Soft-Palate Changes After Orthognathic Surgery: A Three-Dimensional Assessment of Positioning and Morphology

Background/Objectives: This study evaluated, by cone-beam computed tomography, the role of soft-palate morphology and positioning in upper airway volume and minimum cross-sectional area (mCSA) after orthognathic surgery at three time points: one week before surgery (T0); 4-6 months after surgery (T1); and 12-36 months after surgery (T2). Methods: Patients (N = 91) were divided into five groups according to maxillary surgical movement: 1: maxillary advancement; 2: maxillary advancement and counterclockwise rotation with anterior upward movement; 3: maxillary advancement and counterclockwise rotation with posterior downward movement; 4: maxillary advancement and clockwise rotation with anterior downward movement; and 5: maxillary advancement and clockwise rotation with posterior upward movement. Results: Time was an important predictor of change for almost all volume and mCSA parameters (p < 0.05), except for mCSA-nasopharynx (p = 0.114). Groups 1 and 5 showed recurrence of oropharynx volume and minimum cross-sectional area at 12-36 months, while Group 3 had 85% of vertical soft palate morphology and no oblique morphology at 12-36 months. Conclusions: Soft palate angulation did not change at any time or with any type of surgical movement. Maxillary counterclockwise rotation with posterior downward movement seems to be the preferred surgical movement of the maxilla to increase pharyngeal dimensions and improve soft-palate morphology.