Korean J Orthod.  2021 May;51(3):166-178. 10.4041/kjod.2021.51.3.166.

Effect of extraction treatment on upper airway dimensions in patients with bimaxillary skeletal protrusion relative to their vertical skeletal pattern

• Cho HN
• Yoon HJ
• Park JH
• Park YG
• Kim SJ

• KMID: 2515820
• DOI: http://doi.org/10.4041/kjod.2021.51.3.166

Abstract

Objective
To investigate dimensional changes in regional pharyngeal airway spaces after premolar extraction in bimaxillary skeletal protrusion (BSP) patients according to vertical skeletal pattern, and to further identify dentoskeletal risk factors to predict posttreatment pharyngeal changes.
Methods
Fiftyfive adults showing BSP treated with microimplant anchorage after four premolar extractions were included in this retrospective study. The subjects were divided into two groups according to the mandibular plane steepness: hyperdivergent (Frankfort horizontal plane to mandibular plane [FH-MP] ≥ 30) and nonhyperdivergent groups (FH-MP < 30). The control group consisted of 20 untreated adults with skeletal Class I normodivergent pattern and favorable profile. Treatment changes in cephalometric variables were evaluated and compared. The association between posttreatment changes in the dentoskeletal and upper airway variables were analyzed using linear regression analysis.
Results
The BSP patients showed no significant decrease in the pharyngeal dimensions to the lower level in comparison with controls, except for middle airway space (MAS, p < 0.01). The upper airway variable representing greater decrease in the hyperdivergent group than in the nonhyperdivergent group was the MAS (p < 0.01). Posttreatment changes in FH-MP had negative correlation with changes in MAS (β = –0.42, p < 0.01) and inferior airway space (β = –0.52, p < 0.01) as a result of multivariable regression analysis adjusted for sagittal skeletal relationship.
Conclusions
Decreased pharyngeal dimensions after treatment in BSP patients showed no significant difference from the normal range of pharyngeal dimensions. However, the glossopharyngeal airway space may be susceptible to treatment when vertical dimension increased in hyperdivergent BSP patients.

Keyword

Airway; Cephalometrics; Bimaxillary skeletal protrusion; Vertical skeletal pattern

Figure

• 

  Figure 1 Dentoskeletal (A) and pharyngeal (B) cephalometric landmarks and measurements. S, sella; Na, nasion; Po, porion; Or, orbitale; ANS, anterior nasal spine; PNS, posterior nasal spine; A, point A; B, point B; Pog, pogonion; Me, menton; Go, gonion; Sn, subnasale; UL, upper lip; LL, lower lip; Pog’; soft-tissue pogonion; Pt, pterygomaxillary point; Ad1, adenoid point 1; Ad2, adenoid point 2; Ba, basion; TT, tongue tip; H, hyoid bone; RGN, retrognathion; C3, third vertebra; P, tip of soft palate; R, midpoint of S-Ba line; Sb, belly of soft palate; Eb, base of epiglottis. See footnote of Table 1 for the definition of measurements.

• 

  Figure 2 Cephalometric pharyngeal measurements to describe each pharyngeal airway section: PNS-Ad2 and PNS-Ad1 for the nasopharynx; superior posterior airway space (SPAS) for the velopharynx behind the soft palate; middle airway space (MAS) and inferior airway space (IAS) for the glossopharynx behind the tongue base; and vertical airway length (VAL) for the pharyngeal airway length.11 See Figure 1 and footnote of Table 1 for the definition of other landmarks or measurements.

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