Three-dimensional evaluation of nasal and pharyngeal airway after le fort I maxillary distraction osteogenesis

Abstract

The aims of this study were to evaluate volumetric changes in the nasal cavity (NC) and pharyngeal airway space (PAS) after Le Fort I maxillary distraction osteogenesis (MDO) using a three-dimensional (3D) simulation program, and to determine the effects of MDO on respiratory function during sleep with polysomnography (PSG). 3D computed tomography images were obtained and analyzed before surgery (T0) and at a mean 8.2 +/- 1.2 months postsurgery (T1) (SimPlant-OMS software) for 11 male patients (mean age 25.3 +/- 5.9 years) with severe skeletal class III anomalies related to maxillary retrognathia. The simulation of osteotomies and placement of distractors were performed on stereolithographic 3D models. NC and PAS were segmented separately on these models for comparison of changes between TO and T1. PSG including the apnoea hypopnoea index (AHI), sleep efficiency, sleep stages (weakness, stages 1-4, and rapid eye movement (REM)), and mean lowest arterial O-2 saturation were obtained at TO and T1 to investigate changes in respiratory function during sleep. MDO was successful in all cases as planned on the models; the average forward movement at A point was 10.2 mm. Increases in NC and PAS volume after MDO were statistically significant. These increases resulted in significant improvement in sleep quality. PSG parameters changed after MDO; AHI and sleep stages weakness, 1, and 2 decreased, whereas REM, stages 3 and 4, sleep efficiency, and mean O-2 saturation increased.