Bimaxillary 'rotation advancement' procedures in patients with obstructive sleep apnea: a 3-dimensional airway analysis of morphological changes

The aim of this retrospective three dimensional (3D) computed tomographic analysis was to investigate the morphological airway changes in 17 obstructive sleep apnea (OSA) patients following bimaxillary rotation advancement procedures. Morphological changes of the nasal cavity and naso-, oro- and hypopharynx were analysed separately, as were the total airway changes using nine parameters of airway size and four of shape. The Wilcoxon test was used to compare airway changes and the intraclass correlation coefficient to qualify inter-observer reliability. Following bimaxillary advancement and anti-clockwise maxillary rotation, the total airway volume and the lateral dimension of the cross-sectional airway increased significantly. The total length of the airway became shorter (p < 0.05). Remarkable changes were seen in the oropharynx: the length, volume, cross-sectional area (CSA), anteroposterior and medio-lateral distance changed (p < 0.05). This combined with a significant 3D change in the shape of the airway from round to elliptical. The average cross-sectional oropharyngeal area was nearly doubled, the minimal CSA increased 40%, and the hyoid bone was located more anterior and superior. Inter-examiner reliabilities were high (0.89). 3D airway analysis aids the understanding of postoperative pathophysiological changes in OSA patients. The airway became shorter, more voluminous, medio-laterally wider, and more compact and elliptical.