterized by intermittent partial or complete occlusions of the upper airway due to loss of upper airway dilating muscle activity during sleep superimposed on a narrow upper airway. Termination of these events usually requires arousal from sleep and results in sleep fragmentation and hypoxemia, which leads to poor quality of sleep, excessive daytime sleepiness, reduced quality of life and numerous other serious health consequences. Untreated OSA may cause, or be associated with, several adverse outcomes, including daytime sleepiness, increased risk for motor vehicle accidents, cardiovascular disease, and depression. Various treatments are available, including non-surgical treatment such as medication or modification of life style, continuous positive airway pressure (CPAP) and oral appliance (OA). Skeletal surgery for obstructive sleep apnea (OSA) aims to provide more space for the soft tissue in the oropharynx to prevent airway collapse during sleep. Conventional surgical techniques include uvopalatopharyngoplasty(UPPP), genioglossus advancement (GA), and maxillomandibular advancement (MMA). Surgical techniques, efficacy and complications of skeletal surgery are introduced in this review.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.6
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• pp.457-464
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• 2022

Tracheostomy is a surgical procedure that is commonly used to treat upper airway obstruction. In particular, patients with head and neck cancer may require elective or emergency tracheostomy because of airway obstruction due to massive bleeding of the intraoral tumor mass and rapid growth of the tumor mass in the neck area. Here, we report four cases of tracheostomy in patients with head and neck cancer with narrowed airway space and difficulty in breathing. Based on these cases and a literature review, we recommend that oral and maxillofacial surgeons and dental anesthesiologists should cooperate closely and determine the appropriate timing to perform definitive airway management for such patients during palliative treatment, along with continuous evaluation of tumor location, risk of recurrence, and airway involvement.

• Journal of Oral Medicine and Pain
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• v.23 no.1
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• pp.75-84
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• 1998

The Purpose of this Study was to examine the anatomic differences in the upper airway according to severity of respiratory disturbance index of habitual snorers. Forty-three male habitual snorers, aged 28-68, were examined by polysomnography and divided into 4 groups according to severity determined by polysomnography. Anatomic differences in the upper airway were assessed by lateral cephalograms in upright position, and epidemiological surveys were done by using questionnaires. The obtained results were as follows : 1. All subjects were habitual snorers and 35 patients (81.4%) complained the loudness of snoring as severe as be heard outside of the room. 2. According to the results of polysomnography, the number of the primary snoring patients was 7(16.3%), mild obtrusive sleep apnea 7(16.3%), moderate 7(16.3%), and severe 22(51.2%). 3. The respiratory disturbance index (RDI) of subjects was 39.5$\pm$24.4 and the body mass index(BMI) was 26.2$\pm$2. 4. More inferiorly positioned hyoid bone according to the degree of respiratory disturbace index (RDI) was observed. (p<0.001) 5. The width of superior oropharyngeal airway space was according to the degree of RDI. (p<0.001)

• Imaging Science in Dentistry
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• v.47 no.1
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• pp.1-9
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• 2017

Purpose: This retrospective study aimed to evaluate the nasopharyngeal and oropharyngeal dimensions of individuals with skeletal class II, division 1 and division 2 patterns during the pre-peak, peak, and post-peak growth periods for comparison with a skeletal class I control group. Materials and Methods: Totally 124 lateral cephalograms (47 for skeletal class I; 45 for skeletal class II, division 1; and 32 for skeletal class II, division 2) in pre-peak, peak, and post-peak growth periods were selected from the department archives. Thirteen landmarks, 4 angular and 4 linear measurements, and 4 proportional calculations were obtained. The ANOVA and Duncan test were applied to compare the differences among the study groups during the growth periods. Results: Statistically significant differences were found between the skeletal class II, division 2 group and other groups for the gonion-gnathion/sella-nasion angle. The sella-nasion-B-point angle was different among the groups, while the A-point-nasion-B-point angle was significantly different for all 3 groups. The nasopharyngeal airway space showed a statistically significant difference among the groups throughout the growth periods. The interaction among the growth periods and study groups was statistically significant regarding the upper oropharyngeal airway space measurement. The lower oropharyngeal airway space measurement showed a statistically significant difference among the groups, with the smallest dimension observed in the skeletal class II, division 2 group. Conclusion: The naso-oropharyngeal airway dimensions showed a statistically significant difference among the class II, division 1; class II, division 2; and class I groups during different growth periods.

• The korean journal of orthodontics
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• v.26 no.1 s.54
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• pp.43-52
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• 1996

The purpose of this study was to compare and evaluate the upper airway structure between the snorers and asymptomatic control subjects depending on the positional change. Lateral cephalograms in the upright and supine position were taken in 25 female snorers and 20 female asymptomatic control subjects. The length and the area of the soft palate, tongue and airway were measured and evaluated statistically. The results obtained were as follows : 1. The snorers showed longer and higher tongue, narrower and longer airway, inferiorly positioned hyoid bone, longer and broader soft palate and narrower hypopharynx than the control subjects both in the upright and supine position. In addition, the snorers showed broader tongue area and narrower oropharynx area than the control subjects in supine position. 2. Depending on the positional change from upright to supine position, the controls and the snorers showed decreased airway length and superior positioned the hyoid bone. In addition, the snorers showed decreased tongue length and height, airway length and thickness and oropharynx area, but increased tongue area and soft palate area.

• The korean journal of orthodontics
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• v.39 no.2
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• pp.72-82
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• 2009

Objective: The purpose of this study was to investigate the structural changes of the hyoid bone and upper airway after orthognathic surgery for skeletal class III anterior open bite patients, and make comparisons with normal occlusion. Methods: Pre- and post-operative computed tomography (CT) examinations were performed on 12 skeletal class III anterior open bite patients who were treated with mandibular setback osteotomy. Using the V-works $4.0^{TM}$ program, 3-dimensional images of the total skull, mandible, hyoid bone, and upper airway were evaluated. Results: In the Class III open bite group, the hyoid bone were all positioned anteriorly, compared to the Normal group (p < 0.05). The angle between the hyoid plane and mandibular plane in the Class III openbite group before surgery was greater than in the Normal group (p < 0.05), and the difference increased after surgery (p < 0.01). In the Class III openbite group, the volume of the upper airway decreased after surgery (p < 0.001) and the volume of the upper airway was smaller than the Normal group before and after surgery (p < 0.001). Conclusions: The narrow upper airway space in skeletal Class III openbite patients decreased after mandibular setback osteotomy. This may affect the post-surgical stability.

• The korean journal of orthodontics
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• v.40 no.3
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• pp.145-155
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• 2010

Objective: Lateral cephalometric radiographs have been the main form of resource for assessing two dimensional anteroposterior airway changes. The purpose of this study was to evaluate the three dimensional volumetric change in the upper airway space in Class III malocclusion patients who underwent mandibular setback surgery. Methods: Three dimensional cone-beam computed tomographs (CBCT) and their three dimensional reconstruction images were analyzed. The samples consisted of 20 adult patients (12 males and 8 females) who were diagnosed as skeletal Class III and underwent mandibular setback surgery. CBCTs were taken at 3 stages - Baseline (1.8 weeks before surgery), T1 (2.3 months after surgery), and T2 (1 year after surgery). Pharyngeal airway was separated according to the reference planes and reconstructed into the nasopharynx, the oropharynx and the hypopharynx. Measurements at Baseline, T1, and T2 were compared between groups. Results: The result showed the volume of the pharyngeal airway decreased significantly 2.3 months after surgery (p < 0.001) and the diminished airway did not recover after 1 year post-surgery. The oropharynx was the most decreased area. Conclusions: These findings suggest that mandibular setback surgery causes both short-term and long-term decrease in the upper airway space.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.39
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• pp.22.1-22.9
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• 2017

Background: Two-jaw surgery including mandibular and maxillary backward movement procedures are commonly performed to correct class III malocclusion. Bimaxillary surgery can reposition the maxillofacial bone together with soft tissue, such as the soft palate and the tongue base. We analyzed changes of pharyngeal airway narrowing to ascertain clinical correlations with the prevalence of snoring after two-jaw surgery. Methods: A prospective clinical study was designed including a survey on snoring and three-dimensional (3D) computed tomography (CT) in class III malocclusion subjects before and after bimaxillary surgery. We conducted an analysis on changes of the posterior pharyngeal space find out clinical correlations with the prevalence of snoring. Results: Among 67 subjects, 12 subjects complained about snoring 5 weeks after the surgical correction, and examining the 12 subjects after 6 months, 6 patients complained about the snoring. The current findings demonstrated the attenuation of the largest transverse width (LTW), anteroposterior length (APL), and cross-sectional area (CSA) following bimaxillary surgery given to class III malocclusion patients, particularly at the retropalatal level. The average distance of maxillary posterior movements were measured to be relatively higher (horizontal distance 3.9 mm, vertical distance 2.6 mm) in case of new snorers. Conclusions: This study found that bimaxillary surgery could lead to the narrowing of upper airway at the retropalatal or retroglossal level as well as triggering snoring in subjects with class III malocclusion. Based on the current clinical findings, we also found that upper airway narrowing at retropalatal level may contribute to increasing the probability of snoring and that polysonography may need to be performed before orthognathic surgery in subjects with class III malocclusion.