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Received: 13 February 2017 Accepted: 4 September 2017 Published: xx xx xxxx

Airway Changes after Cleft Orthognathic Surgery Evaluated by Three-Dimensional Computed Tomography and Overnight Polysomnographic Study Chun-Shin Chang1,2, Christopher Glenn Wallace2, Yen-Chang Hsiao2, Yuh-Jia Hsieh3, Yi-Chin Wang3, Ning-Hung Chen4, Yu-Fang Liao3, Eric Jen-Wein Liou3, Philip Kuo-Ting Chen   2, Jyh-Ping Chen1 & Yu-Ray Chen2 Cleft lip and palate is the most common congenital craniofacial anomaly. Up to 60% of these patients will benefit from cleft orthognathic surgery, which consists primarily of maxillary advancement and mandibular setback to address midface retrusion and relative mandibular protrusion, respectively. It is believed that maxillary advancement can enlarge the airway whilst mandibular setback can reduce the airway, but this has not previously been quantified for cleft patients undergoing orthognathic surgery. This unique longitudinal prospective study of 18 patients was conducted between April 2013 and July 2016. No significant changes occurred by six months postoperatively in body mass index, apnoea-hypopnoea index or lowest oxygen saturation (LSAT). There was a mean increase of 0.73 cm3 in velopharyngeal volume, a mean decrease of 0.79 cm3 in oropharyngeal volume, an improvement in snoring index, and no statistically significant change in hypopharyngeal volume. In conclusion, cleft orthognathic surgery that produced anterior advancement of the maxilla, setback of the mandible and clockwise rotation of the maxillo-mandibular complex resulted in increased velopharyngeal, decreased oropharyngeal and unchanged hypopharyngeal airways, and improved snoring, but did not significantly alter objective sleep-related breathing function. Our Craniofacial Center multidisciplinary team includes craniofacial plastic surgeons, craniofacial orthodontists, speech therapists, social workers and other subspecialists. Since 1976, this team has treated more than 30,000 cleft patients and more than 10,000 of them have received orthognathic surgery. During more than three decades, our Craniofacial Center has progressively optimised our management strategies for our patients with cleft lip and palate. The primary lip and palate repair carried out during infancy and early childhood lays the foundation for providing an aesthetic facial appearance and speech that is normal. One long-term negative effect of these early surgical interventions is a significant incidence of maxillary growth restriction that produces secondary deformities of the jaws and malocclusion, which affects speech, airway and self-esteem1. Up to 60% of cleft patients will require orthognathic surgery2. If a patient has residual maxillofacial deformities (mid-face retrusion and mandibular protrusion) in adolescence, our management is to combine Le Fort I maxillary advancement and bilateral sagittal split setback with single splint techniques3,4. 1

Department of Chemical and Materials Engineering, College of Engineering, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan (R.O.C.). 2Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.). 3Craniofacial Research Center, Department of Medical Research, Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.). 4Sleep Center, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan (R.O.C.). Correspondence and requests for materials should be addressed to P.K.-T.C. (email: [email protected]) Scientific Reports | 7: 12260 | DOI:10.1038/s41598-017-12251-4

1

www.nature.com/scientificreports/ AHI/hr

LSAT(%)

NSD scores

Patient No.

Age

Sex

Pre

BMI Post

Pre

Post

Pre

Post

Pre

Post

1

18

M

20.8

21.0

0.4

0.9

93

93

2

2

2

18

M

24.0

22.1

1.8

0.2

91

94

1

1

3

18

M

17.6

18.1

0

1.4

95

89

1

1

4

21

F

19.1

19.5

0

0.5

95

95

1

1

5

18

F

18.1

16.2

0.5

0

91

94

1

1

6

24

M

22.3

23.1

5.3

0

92

93

1

1

7

18

F

22.3

21.9

6.4

0.5

89

91

1

1

8

16

F

17.3

17.7

0.2

0.2

94

95

1

1

9

18

M

16.5

16.5

0.2

0

94

95

1

1

10

27

M

25.3

25.3

9.7

9.3

72

76

1

1

11

18

M

22.4

23.0

0

2.9

93

89

1

1

12

16

F

20.5

20.4

0.2

0.4

95

94

1

1

13

18

F

19.2

19.2

0

0.4

94

96

1

1

14

18

F

23.4

22.7

0

0

98

97

1

1

15

18

M

17.0

17.3

6.2

6.3

83

91

1

1

16

22

F

14.7

14.9

0.8

0.9

91

97

1

1

17

23

M

25.6

23.4

2.1

4.8

87.

89.

1

1

18

26

F

20.3

19.5

2.1

4.8

89

88.

1

1

Mean

19.72

20.36

20.10

1.99

1.86

90.89

92.00

Standard Deviation

3.30

3.16

2.92

2.90

2.69

5.85

4.90

p

0.247

0.810

0.168

1.000

Table 1.  Demographic, polysomnographic results and nasal septum deviation scores.

Landmark

Before surgery

6-months after surgery

Mean difference

Paired-T test p value

A

52.62 ± 4.12

57.02 ± 4.39

−4.41 ± 2.41

Airway Changes after Cleft Orthognathic Surgery Evaluated by Three-Dimensional Computed Tomography and Overnight Polysomnographic Study.

Cleft lip and palate is the most common congenital craniofacial anomaly. Up to 60% of these patients will benefit from cleft orthognathic surgery, whi...
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