Changes in head posture, hyoid bone position and airway dimensions after orthognatic surgery

Mandibular/bimaxillary advancement surgery is described as a potential means of increasing the oropharyngeal airspace , provided a significant improvement in breathing capacity. Aim: To evaluate postural changes suffered in the positioning of the head and the hyoid bone, dentofacial deformity patients undergoing orthognathic surgery with consequent dimensional changes of oropharyngeal airspace. Methods: We evaluated the archived records of patients with postoperative 6 months minimum, being used as criteria for selecting individuals with dental class II malocclusion and facial Pattern II, jaw or maxilomandibular deficiency, patients undergoing orthodontic-surgical treatment through mandibular advancement or of both bony bases, associated or not to genioplastia. Twenty-eight patients were part of the sample and were evaluated by means of lateral radiographs in lateral standard digitized, in three distinct periods: pre-operative, immediate postoperative period and late postoperative period (minimum 6 months). 12 linear measures and two angular cephalometric analysis were used in this research. Results: With the surgery, there was an average of mandibular advancement 6, 76 mm, while remaining stable in the long-term follow-up period; the hyoid bone moved onward and upward, extending your movement in the post-operative. The cervical region presented minimal movement of the head extension in the immediate post operative with almost total returns the position of the head in the post-operative. The surgical movement of oropharyngeal air space was in the same direction of the mandibular movement, but to a lesser extent (1,88 -2,76 mm). In the post-operative period was a late partial reduction of the diameter of the air space between 34-56% of gain, representing an apparent accommodation of this anatomical region soft tissue. Conclusion: Orthognathic surgery of mandibular advancement or bimaxillary promotes significant changes in aesthetics, in the position of the hyoid bone and upper airway dimensions, getting better quality of life to these patients

Cirurgia ortognática no tratamento da síndrome da apneia obstrutiva do sono ­ relato de caso / Orthognathic surgery in obstructive sleep apnea syndrome treatment - case report

A Síndrome da Apneia Obstrutiva do Sono (SAOS) representa uma complexa alteração das vias aéreas superiores, cujo evento principal corresponde ao colapso de suas paredes na inspiração durante o sono ao nível da faringe. Apresenta como sinais e sintomas clássicos o ronco, a interrupção da respiração de forma intermitente durante o sono, agitação ao dormir, sensação de sufocamento ao despertar, sonolência diurna excessiva, impotência sexual, cefaleia e irritabilidade. O artigo descreve o caso clínico de um paciente adulto, sexo masculino, com face padrão II por retrusão de mandíbula e protrusão de maxila e diagnóstico polissonográfico de apneia severa do sono (IAH de 56,7 eventos/hora), roncos frequentes de moderada a alta intensidade sonora e saturação mínima da oxi-hemoglobina de 79%. O planejamento cirúrgico consistiu no avanço mandibular de 14 mm com giro anti-horário, associado ao avanço maxilar de 8 mm, com abaixamento de 4 mm da espinha nasal posterior. No pós-operatório imediato, o paciente relatou melhora progressiva dos sintomas, com redução do ronco e da sonolência diurna. Após quatro meses da cirurgia, a polissonografia indicou IAH de 4 eventos/hora de sono, apenas em decúbito dorsal e durante o sono REM, com ausência de roncos e de dessaturação da oxi-hemoglobina. No pós-operatório tardio (12 meses), os resultados faciais apresentaram-se estáveis, bem como a melhora da capacidade respiratória e da qualidade do sono. Concluiu-se que a técnica relatada foi eficaz no tratamento da SAOS, com a melhora dos sintomas, diminuição do ronco e da sonolência diurna e melhora considerável das funções cognitivas.(AU)

Obstructive Sleep Apnea Syndrome (OSAS) represents a complex alteration of the upper airways, whose main event corresponds to the collapse of its walls in inspiration during sleep at the pharynx level. It presents as classic signs and symptoms snoring, interruption of breathing intermittently during sleep, restlessness during sleep, suffocation sensation upon awakening, excessive daytime sleepiness, sexual impotence, headache and irritability. The article describes a case report of an adult patient, male, with Class II malocclusion due to jaw retrusion and maxillary protrusion and polysomnographic diagnosis of severe sleep apnea (AHI of 56.7 events/hour), frequent moderate to high-sounding snoring and minimal oxyhemoglobin saturation of 79%. The surgical planning consisted of a 14 mm mandibular advancement with counterclockwise rotation, associated with maxillary advancement of 8 mm, with 4 mm lowering of posterior nasal spine. In the immediate postoperative period, the patient reported a progressive improvement of the symptoms, with reduction of snoring and daytime sleepiness. After four months of surgery, polysomnography indicated AHI of 4 events/hour of sleep, only in dorsal decubitus and during REM sleep, with no snoring and oxyhemoglobin desaturation. In the post-surgical follow up (12 months), facial results were stable as well as improvement in respiratory capacity and sleep quality. It was concluded that the reported technique was effective in the treatment of OSAS, with improvement of symptoms, reduction of snoring and daytime sleepiness and considerable improvement of cognitive functions.(AU)

Avaliação da relação entre o Padrão II e as fases de maturação das vértebras cervicais / Evaluation of the relation between Standard II and phases of cervical vertebral maturation

Este estudo objetivou prever o melhor momento do crescimento crânio-facial e instituir a terapia mais apropriada para cada caso, seja ela ortodôntica ou ortopédica. É um desafio que vem sendo superado pelos profissionais da Odontologia após a introdução do método de avaliação da idade esquelética através da visualização das vértebras cervicais, utilizando a telerradiografia em norma lateral. Assim, o presente estudo teve o objetivo de avaliar a relação entre o padrão II facial e as fases de maturação óssea das vértebras cervicais C2, C3 e C4, em indivíduos dos sexos masculino e feminino, apresentando padrão II facial, com idades entre 8 e 13 anos, e nas diferentes fases de maturação óssea das vértebras cervicais. A amostra foi formada por 29 telerradiografias em norma lateral de indivíduos sem prévio tratamento ortodôntico ou ortopédico facial. Os resultados mostraram que a discrepância entre os arcos (ANB) é maior quando a fase de maturação óssea das vértebras cervicais é mais precoce, e as demais medidas analisadas (AFAI, CoA, CoGn e SN.GoM) apresentaram variação, atingindo seu valor máximo na fase 6 (finalização). Diante do exposto, conclui-se que, das medidas estudadas, apenas o ângulo da discrepância maxilomandibular (ANB) diminui à proporção que as fases de maturação das vértebras cervicais avançam em direção à finalização.

This article aimed at predicting the best moment of the cranium-facial growth and applying the most appropriate therapy for each case, either orthodontic or orthopedic. This is a challenge which has been overcome by dentistry professionals after the introduction of skeletal age evaluation method through cervical vertebrae visualization using lateral cephalometric radiography. Thus, this study aimed to evaluate the relation between facial pattern II and phases of skeletal maturation of cervical vertebrae C2, C3 and C4, in both gender individuals, age between 8 and 13 years old, in different phases of skeletal maturation of cervical vertebrae. The sample was composed of 29 lateral cephalometric radiographies of individuals without previous facial orthodontic or orthopedic treatment. The results showed that the discrepancy between the arches (ANB) is greater when the phase of skeletal maturation of cervical vertebrae is premature, and the other analyzed measures (AFAI, CoA, CoGn and SN.GoM) showed variation, reaching its maximum value at phase 6 (termination). It was concluded that among the studied measures, only the maxillomandibular discrepancy angle (ANB) decreases on the proportion that the phases of skeletal maturation of cervical vertebrae progress toward termination.