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      The Effect of Bimaxillary Orthognathic Surgery on Nasalance, Articulation Errors, and Speech Intelligibility in Skeletal Class III Deformity Patients

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          Abstract

          BACKGROUND

          We aimed to detect the changes in nasalance, articulation errors, and speech intelligibility after bimaxillary orthognathic surgery in skeletal class III patients.

          METHODS

          This double-blinded before and after quasi-experimental study was conducted in the Department of Maxillofacial Surgery, Qaem Hospital, Mashhad, Iran from Mar 2019 to Apr 2020. The main intervention was maxillary advancement with LeFort I osteotomy and mandibular setback surgery with bilateral sagittal split osteotomy (BSSO). The nasalance score, speech intelligibility, and articulation errors were evaluated one week preoperatively (T 0), 1 and 6 months (T 1, T 2) postoperatively by a speech therapist. The significance level was set at 0.05 using SPSS 21.

          RESULTS

          Eleven women (55%) and 9 men (45%) with a mean age of 31.95 ± 4.72 yr were enrolled. The mean maxillomandibular discrepancy was 6.15 ± 1.53 mm. The mean scores of nasalance for the oral, nasal, and oral-nasal sentences were significantly improved postoperatively ( P<0.001). Pre-operative articulation errors of consonants /r/, /z/, /s/ and /sh/ were corrected following the surgery. The percentage of speech intelligibility was significantly increased over time ( P<0.001).

          CONCLUSION

          The patients might show a normal articulation pattern and a modified nasalance feature, following maxillary advancement plus mandibular setback surgery.

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          Most cited references33

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          Effects of orthognathic surgery on oropharyngeal airway: a meta-analysis.

          C T Mattos, G N L Vilani, E F Sant'Anna … (2011)
          Oropharyngeal changes caused by orthognathic surgery have been a concern because the sleep quality of patients may be enhanced or worsened by these changes. The purpose of this meta-analysis was to identify, review and compare scientific literature about changes in airway in adult patients undergoing orthognathic surgery to correct anteroposterior osseous discrepancies. An electronic search of four databases was carried out up to July 2010, with supplemental hand searching of the references of the retrieved articles. Quality assessment of the included articles was carried out. Data were extracted and a meta-analysis was performed. Heterogeneity was assessed amongst the studies and results were presented in forest plots. 49 studies met the inclusion criteria. Only studies with moderate or high methodological soundness were included in the review. Moderate evidence was found to support a significant decrease in the oropharyngeal airway in mandibular setback surgery, a milder decrease in bimaxillary surgery to correct Class III and an increase in maxillomandibular advancement surgery. Evidence is lacking on airway volume changes after orthognathic surgery.
          Article 0 comments Cited 29 times – based on 0 reviews     Review now
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            Effects of bimaxillary surgery and mandibular setback surgery on pharyngeal airway measurements in patients with Class III skeletal deformities.

            Fengshan Chen, Kazuto Terada, Yongmei Hua … (2007)
            The purpose of this study was to compare the short-term and long-term effects of bimaxillary surgery with those of mandibular setback surgery concerning pharyngeal airway measurements at 3 levels: nasopharynx, oropharynx, and hypopharynx.
            Article 0 comments Cited 22 times – based on 0 reviews     Review now
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              Changes in oropharyngeal airway and respiratory function during sleep after orthognathic surgery in patients with mandibular prognathism.

              D Hasebe, T. Kobayashi, M. Hasegawa … (2011)
              The aim of this study was to examine the effects of mandibular setback surgery on pharyngeal airway space and respiratory function during sleep. The subjects were 22 patients in whom mandibular prognathism was corrected by bilateral sagittal split ramus osteotomy; either one jaw or two jaw surgery. Polysomnography was performed before surgery and 6 months after surgery, and the apnea hypopnea index (AHI) and arterial oxygen saturation during sleep were measured to assess respiratory function during sleep. Morphological changes were studied using cephalograms taken immediately before, a few days after and 6 months after surgery. As a control, 10 subjects without sleep-disordered breathing underwent the same examinations. AHI was not changed significantly after surgery, although two patients were diagnosed with mild obstructive sleep apnea (OSA) syndrome after surgery. They were not obese, but the amounts of mandibular setback at surgery were large. In conclusion, a large amount of mandibular setback might inhibit biological adaption and cause sleep-disordered breathing, and it might be better to consider maxillary advance or another technique that does not reduce the airway for patients with skeletal class III malocclusions who have large anteroposterior discrepancy and/or maxillary hypoplasia.
              Article 0 comments Cited 17 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): World J Plast Surg
                Journal ID (iso-abbrev): World J Plast Surg
                Journal ID (publisher-id): WJPS
                Title: World Journal of Plastic Surgery
                Publisher: Iranian Society for Plastic Surgeons (Tehran, Iran )
                ISSN (Print): 2228-7914
                ISSN (Electronic): 2252-0724
                Publication date (Print): January 2021
                Volume: 10
                Issue: 1
                Pages: 8-14
                Affiliations
                [1 ]Department of Speech Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
                [2 ]Student Research Committee, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
                [3 ]Department of Oral and Maxillofacial Surgery, Mashhad Dental School, Mashhad University of Medical Science, Mashhad, Iran.
                [4 ]Department of Orthodontics, Tehran Dental School, Tehran University of Medical Science, Tehran, Iran.
                [5 ]Oral and maxillofacial diseases research center, Mashhad University of Medical Sciences, Mashhad, Iran
                Author notes
                [* ]Corresponding Author: Sa-hand Samieirad, Associate Pro-fessor, Oral and maxillofacial surgery department, Mashhad dental school, Mashhad Univer-sity of Medical Sciences, Mashhad, Iran. Tel/Fax: +9851-38829501-15, Email: samiee-rads@mums.ac.ir
                Article
                DOI: 10.29252/wjps.10.1.8
                PMC ID: 8016386
                SO-VID: 1dfaa20d-a0d8-436f-aa9d-f067c411dab4
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 7 February 2020
                Date accepted : 27 June 2020
                Categories
                Subject: Original Article

                Keywords: bimaxillary,orthognathic surgery,nasalance,articulation
                Data availability:
                Keywords: bimaxillary, orthognathic surgery, nasalance, articulation

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