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Volume 18
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10.3390/cmtr18030039
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Article

Evaluation of the Upper Airway in Class II Patients Undergoing Maxillary Setback and Counterclockwise Rotation in Orthognatic Surgery

by
Flávio Fidêncio de Lima
1,2,
Tayná Mendes Inácio De Carvalho
1,3,
Bianca Pulino
4,5,6,*,
Camila Cerantula
7,
Mônica Grazieli Correa
2 and
Raphael Capelli Guerra
4,5,6,8,*
1
Department of Oral and Maxillofacial Surgery, Encore Clinic, São Paulo 04545-041, Brazil
2
Dental research Division, School of Dentistry, Universidade Paulista-UNIP, São Paulo 04026-002, Brazil
3
School of Dentistry of São José dos Campos, São Paulo State University (UNESP), São José dos Campos 12245-000, Brazil
4
Hospital Sírio-Libanês, Institute of Education and Research, São Paulo 01308-050, Brazil
5
Department of Oral and Maxillofacial Surgery, Leforte Hospital, Américas Health Network, São Paulo 01507-000, Brazil
6
Department of Oral and Maxillofacial Surgery, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
7
School of Dentistry of Araçatuba, São Paulo State University (UNESP), Araçatuba 16015-050, Brazil
8
Faculdade Israelita de Ciências de Saúde Albert Einstein, São Paulo 05653-120, Brazil
*
Authors to whom correspondence should be addressed.
Craniomaxillofac. Trauma Reconstr. 2025, 18(3), 39; https://doi.org/10.3390/cmtr18030039
Submission received: 12 June 2025 / Revised: 14 August 2025 / Accepted: 31 August 2025 / Published: 4 September 2025
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Abstract

Introduction: Maxillary setback in orthognathic surgery has been extensively discussed regarding its effects on bone healing and facial soft tissue profile; however, its impact on upper airway volume remains unclear. Objective: We evaluate the influence of maxillary setback combined with counterclockwise (CCW) rotation of the occlusal plane on upper airway dimensions. Methods: A retrospective observational case series was conducted with eight patients diagnosed with Class II malocclusion who underwent orthognathic surgery involving maxillary setback and CCW mandibular rotation. All procedures were performed by the same surgeon. Preoperative (T1) and 6-month postoperative (T2) facial CT scans were analyzed using Dolphin Imaging software11.7 to measure airway volume (VOL), surface area (SA), and linear distances D1, D2 and D3. Statistical analysis was performed using the Wilcoxon test with a 5% significance level. Results: Significant skeletal changes were observed, including 10.2 mm of mandibular advancement, 5.2 mm of hyoid advancement, and 4.1° of CCW rotation. Although increases in airway volume and surface area were noted, they did not reach statistical significance (p = 0.327 and p = 0.050, respectively), but suggesting a favorable trend toward airway adaptation. Conclusions: Maxillary setback combined with CCW rotation appears to safely correct Class II skeletal deformities without compromising upper airway space. These preliminary findings highlight the technique’s potential for both functional and aesthetic outcomes, warranting further long-term studies.
Keywords: orthognathic surgery; airway management; maxillary setback; counterclockwise rotation orthognathic surgery; airway management; maxillary setback; counterclockwise rotation

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MDPI and ACS Style

de Lima, F.F.; De Carvalho, T.M.I.; Pulino, B.; Cerantula, C.; Correa, M.G.; Guerra, R.C. Evaluation of the Upper Airway in Class II Patients Undergoing Maxillary Setback and Counterclockwise Rotation in Orthognatic Surgery. Craniomaxillofac. Trauma Reconstr. 2025, 18, 39. https://doi.org/10.3390/cmtr18030039

AMA Style

de Lima FF, De Carvalho TMI, Pulino B, Cerantula C, Correa MG, Guerra RC. Evaluation of the Upper Airway in Class II Patients Undergoing Maxillary Setback and Counterclockwise Rotation in Orthognatic Surgery. Craniomaxillofacial Trauma & Reconstruction. 2025; 18(3):39. https://doi.org/10.3390/cmtr18030039

Chicago/Turabian Style

de Lima, Flávio Fidêncio, Tayná Mendes Inácio De Carvalho, Bianca Pulino, Camila Cerantula, Mônica Grazieli Correa, and Raphael Capelli Guerra. 2025. "Evaluation of the Upper Airway in Class II Patients Undergoing Maxillary Setback and Counterclockwise Rotation in Orthognatic Surgery" Craniomaxillofacial Trauma & Reconstruction 18, no. 3: 39. https://doi.org/10.3390/cmtr18030039

APA Style

de Lima, F. F., De Carvalho, T. M. I., Pulino, B., Cerantula, C., Correa, M. G., & Guerra, R. C. (2025). Evaluation of the Upper Airway in Class II Patients Undergoing Maxillary Setback and Counterclockwise Rotation in Orthognatic Surgery. Craniomaxillofacial Trauma & Reconstruction, 18(3), 39. https://doi.org/10.3390/cmtr18030039

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