Determinants of Early Airway Remodeling After Maxillomandibular Advancement: The Role of Maxillary Repositioning

To evaluate early (3 mo) changes in oropharyngeal airway dimensions following maxillomandibular advancement (MMA) and to determine whether specific skeletal movements, particularly maxillary advancement, are associated with the magnitude of airway expansion.

A retrospective cohort study was conducted including 80 consecutive patients who underwent MMA with custom-made fixation plates. Preoperative and 3-month postoperative cone-beam computed tomography (CBCT) scans were analyzed to measure total airway volume and minimal cross-sectional area. Skeletal movements were quantified using virtual surgical planning data. Paired t tests were used to assess pre- and postoperative differences. Pearson correlation and multivariable linear regression analyses were performed to identify predictors of airway change.

Mean minimal cross-sectional area increased from 144.0±73.8 mm2 to 298.1±126.1 mm2 (Δ=154.1±112.8 mm2; P<0.001). Mean total airway volume increased from 19.4±17.8 cc to 30.2±20.8 cc (Δ=10.8±7.9 cc; P<0.001). Maxillary advancement was significantly associated with increased minimal cross-sectional area (r=0.29, P=0.009) and modestly associated with volumetric change (r=0.22, P=0.049). BMI was independently associated with changes in minimal area, while sex was the only independent predictor of volumetric change in multivariable analysis.

Maxillomandibular advancement produces significant early expansion of the oropharyngeal airway. Maxillary advancement plays a meaningful role in increasing minimal cross-sectional area, suggesting its importance in surgical planning aimed at optimizing airway outcomes.