Posterior airway compromise following orthognathic surgery in skeletal class III patient - A systematic review and meta-analysis

Abstract

Obstructive Sleep Apnea (OSA) has been proven to have short- and long-term adverse effects on patients. OSA is associated with severe co-morbidities. Clinical studies have evaluated the volumetric changes in the posterior airway space following Orthognathic surgeries. The following study aims to assess the long-term airway compromise following different procedures for correcting skeletal Cl-III relationships. The research followed the PRISMA protocol guidelines and included a comprehensive electronic search of the National Institutes of Health (NIH), PubMed, and Embase databases, utilizing specific inclusion and exclusion criteria. All studies included airway measurements taken at three different time points, ensuring long-term follow-up of at least six months. Two authors evaluated quality blindly. We compared the types of surgical procedures alongside the volumetric airway measurements taken before and after the operation. Meta-analysis was performed using a random effect model if heterogeneity was detected. Otherwise, a common effect model was conducted under a 95 % confidence level. Sixteen publications met the inclusion criteria for qualitative assessment, and nine were eligible for quantitative evaluation. All included studies were rated within low to moderate risk of bias. Posterior airway volume changes in class III patients between the mandible-only and bimaxillary procedures immediately after the surgery were significantly different; p < 0.05. However, this difference between those groups was not found in long-term follow-up, and airway volumes were comparable. In conclusion, the meta-analysis results confirm that bimaxillary and mandible-only surgery similarly decrease the posterior airway space volumes in long-term follow-up.