The International journal of adult orthodontics and orthognathic surgery

Publications in this journal

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  Article: Evaluation of the esthetic results of a 40-patient group treated surgically for dentoskeletal class III malocclusion.

  Roberto Becelli, Giancarlo Renzi, Andrea Carboni, Giulio Cerulli, Maurizio Perugini
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  ABSTRACT: A dentoskeletal Class III malocclusion results in unesthetic alterations of the soft tissues, which may cause psychologic and interpersonal problems. Surgical treatment, if based on cephalometric evaluations alone, can result in inadequate correction of facial esthetics. The aim of this paper is to discuss the esthetic needs observed in surgical planning of a group of 40 Class III patients and to compare the presurgical esthetic parameters with those recorded in the sixth month of follow-up. To obtain the proper esthetic result and to restore proper stomatognathic functionality, surgical treatment planning required the integration and correction of skeletal cephalometric planning. In 24 of the 40 patients, the skeletal and esthetic planning were in agreement with each other. In the remaining 16 patients, the correction of skeletal planning with the esthetic planning was necessary to obtain the correct esthetic and functional restoration. In all patients, esthetic, radiographic, and functional analysis at the sixth month of follow-up revealed the restoration of correct facial esthetics in the vertical, transverse, and sagittal planes; no temporomandibular joint problems; and a high degree of personal satisfaction regarding the esthetic and functional result obtained, including improvements in social life and in masticatory function. Cephalometric indications should always be compared with esthetic clinical indications and, possibly, the skeletal planning must be corrected by the esthetic needs, so that esthetic and functional success can be reached at the same time.
  The International journal of adult orthodontics and orthognathic surgery 02/2002; 17(3):171-9.
• Article: Long-term stability of surgical class III treatment: a study of 5-year postsurgical results.

  Bret R Busby, L'Tanya J Bailey, William R Proffit, Ceib Phillips, Raymond P White
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  ABSTRACT: Previous studies have documented the stability of Class III surgical procedures in the first postsurgical year and during a postsurgical period > 2 years. To evaluate long-term changes, postoperative cephalometric radiographs at 1 year and > or = 5 years were digitized for 79 patients who had received either a bilateral sagittal split osteotomy for mandibular setback, a Le Fort I maxillary advancement, or a combination of the 2 procedures. From 1 year to longest follow-up, the mean changes were quite small. Eighty-five percent of the maxillary advancement group and the mandibular setback group and 80% of the bimaxillary surgery group showed less than 4 mm of postsurgical change from 1 year to > or = 5 years. Long-term, the mandibular setback alone was more stable than when combined with maxillary surgery. This is opposite of what was observed during the first postsurgical year. Bimaxillary surgery in Class III patients improved the stability of the mandibular setback short-term and the maxillary advancement in the short and long term if the maxilla was also moved down during surgery. This study also suggests that bimaxillary surgery in Class III patients is more stable than bimaxillary surgery in Class II patients. On questionnaires that evaluated patient perception, 92% of patients reported satisfaction with healing since surgery. Eighty-nine percent thought their experience was positive and were happy with the surgical results. The predominant problems were altered feelings in the face or mouth (68%) and surprise at the length of their recovery (41%).
  The International journal of adult orthodontics and orthognathic surgery 02/2002; 17(3):159-70.
• Article: Relationship between bilateral condylar bone change and mandibular morphology: a study using morphometry.

  Bashar Alkhamrah, Kazuhiro Yamada, Masaki Yamaki, Iyad M Ali, Kooji Hanada
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  ABSTRACT: This study was undertaken to evaluate the relationship between bilateral condylar bone change (BCBC) and mandibular morphology. Thirty Japanese women with BCBC as diagnosed from computed tomographic scans were compared to 2 control groups: 26 Class I and 25 Class II Japanese women. All cephalograms were traced and scanned, and 14 homologous landmarks were digitized. Coordinates were used for cephalometric analysis, Procrustes analysis, Euclidean distance matrix analysis (EDMA), and thin-plate spline (TPS) analysis. Comparison of the cephalometric data for the BCBC and Class I groups revealed significant shrinkage in the condylar process and ramus height, in addition to a shorter body length. The centroid size showed that BCBC mean geometric forms were smaller than those of Class I and Class II. The landmark morphology of the BCBC group differed from both Class I and Class II, as shown by the residuals (P < .001). EDMA showed expansion of infradentale-pogonion (9.9%) and along the anterior slope height of the condyle (28.6%), while the posterior slope height decreased (21.6%). The vertical ramus height (gonioncondylion) also decreased by 11.8% in comparison to Class I. Compared to Class II, BCBC ramus height was shorter by 8.9%, condylar width decreased 13.7%, and the posterior condylar slope was 22% shorter. TPS analysis showed increased antegonial notching, a vertically expanded symphysis, and a collapsed and more horizontal condyle in the BCBC group. The combination of the above methods was very helpful in assessing mandibular morphology and showed that BCBC might be related not only to changes in the condyle, but may dictate changes in the rest of the mandible as well.
  The International journal of adult orthodontics and orthognathic surgery 02/2002; 17(3):207-16.
• Article: The floating bone technique of the vertical ramus in hemifacial microsomia: case report.

  Massimo Politi, Salvatore Sembronio, Massimo Robiony, Fabio Costa
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  ABSTRACT: This article describes a case in which distraction osteogenesis of the vertical ramus of the mandible was used for a young woman with hemifacial microsomia. Failure of distraction occurred because of the wrong vector of distraction. The floating bone technique was applied to the vertical ramus and was used to correct the malocclusion and to recover the height of the vertical ramus. Complete skeletal correction of the asymmetry was obtained, with excellent esthetic results. The case shows that the floating bone technique is a valid method to help the surgeon in the management of malocclusion after distraction and also in cases of failure of distraction. The floating bone is possible on both the vertical ramus and on the horizontal ramus.
  The International journal of adult orthodontics and orthognathic surgery 02/2002; 17(3):223-9.
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  Article: The anatomic basis for palatal implants in orthodontics.

  Karl Andreas Schlegel, Florian Kinner, Karl Dieter Schlegel
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  ABSTRACT: Orthodontic anchorage without negative reciprocal influences on tooth position can be achieved by the use of immobile implants. An existing dentition permits placement of endosseous implants in only a few regions. These are the edentulous parts of the ridge due to previous extractions, the ascending ramus of the mandible, and the os palatinum. A precondition for successful implant osseointegration is a satisfactory bone base. The midline of the os palatinum is of particular anatomic interest due to the increasing use of anchorage implants in this area. Even though most implants are incorporated uneventfully, in some cases, the osseointegration of these implants fails. Therefore, anatomic data characterizing the palatal midline region are of clinical importance. In this study, trephine bur biopsies provided the material for histologic facings. The donor age covered a span from 12 to 53 years and illustrated that complete ossification of the suture palatina mediana (SPM) is rare before the age of 23 years. Therefore, especially in adult orthodontic treatment, the use of palatal implants should be considered. The anterior SPM is less often ossified than the posterior region. Implant placement should take this into account and consider that a bone bed more favorable to osseointegration might be found posterior to the interconnecting line of the first premolars.
  The International journal of adult orthodontics and orthognathic surgery 02/2002; 17(2):133-9.
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  Article: Factors influencing postoperative satisfaction of orthognathic surgery patients.

  Bo Chen, Zhen-kang Zhang, Xing Wang
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  ABSTRACT: The purpose of this study was to investigate the postoperative satisfaction of orthognathic surgery patients and related factors. The authors assessed 108 orthognathic surgery patients using the Minnesota Multiphasic Personality Inventory and the Symptom Checklist 90 preoperatively. The degree of deformity, expectations for surgery, and support of significant others were also evaluated before surgery. The patients were given questionnaires at 4 time points, from 10 days to 1 year after surgery. A multiple regression test was used to analyze the relative importance of psychologic factors and other variables in explaining the degree of patients'satisfaction with surgery. Postoperative satisfaction was high and increased with time. Patients with more education and more severe deformities reported greater satisfaction. During the early stage after surgery, patients with a high degree of interpersonal sensitivity, whose close relatives did not support surgery, or who accepted surgery passively tended to be more dissatisfied. Patients who had realistic expectations were more satisfied in the long term. Complications such as pain and swelling influenced patients' satisfaction soon after surgery, whereas the responses of people around the patients influenced their satisfaction at all stages postoperatively.
  The International journal of adult orthodontics and orthognathic surgery 02/2002; 17(3):217-22.
• Article: Costs of surgical-orthodontic treatment in community hospital care: an analysis of the different phases of treatment.

  Kari Panula, Leo Keski-Nisula, Katri Keski-Nisula, Kyosti Oikarinen, Sanna Keski-Nisula
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  ABSTRACT: To determine the distribution of costs and various influencing factors in the entire process of surgical-orthodontic treatment in community hospital care, a retrospective study was carried out. The records and radiographs of 99 community hospital patients operated on between 1994 and 2001 were included. Cost analysis data were gathered from 4 phases of treatment: the orthodontics, the surgical outpatient assessments, the surgery/surgeries, and the inpatient period. The results showed that the surgical phases together are responsible for roughly 61% of the costs, 28% of which were attributed to the surgical operation itself. Orthodontics made up approximately 39% of the total costs, with an average of 26 visits. The average total costs of all treatments were US $6,206 +/- 912. Patients that could be operated on with bilateral sagittal split ramus osteotomy of the mandible only had the lowest costs, and those who required bimaxillary osteotomies had the highest costs. Of the several clinical and cephalometric measurements made in this study, only skeletal open bite and orthodontic space closure after tooth extraction were found to affect the costs. It can be concluded that surgical-orthodontic treatment is a rather expensive way to correct dentofacial malocclusions due to the high costs of the surgical phase. Skeletal open bite constituted the most costly entity, while malocclusion resulting from mandibular deformity was the cheapest.
  The International journal of adult orthodontics and orthognathic surgery 02/2002; 17(4):297-306.
• Article: Actinomycosis as a rare complication of orthognathic surgery.

  Peter Maurer, Cornelia Otto, Alexander W Eckert, Johannes Schubert
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  ABSTRACT: Modern orthognathic surgery is said to be clean contaminated due to the intraoral means of access. Complications after orthognathic surgery, a common operation, occur about 10% of the time. Actinomycosis, a rare specific infection, plays a negligible role. Diagnostically, it should be differentiated from other infections that occur a long time after the operation. Three cases of actinomycosis that occurred after orthognathic surgery were observed, and therapeutic measurements are described case by case.
  The International journal of adult orthodontics and orthognathic surgery 02/2002; 17(3):230-3.
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  Article: Elliptic Fourier analysis of facial profiles during growth and development.

  Virgilio F Ferrario, Chiarella Sforza, Claudia Dellavia, Veronica Ciusa, Graziano Serrao
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  ABSTRACT: The quantitative analysis of facial soft tissues is of overwhelming importance for orthodontic patients. To assess the normal age-related variations in shape, soft tissue facial profiles were studied in 96 healthy male children 3 to 11 years of age and 16 young men (age 18). Standardized left-side photographs were taken of each subject, and facial profiles were traced between trichion and cervical point. The line joining the 2 landmarks was set as the baseline, and each outline was automatically digitized and mathematically reconstructed by a 30-harmonic elliptic Fourier series expansion. The same soft tissue profile was traced and digitized from the Bolton standards of comparable age. All profiles were standardized to the same area, and shape modifications were quantified by calculating the morphologic distance between the Fourier reconstructions of each facial profile and of (1) the 18-year-old Bolton standard (MD-18) and (2) the age-related Bolton standard. Descriptive statistics were computed for each age class. On average, MD-18 was 7.23 at 3 years of age, increased between 6 and 9 years of age, and decreased hereafter, reaching 6.86 at 18 years of age. Within-group variability peaked at 8 years of age, and was minimal at 6 and 18 years of age. The current soft tissue child profiles seemed different from the profile obtained from the Bolton standards.
  The International journal of adult orthodontics and orthognathic surgery 02/2002; 17(4):348-54.
• Article: Extrusion-based leveling with segmented arch mechanics.

  Hassan Noroozi, Hassan Moeinzad
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  ABSTRACT: Leveling of the dental arch may be accomplished through anterior intrusion, posterior extrusion, or a combination. Posterior extrusion is usually preferred in vertically balanced adolescents and in surgical-orthodontic treatment of adults suffering from deep bite and mandibular deficiency. A major disadvantage of posterior extrusion, when accomplished by continuous archwires, is incisor flaring. Here a segmented arch arrangement is proposed for posterior extrusion that combines the clinical simplicity of continuous mechanics with better control of incisor position.
  The International journal of adult orthodontics and orthognathic surgery 02/2002; 17(1):47-9.
• Article: Effects of orthodontic treatment on gingival crevicular fluid flow rate and composition: clinical implications and applications.

  Smaro Kavadia-Tsatala, Eleftherios G Kaklamanos, Lazaros Tsalikis
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  ABSTRACT: The gingival crevicular fluid (GCF) flow rate and composition vary according to the condition of the periodontal tissues. The levels of some of its constituents have been shown to correlate with the actual clinical measurements of periodontal disease progression and reflect changes occurring deep in the periodontium. During the course of orthodontic treatment, the forces exerted produce a distortion of the periodontal ligament extracellular matrix, resulting in alterations in cellular shape and cytoskeletal configuration. Such events lead to the synthesis and presence in the deeper periodontal tissues of extracellular matrix components, tissue-degrading enzymes, acids, and inflammatory mediators; induce cellular proliferation and differentiation; and promote wound healing and tissue remodeling. These changes may modify both the GCF flow rate and its components. Consequently, analysis of GCF samples may provide a better understanding of the biochemical processes associated with tooth movement and may help the clinician make therapeutic choices based on qualitative and quantitative information.
  The International journal of adult orthodontics and orthognathic surgery 02/2002; 17(3):191-205.
• Article: Stability of maxillary advancement for correction of skeletal Class III malocclusion after combined maxillary and mandibular procedures: preliminary results of an active control equivalence trial for semirigid and rigid fixation of the maxilla.

  Massimo Politi, Fablo Costa, Massimo Robiony, Franca Soldano, Miriam Isola, Franco Soldano
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  ABSTRACT: In this paper preliminary results are presented of a prospective study designed to examine the effect of maxillary fixation methods on postoperative stability. The purpose of this study was to evaluate the stability of Le Fort I osteotomy stabilized with semirigid fixation of the maxilla (SRMF) or rigid fixation of the maxilla (RMF). All patients had skeletal Class III malocclusion and underwent bimaxillary surgery (Le Fort I maxillary advancement with or without superior repositioning and bilateral sagittal split osteotomies of the mandible). Standardized cephalometric analysis was performed on serial radiographs of 42 patients immediately before surgery, 1 week after surgery, after release of fixation, and 1 year postoperatively. The patients were randomized into 2 treatment groups: 23 patients received RMF (group A), and 19 patients received SRMF (group B). Within the groups, patients showed good stability with regard to their baseline characteristics. To show the therapeutic equivalence of the 2 treatments, analysis of the recorded data followed the approach for an equivalence trial. The mean surgical advancement was 5.34 +/- 1.50 mm for group A and 4.51 +/- 1.37 mm for group B. The mean amount of postsurgical relapse was 0.98 +/- 1.27 mm for group A and 0.30 +/- 1.04 mm for group B. Group A patients experienced 93% of their relapse (0.92 mm) during fixation, while group B patients experienced 96% of their relapse (0.29 mm) after release of fixation. RMF provided better stability than SRMF for all maxillary landmarks in the vertical plane. All considered points both in horizontal and vertical plane exhibited full equivalence for 95% confidence intervals, which seems to indicate equivalent stability between the surgical procedures.
  The International journal of adult orthodontics and orthognathic surgery 02/2002; 17(2):98-110.
• Article: Treatment and posttreatment dentoalveolar changes following intrusion of mandibular molars with application of a skeletal anchorage system (SAS) for open bite correction.

  Junji Sugawara, Un Bong Baik, Mikako Umemori, Ichiro Takahashi, Hiroshi Nagasaka, Hiroshi Kawamura, Hideo Mitani
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  ABSTRACT: The skeletal anchorage system (SAS) consists of titanium anchor plates and monocortical screws that are temporarily implanted in either the maxilla or the mandible as absolute orthodontic anchorage. With SAS, anterior open bite can be improved by the counterclockwise rotation of the mandible, accompanied by the intrusion of molars. The present study was designed to evaluate treatment and posttreatment dentoalveolar changes following the intrusion of mandibular molars. Nine adult open bite patients (7 women and 2 men) successfully treated with SAS were included in the following study. The amount of intrusion, relapse, and dentoalveolar changes were measured on cephalometric radiographs, panoramic radiographs, and dental casts. The results of this study were as follows: (1) the average amount of intrusion of the mandibular first and second molars was 1.7 mm and 2.8 mm, respectively; (2) the average relapse rates were 27.2% at the first molars and 30.3% at the second molars; (3) there were no significant changes in crestal bone heights, clinical crown length, or root length; and (4) counterclockwise rotation of the mandible and decrease of anterior facial height were observed during treatment. Thus, it was concluded that SAS would be a valid modality to intrude mandibular molars for correction of open bite.
  The International journal of adult orthodontics and orthognathic surgery 02/2002; 17(4):243-53.
• Article: Indications and procedures for segmental dentoalveolar osteotomy: a review of 13 patients.

  Satoshi Yokoo, Takahide Komori, Sanae Watatani, Yasuyuki Shibuya, Hitoshi Komurasaki, Chizu Tateishi
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  ABSTRACT: The authors evaluated the surgical area, indications, and procedures for segmental dentoalveolar osteotomy carried out on 16 jaws in 13 patients treated at the Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, between 1990 and 2001. Osteotomy was indicated mainly in cases where tooth repositioning by orthodontic treatment was limited, where social conditions (e.g., age, time, finances) precluded orthodontic treatment, or where revision of orthodontic or surgical treatment was required. In cases of maxillary anterior segmental dentoalveolar osteotomy, the modified Wunderer method was used, where after an incision was made in the palatal mucosa, a mucoperiosteal flap was abraded as much as possible until the area of the osteotomy on the palatal side could be visualized. In maxillary posterior segmental dentoalveolar osteotomy, the operation was carried out in 2 stages because of the risk of necrosis of the bone fragments. In the first stage, an osteotomy was carried out on the vestibular side, since the vestibular gingival pedicle was intact. In the second stage, 3 weeks later, another osteotomy was performed after the palatal mucoperiosteal flap was abraded to visualize the area of the osteotomy as well as that of the maxillary anterior segmental dentoalveolar osteotomy.
  The International journal of adult orthodontics and orthognathic surgery 02/2002; 17(4):254-63.
• Article: Neuromuscular evaluation of post-orthodontic stability: an experimental protocol.

  Virgilio F Ferrario, Paolo V Marciandi, Gianluca M Tartaglia, Claudia Dellavia, Chiarella Sforza
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  ABSTRACT: To prevent relapse after orthodontic treatment, retention is often considered indispensable. Soft tissues are thought to have a significant influence on dental movements. To quantify the influence of masticatory muscles on post-treatment relapse, and in an attempt to avoid unnecessary procedures, 2 male orthodontic patients (13 and 30 years old at debonding) were followed up. The patients completed 2 years of fixed orthodontic treatment and received no post-orthodontic retention. After 1 week and again after 6 months, alginate impressions of dental arches and a surface electromyographic (EMG) assessment of the masseter and temporalis muscles during maximum voluntary clenching were performed. The younger patient received surface EMG monitoring once a month for the first 6 months and at the 1-year follow-up appointment. Arch dimensions and the 3-dimensional inclination of the facial axis of the clinical crown (FACC) were measured using a computerized digitizer. Symmetry in muscular contraction was measured by the percentage overlapping coefficient (POC), and potential lateral displacing components were assessed by the torque coefficient (TC). At the 6-month follow-up, no clinical modifications were observed. Quantitative evaluation assessed that arch dimensions had changed slightly (up to 1 mm). While the adolescent patient had no modifications in FACC inclinations, the 30-year-old patient showed significant alterations (up to 18 degrees). In all examinations of the adolescent patient, POC was higher than 86% and TC was lower than 10%. In the adult, POC was inside the normal range, while all TCs were higher than 10.5%. The larger TC measured in the adult may explain the larger modifications in the 3-dimensional position of his dental crowns. In conclusion, a surface EMG assessment may help in the detection of patients who might need post-orthodontic retention.
  The International journal of adult orthodontics and orthognathic surgery 02/2002; 17(4):307-13.
• Article: Readiness for orthognathic surgery: a survey of practitioner opinion.

  Karin K Cain, John D Rugh, John P Hatch, C Lynn Hurst
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  ABSTRACT: The purpose of this study was to determine if a general consensus exists among orthodontists regarding the features of an adequate presurgical setup. A questionnaire was developed to assess the importance of 12 criteria for surgical readiness. Each criterion was rated on a 5-point scale (1 = Unimportant, 5 = Critical). This questionnaire was sent to 104 randomly selected, board-certified orthodontists in the United States and Puerto Rico. Usable questionnaires were returned by 57 respondents (55% response rate). The highest and most consistent ratings were given for Arch Compatibility in the transverse dimension (mean = 4.66, SD = 0.55), Crossbite (mean = 4.57, SD = 0.63), and Torque of the Anterior Teeth (mean = 4.38, SD = 0.73). Further analysis showed a correlation between surgical experience of the orthodontist and a higher rating of importance for Torque of the Mandibular Teeth (Spearman r = 0.38), Torque of the Maxillary Teeth (Spearman r = 0.37), and Torque of the Anterior Teeth (Spearman r = 0.28). These results suggest that as orthodontists gain surgical experience, they attribute more importance to correcting the torque of the teeth. Also, the relatively large differences in opinion regarding presurgery orthodontic setup support a need for further research and/or educational effort regarding what criteria are important before surgery.
  The International journal of adult orthodontics and orthognathic surgery 02/2002; 17(1):7-11.
• Article: Psychologic implications of orthognathic surgery in patients with skeletal Class II or Class ill malocclusion.

  Lucia Gerzanic, Reinhold Jagsch, Ingeborg M Watzke
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  ABSTRACT: The psychologic profile of 100 consecutive patients undergoing orthognathic surgery for correction of Class II or Class III malocclusion was monitored in a prospective observational study. Patients and their relatives or friends completed questionnaires about their self-image before surgery, 6 weeks postoperatively, and 6 months postoperatively. Preoperatively, patients with Class III malocclusion felt significantly less attractive (P = .03), had slightly higher attention to physical appearance, and had slightly stronger feelings of insecurity regarding their facial appearance compared with Class II patients. Grading of attractiveness/self-confidence improved significantly in Class III patients at 6 weeks postoperatively (P = .006), while in Class II patients the improvement was less pronounced and only significant at 6 months postoperatively (P = .002). Grading of attractiveness/self-confidence by relatives/friends of patients with Class II and Class III was similar preoperatively, but was significantly higher for Class III patients 6 weeks postoperatively in comparison with Class II patients (P = .048). These data indicate that the psychologic profiles are significantly different between Class II and Class III patients preoperatively and show different dynamics postoperatively.
  The International journal of adult orthodontics and orthognathic surgery 02/2002; 17(2):75-81.
• Article: Intraoperative measurement of maxillary repositioning in a series of 30 patients with maxillomandibular vertical asymmetries.

  Giancarlo Renzi, Andrea Carboni, Maurizio Perugini, Roberto Becelli
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  ABSTRACT: Vertical asymmetry of the maxilla can determine the inclination of the occlusal plane and result in a lack of internal reference points usually employed to measure surgical movements. Maxillary repositioning is therefore based upon surgical planning, which is commonly elaborated on dental casts and model surgery. The absolute precision of surgical planning is not guaranteed by dental casts and model surgery, and the intraoperative assessment of maxillary repositioning is considered to be of paramount importance in such cases. This article describes a simple, noninvasive intraoperative technique that is useful in measuring the vertical dimension of the maxilla and helps to indicate precise repositioning. It illustrates the technique and reports the results obtained in a series of 30 patients treated surgically for maxillomandibular malformations with vertical asymmetries and occlusal plane inclination from January to December 2000 at the Maxillofacial Surgery Department of "La Sapienza" University in Rome, Italy.
  The International journal of adult orthodontics and orthognathic surgery 02/2002; 17(2):111-5.
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  Available from: sonocentroconcordia.com.br

  Article: Effect of mandibular setback surgery on the posterior airway size.

  Maija Liukkonen, Kimmo Vähätalo, Timo Peltomäki, Jaakko Tiekso, Risto-Pekka Happonen
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  ABSTRACT: Treatment of dentofacial deformities with jaw osteotomies has an effect on airway anatomy, and therefore, mandibular setback surgery has the potential to diminish airway size. The purpose of this study was to evaluate the long-term effect of mandibular setback surgery on the airway size. The material consisted of pre- and postoperative (minimum 1 year) lateral radiograms of 22 individuals (18 females and 4 males) with a mean age of 30 years, who had undergone mandibular setback surgery to correct skeletal Class III discrepancies. Hard and soft tissue points were digitized with a Numonics Accugrid digitizer and analyzed with Xmetrix software. A paired t test was used to evaluate the difference between pre- and postoperative measurements. In addition, Pearson's coefficient correlation was calculated to reveal the possible association between the skeletal change in relation to the change in airway size. The mean value for the initial SNA was 81.3 degrees, 85.4 degrees for SNB, 36.9 degrees for S-Na/MP, and for the posterior airway, 10.5 mm and 12.0 mm retropalatinally and retrolingually, respectively. At the postoperative evaluation, SNB was 80.7 degrees, S-Na/MP 41.0 degrees, and the posterior airway retropalatinally 8.3 mm and retrolingually 9.8 mm. Statistical analysis revealed a highly significant correlation between the change in the ANB angle and in the S-Na/MP angle versus the change in the upper airway size, both retropalatinally and retrolingually. Mandibular setback surgery with posterior rotation may gradually result in increased upper airway resistance in cases where neuromuscular adaptation is insufficient to compensate for the reduction in the airway size. Therefore, large anteroposterior discrepancies should be corrected by combined maxillary and mandibular osteotomies.
  The International journal of adult orthodontics and orthognathic surgery 02/2002; 17(1):41-6.