Journal of Shandong University (Health Sciences) ›› 2026, Vol. 64 ›› Issue (4): 44-50.doi: 10.6040/j.issn.1671-7554.0.2025.1576

• Clinical Medicine • Previous Articles    

Impact of orthognathic surgery on upper airway dimensions in patients with severe skeletal class Ⅲ malocclusion and identification of key influencing factors

ZHOU Zhiyuan1, SHI Yuxin2, GU Heze3, HOU Yiyang3, XU Xin1   

  1. 1. Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University &
    Shandong Key Laboratory of Oral Tissue Regeneration &
    Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration &
    Shandong Provincial Clinical Research Center for Oral Diseases, Jinan 250012, Shandong, China;
    2. Ningbo Savaid Stomatology &
    Otolaryngology Research Institute, Ningbo 315016, Zhejiang, China;
    3. School of Stomatology, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China
  • Published:2026-04-09

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Abstract: Objective To investigate the impact of orthognathic surgery on the upper airway dimensions in patients with severe skeletal class Ⅲ malocclusion and to identify key craniofacial factors influencing upper airway size, thereby providing scientific evidence for optimizing surgical plans and ensuring airway safety. Methods This retrospective study included 21 patients with severe skeletal class III malocclusion who underwent combined orthodontic-orthognathic treatment by the same medical team. All patients underwent bimaxillary orthognathic surgery, with some receiving concomitant genioplasty. Cone-beam computed tomography images were collected preoperatively and at least 6 months postoperatively. Craniofacial and upper airway parameters(total volume, segmental volumes, and minimum cross-sectional area)were measured. Changes in these parameters before and after surgery were analyzed, along with correlations between changes in craniofacial and upper airway indicators. Results Postoperatively, patients showed significant improvements in sagittal and vertical relationships: effective mandibular length decreased by 5.35 mm, Wits appraisal improved by 8.77 mm, APDI decreased by 9.92°, mandibular plane angle decreased by 1.51°, and ODI increased by 13.45°(all P<0.05). Soft tissue profile also improved significantly: lower lip protrusion decreased by 7.09 mm, and soft tissue pogonion decreased by 6.36 mm(both P<0.001). No statistically significant differences were found in total upper airway volume, segmental volumes, or minimum cross-sectional area between preoperative and postoperative measurements(P>0.05). Correlation analysis revealed that ΔCo-ANS(maxillary advancement), ΔCo-Pog(mandibular setback), and ΔL6-MP(change in mandibular molar height)were significantly positively correlated with changes in total upper airway volume, minimum cross-sectional area, and oropharyngeal volume(r=0.442-0.548, P<0.05). Conclusion An orthognathic surgery strategy with an airway-oriented approach, emphasizing adequate ma-xillary advancement and coordinated mandibular adjustment, effectively correct maxillofacial deformities in patients with severe skeletal Class III malocclusion while maintaining upper airway space.The amount of maxillary advancement(ΔCo-ANS), mandibular setback amount(ΔCo-Pog), and changes in mandibular molar height(ΔL6-MP)are key factors contributing to increased upper airway volume, providing a reference for individualized surgical planning in clinical practice.

Key words: Skeletal class Ⅲ malocclusion, Orthognathic surgery, Upper airway, Cone-beam computed tomography, Key craniomaxillofacial anatomical factors

CLC Number: 

  • G649.28
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