Comparing Outcomes of Airway Changes and Risk of Sleep Apnea after Bimaxillary Orthognathic Surgery and Mandibular Setback Surgery in Patients with Skeletal Class III Malocclusion: A Systematic Review and Meta-Analysis

Safi, Mehrnaz; Amiri, Ali; Nasrabadi, Navid; Khosravi, Setareh

doi:10.1590/pboci.2021.064

Mehrnaz Safi

Department of Pedodontics, Dental School, Zanjan University of Medical Sciences, Zanjan, Iran.

http://orcid.org/0000-0001-7260-0142

Ali Amiri

Department of Orthodontics, College of Stomatology, The First Affiliated Stomatological Hospital, Xi’an Jiaotong University, Xi’an 710004, PR China.

http://orcid.org/0000-0001-9416-808X

Navid Nasrabadi

Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

http://orcid.org/0000-0002-6365-6619

Setareh Khosravi

Department of Orthodontics, School of Dentistry, Shahed University, Tehran, Iran.

http://orcid.org/0000-0002-7360-269X

Correspondence: Ali Amiri, Department of Orthodontics, College of Stomatology, The First Affiliated Stomatological Hospital, Xi’an Jiaotong University, Xi’an 710004, PR China. E-mail:draliamiri2020@gmail.com

Authors’ Contributions

MS https://orcid.org/0000-0001-7260-0142 Writing - Original Draft, and Writing - Review and Editing.

AA https://orcid.org/0000-0001-9416-808X Conceptualization, Methodology, Validation, Formal Analysis, Investigation, Data Curation, Writing - Original Draft, Writing - Review and Editing, Visualization and Supervision.

NN https://orcid.org/0000-0002-6365-6619 Writing - Original Draft, and Writing - Review and Editing.

SK https://orcid.org/0000-0002-7360-269X Writing - Original Draft, and Writing - Review and Editing.

All authors declare that they contributed to critical review of intellectual content and approval of the final version to be published.

Conflict of Interest

The authors declare no conflicts of interest.

Academic Editor: Alessandro Leite Cavalcanti

PICO or PECO	Description
P	Population/Patient: Patients with Class III Malocclusion
E	Exposure/Intervention: Bimaxillary Orthognathic Surgery or Mandibular Setback Surgery
C	Comparison: Pre-Surgery and Post-Surgery Parameters /Mandibular Setback vs. Maxillary Advancement
O	Outcome: Upper Airway Total Volume and Sleep Apnea

Study/Year	Study Design	Sample Size		Age (Years)	Sort of Surgery	Measurements	Quality Score by MINORS
		Male	Female	Mean-Range
Agarwal et al. (2019) [¹⁴[14] Agarwal SS. Evaluation of pharyngeal airway dimensions following mandibular setback surgery in patients treated with surgery first orthognathic approach. J Sleep Disord Ther 2019; 8(302):1-5. https://doi.org/10.4172/2167-0277.1000302 https://doi.org/10.4172/2167-0277.100030... ]	Retrospective	5	5	NA	Mandibular Setback	Upper Airway Total Volume	Parameters of Pre and Post-Surgery	15
On et al. (2019) [⁸[8] On SW, Kim HJ, Cho DH, Moon YR, Song SI. Silent changes in sleep quality following mandibular setback surgery in patients with skeletal class III malocclusion: a prospective study. Sci Rep 2019; 9(1):1-10. https://doi.org/10.1038/s41598-019-46166-z https://doi.org/10.1038/s41598-019-46166... ]	Prospective	29	21	21.86	Mandibular Setback	Upper Airway Total Volume Apnea-hypopnea index (AHI)	Parameters of Pre and Post-Surgery	18
Havron et al. (2019) [¹⁵[15] Havron AG, Aronovich S, Shelgikar AV, Kim HL, Conley RS. 3D Airway changes using CBCT in patients following mandibular setback surgery ± maxillary advancement. Orthod Craniofac Res 2019; 22(Suppl 1):30-5. https://doi.org/10.1111/ocr.12291 https://doi.org/10.1111/ocr.12291... ]	Retrospective	14		NA	Mandibular Setback	Upper Airway Total Volume	Mandibular Setback + Maxillary Advancement	21
Cosmin Ioan et al. (2019) [¹⁶[16] Faur CI, Roman RA, Bran S, Dinu C, Coclici A, Rotaru H, Hedesiu M. The changes in upper airway volume after orthognathic surgery evaluated by individual segmentation on CBCT images. Maedica 2019; 14(3):213-9. https://doi.org/10.26574/maedica.2019.14.3.213 https://doi.org/10.26574/maedica.2019.14... ]	Prospective	9		27	BOS	Upper Airway Total Volume	Parameters of Pre and Post-Surgery	17
Jeong et al. (2018) [¹⁷[17] Jeong S, Sung J, Kim S, Kim Y, Shin S, Kim SS. Upper airway morphologic changes after mandibular setback surgery in skeletal class III malocclusion patients measured using cone beam computed tomography superimposition. Int J Oral Maxillofac Surg 2018; 47(11):1405-10. https://doi.org/10.1016/j.ijom.2018.05.002 https://doi.org/10.1016/j.ijom.2018.05.0... ]	Retrospective	10	8	22.7	Mandibular Setback	Upper Airway Total Volume	Parameters of Pre and Post-Surgery	18
Tepecik et al. (2018) [¹⁸[18] Tepecik T, Ertas Ü, Akgün M. Effects of bimaxillary orthognathic surgery on pharyngeal airway and respiratory function at sleep in patients with class III skeletal relationship. J Craniomaxillofac Surg 2018; 46(4):645-53. https://doi.org/10.1016/j.jcms.2018.01.009 https://doi.org/10.1016/j.jcms.2018.01.0... ]	Prospective	7	14	NA	BOS	Upper Airway Total Volume Apnea-Hypopnea Index (AHI)	Parameters of Pre and Post-Surgery	20
Jang et al. (2018) [¹⁹[19] Jang SI, Ahn J, Paeng JY, Hong J. Three-dimensional analysis of changes in airway space after bimaxillary orthognathic surgery with maxillomandibular setback and their association with obstructive sleep apnea. Maxillofac Plast Reconstr Surg 2018; 40(1):33. https://doi.org/10.1186/s40902-018-0171-3 https://doi.org/10.1186/s40902-018-0171-... ]	Prospective	13		>18	BOS	Upper Airway Total Volume Apnea-Hypopnea Index (AHI)	Parameters of Pre and Post-Surgery	18
Vaezi et al. (2017) [²⁰[20] Vaezi T, Zarch SH, Eshghpour M, Kermani H. Two-dimensional and volumetric airway changes after bimaxillary surgery for class III malocclusion. J Korean Assoc Oral Maxillofac Surg 2017; 43(2):88-93. https://doi.org/10.5125/jkaoms.2017.43.2.88 https://doi.org/10.5125/jkaoms.2017.43.2... ]	Prospective	4	6	20.4	BOS	Upper Airway Total Volume	Parameters of Pre and Post-Surgery	16
Lee et al. (2017) [²¹[21] Lee UL, Oh H, Min SK, Shin JH, Kang YS, Lee WW, et al. The structural changes of upper airway and newly developed sleep breathing disorders after surgical treatment in class III malocclusion subjects. Medicine 2017; 96(22):e687. https://doi.org/10.1097/MD.0000000000006873 https://doi.org/10.1097/MD.0000000000006... ]	Prospective	5	17	22.1	BOS	Upper Airway Total Volume Apnea-Hypopnea Index (AHI)	Parameters of Pre and Post-Surgery	18
Kim et al. (2016) [²²[22] Kim HS, Kim GT, Kim S, Lee JW, Kim EC, Kwon YD. Three-dimensional evaluation of the pharyngeal airway using cone-beam computed tomography following bimaxillary orthognathic surgery in skeletal class III patients. Clin Oral Investig 2016; 20(5):915-22. https://doi.org/10.1007/s00784-015-1575-4 https://doi.org/10.1007/s00784-015-1575-... ]	Prospective	16	22	23.84	Mandibular Setback	Upper Airway Total Volume	Parameters of Pre and Post-Surgery	15
Canellas et al. (2016) [²³[23] Canellas JD, Barros HL, Medeiros PJ, Ritto FG. Effects of surgical correction of class III malocclusion on the pharyngeal airway and its influence on sleep apnoea. Int J Oral Maxillofac Surg 2016; 45(12):1508-12. https://doi.org/10.1016/j.ijom.2016.09.002 https://doi.org/10.1016/j.ijom.2016.09.0... ]	Prospective	11	22	24.5	BOS	Upper Airway Total Volume Apnea-Hypopnea Index (AHI)	Mandibular Setback + Maxillary Advancement	19
Azevêdo et al.(2016) [²⁴[24] Azevêdo MS, Machado AW, Barbosa ID, Esteves LS, Rocha VÁ, Bittencourt MA. Evaluation of upper airways after bimaxillary orthognathic surgery in patients with skeletal Class III pattern using cone-beam computed tomography. Dental Press J Orthod 2016; 21(1):34-41. https://doi.org/10.1590/2177-6709.21.1.034-041.oar https://doi.org/10.1590/2177-6709.21.1.0... ]	Retrospective	9	5	17-40	Mandibular Setback Maxillary Advancement	Upper Airway Total Volume	Parameters of Pre and Post-Surgery	14
Hatab et al. (2015) [²⁵[25] Hatab NA, Konstantinovic VS, Mudrak JK. Pharyngeal airway changes after mono-and bimaxillary surgery in skeletal class III patients: Cone-beam computed tomography evaluation. J Craniomaxillofac Surg 2015; 43(4):491-6. https://doi.org/10.1016/j.jcms.2015.02.007 https://doi.org/10.1016/j.jcms.2015.02.0... ]	Prospective	9	11	21.7	Mandibular Setback	Upper Airway Total Volume	Mandibular Setback + Maxillary Advancement	20
Hsieh et al. (2015) [²⁶[26] Hsieh YJ, Chen YC, Chen YA, Liao YF, Chen YR. Effect of bimaxillary rotational setback surgery on upper airway structure in skeletal Class III deformities. Plast Reconstr Surg 2015; 135(2):361e-9e. https://doi.org/10.1097/PRS.0000000000000913 https://doi.org/10.1097/PRS.000000000000... ]	Retrospective	18	54	24.0	Mandibular Setback	Upper Airway Total Volume	Parameters of Pre and Post-Surgery	19
Wang et al. (2015) [²⁷[27] Wang H, Qi S, Yan M, Zhang C, Ren S, Zhang J. Cone-beam computed tomography evaluation of upper airway change in skeletal Class III patients after orthodontic-mandibular setback surgery. Zhonghua Kou Qiang Yi Xue Za Zhi 2015; 50(10):615-8.]	Prospective	13	15	19	Mandibular Setback	Upper Airway Total Volume	Mandibular Setback + Maxillary Advancement	15
Hart et al. (2015) [²⁸[28] Hart PS, McIntyre BP, Kadioglu O, Currier GF, Sullivan SM, Li J, et al. Postsurgical volumetric airway changes in 2-jaw orthognathic surgery patients. Am J Orthod Dentofacial Orthop 2015; 147(5):536-46. https://doi.org/10.1016/j.ajodo.2014.12.023 https://doi.org/10.1016/j.ajodo.2014.12.... ]	Retrospective	31	40	19	Mandibular Setback + Maxillary Advancement	Upper Airway Total Volume	Parameters of Pre and Post-Surgery	14
Burkhard et al. (2014) [²⁹[29] Burkhard JP, Dietrich AD, Jacobsen C, Roos M, Lübbers HT, Obwegeser JA. Cephalometric and three-dimensional assessment of the posterior airway space and imaging software reliability analysis before and after orthognathic surgery. J Craniomaxillofac Surg 2014; 42(7):1428-36. https://doi.org/10.1016/j.jcms.2014.04.005 https://doi.org/10.1016/j.jcms.2014.04.0... ]	Retrospective	3	8	26	Mandibular setback + Maxillary Advancement	Upper Airway Total Volume	Parameters of Pre and Post-Surgery	13
Li et al. (2014) [³⁰[30] Li YM, Liu JL, Zhao JL, Dai J, Wang L, Chen JW. Morphological changes in the pharyngeal airway of female skeletal class III patients following bimaxillary surgery: a cone beam computed tomography evaluation. Int J Oral Maxillofac Surg 2014; 43(7):862-7. https://doi.org/10.1016/j.ijom.2014.03.009 https://doi.org/10.1016/j.ijom.2014.03.0... ]	Retrospective	0	29	23	Mandibular Setback + Maxillary Advancement	Upper Airway Total Volume	Parameters of Pre and Post-Surgery	19
Uesugi et al. (2014) [³¹[31] Uesugi T, Kobayashi T, Hasebe D, Tanaka R, Ike M, Saito C. Effects of orthognathic surgery on pharyngeal airway and respiratory function during sleep in patients with mandibular prognathism Int J Oral Maxillofac Surg 2014; 43(9):1082-90. https://doi.org/10.1016/j.ijom.2014.06.010 https://doi.org/10.1016/j.ijom.2014.06.0... ]	Prospective	21	19	23	Mandibular Setback	Upper Airway Total Volume	Mandibular Setback + Maxillary Advancement	19
Park et al. (2012) [³²[32] Park SB, Kim YI, Son WS, Hwang DS, Cho BH. Cone-beam computed tomography evaluation of short-and long-term airway change and stability after orthognathic surgery in patients with Class III skeletal deformities: bimaxillary surgery and mandibular setback surgery. Int J Oral Maxillofac Surg 2012; 41(1):87-93. https://doi.org/10.1016/j.ijom.2011.09.008 https://doi.org/10.1016/j.ijom.2011.09.0... ]	Retrospective	23	13	23	Mandibular Setback + Maxillary Advancement	Upper Airway Total Volume	Mandibular Setback + Maxillary Advancement	20
Hong et al. (2011) [³³[33] Hong JS, Park YH, Kim YJ, Hong SM, Oh KM. Three-dimensional changes in pharyngeal airway in skeletal class III patients undergoing orthognathic surgery. J Oral Maxillofac Surg 2011; 69(11):e401-8. https://doi.org/10.1016/j.joms.2011.02.011 https://doi.org/10.1016/j.joms.2011.02.0... ]	Retrospective	14	7	27	Mandibular Setback	Upper Airway Total Volume	Parameters of Pre and Post-Surgery	19
Park et al. (2010) [³⁴[34] Park JW, Kim NK, Kim JW, Kim MJ, Chang YI. Volumetric, planar, and linear analyses of pharyngeal airway change on computed tomography and cephalometry after mandibular setback surgery. Am J Orthod Dentofacial Orthop 2010; 138(3):292-9. https://doi.org/10.1016/j.ajodo.2009.10.036 https://doi.org/10.1016/j.ajodo.2009.10.... ]	Retrospective	5	7	26	Mandibular Setback	Upper Airway Total Volume	Parameters of Pre and Post-Surgery	14
Jakobsone et al. (2010) [³⁵[35] Jakobsone G, Neimane L, Krumina G. Two-and three-dimensional evaluation of the upper airway after bimaxillary correction of Class III malocclusion. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 110(2):234-42. https://doi.org/10.1016/j.tripleo.2010.03.026 https://doi.org/10.1016/j.tripleo.2010.0... ]	Prospective	8	6	20	Mandibular Setback + Maxillary Advancement	Upper Airway Total Volume	Parameters of Pre and Post-Surgery	15

[1] Correspondence: Ali Amiri, Department of Orthodontics, College of Stomatology, The First Affiliated Stomatological Hospital, Xi’an Jiaotong University, Xi’an 710004, PR China. E-mail:draliamiri2020@gmail.com

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Comparing Outcomes of Airway Changes and Risk of Sleep Apnea after Bimaxillary Orthognathic Surgery and Mandibular Setback Surgery in Patients with Skeletal Class III Malocclusion: A Systematic Review and Meta-Analysis

ABSTRACT

Objective:

Material and Methods:

Results:

Conclusion: