Airway Space Changes After Nasopharyngeal Adenoidectomy in Conjunction With Le Fort I Osteotomy

Abstract

The purpose of the present study was to evaluate the nasopharyngeal airway changes after transnasal adenoidectomy and to determine whether a specific facial morphologic type is associated with hypertrophied nasopharyngeal adenoids. The nasopharyngeal adenoid tissues are present during childhood but usually spontaneously atrophy by 12 to 14 years of age. However, some patients have hypertrophied nasopharyngeal adenoid tissues that can remain after 14 years of age and can cause dysfunction of the eustachian tubes, cause nasal airway obstruction, affect speech, and adversely alter facial growth. In these cases, nasopharyngeal adenoidectomy could be indicated. In patients requiring orthognathic surgery, the adenoidectomy can be performed using a transnasal approach in conjunction with maxillary Le Fort I osteotomy, eliminating the need for a separate surgical procedure. The records of 40 patients, 27 females and 13 males, with an average age of 16.77 years (range, 13 to 20) who had undergone transnasal adenoidectomy in conjunction with orthognathic surgery that included Le Fort I osteotomy were analyzed. The pre- and postoperative lateral cephalograms were analyzed for airway changes after surgery, with an average interval between surgery and the postoperative radiographs of 7.36 months. The measurements of the airway changes were taken from the junction of the atlas and the base of the skull to the most anterior area of the adenoid tissue before surgery and to the posterior pharyngeal wall postoperatively, parallel to the Frankfort horizontal plane. The maxillary depth, mandibular depth, and occlusal plane angulation measurements were recorded preoperatively to assess the most common skeletal type presenting with hyperplastic nasopharyngeal adenoid tissues. All patients showed an increased airway space after adenoidectomy, with an average improvement of 8.71 mm (range, 3 to 18). Of the 40 patients, 21 were skeletal Class II (ANB >4°), 6 skeletal Class III (ANB <0°), and 13 skeletal Class I (ANB 0° to 4°). Also, 29 patients had a high occlusal plane angle (>12°), 1 a low occlusal plane angle (<4°), and 10 a normal occlusal plane angle (4° to 12°). Statistical analysis was performed using the paired t test to validate the results. No complications were identified with the surgical technique in any patient. Nasopharyngeal adenoidectomy can be peformed safely through a transnasal approach in conjunction with orthognathic surgery providing predictable improvement in the nasopharyngeal airway.