Cephalometric and three-dimensional assessment of the posterior airway space and imaging software reliability analysis before and after orthognathic surgery

Abstract

Purpose: This study aimed to compare the reliability of three different imaging software programs for measuring the PAS and concurrently to investigate the morphological changes in oropharyngeal structures in mandibular prognathic patients before and after orthognathic surgery by using 2D and 3D analyzing technique.

Material and methods: The study consists of 11 randomly chosen patients (8 females and 3 males) who underwent maxillomandibular treatment for correction of Class III anteroposterior mandibular prognathism at the University Hospital in Zurich. A set of standardized LCR and CBCT-scans were obtained from each subject preoperatively (T0), 3 months after surgery (T1) and 3 months to 2 years postoperatively (T2). Morphological changes in the posterior airway space (PAS) were evaluated longitudinally by two different observers with three different imaging software programs (OsiriX(®) 64-bit, Switzerland; Mimics(®), Belgium; BrainLab(®), Germany) and manually by analyzing cephalometric X-rays.

Results: A significant increase in the upper airway dimensions before and after surgery occurred in all measured cases. All other cephalometric distances showed no statistically significant alterations. Measuring the volume of the PAS showed no significant changes in all cases. All three software programs showed similar outputs in both cephalometric analysis and 3D measuring technique.

Conclusion: A 3D design of the posterior airway seems to be far more reliable and precise phrasing of a statement of postoperative gradients than conventional radiography and is additionally higher compared to the corresponding manual method. In case of Class III mandibular prognathism treatment with bilateral split osteotomy of the mandible and simultaneous maxillary advancement, the negative effects of PAS volume decrease may be reduced and might prevent a developing OSAS.

Keywords: CBCT; Cephalometry; Imaging software; Orthognathic surgery; Posterior airway.