{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:53:28Z","timestamp":1787507608709,"version":"build-2736575974"},"reference-count":27,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,7,7]],"date-time":"2023-07-07T00:00:00Z","timestamp":1688688000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Introduction: Mandibular setback surgery (MSS) is one of the treatment options to resolve mandibular prognathism in patients suffering from skeletal class III malocclusion, which cannot be treated with simple orthodontic treatment. The mandibular setback surgical operation can involve changes in the pharyngeal morphology, resulting in a narrowing of the posterior airway space (PAS). This aspect is associated with an increase in airflow resistance, which increases the risk of developing snoring or obstructive sleep apnea syndrome (OSAS). The aim of this study is to evaluate the medium- and long-term effects of mandibular setback surgery on the upper airways and its possible association with OSAS in patients suffering from class III skeletal malocclusion. Material and methods: A total of 12 patients (5 males and 7 females) were enrolled in this study. The statistical tests highlighted a significant change in the PAS and BMI values in relation to T0, before surgery (PAS: 12.7 SD: 1.2; BMI: 21.7 SD: 1.2), and T1, after surgery (PAS: 10.3 SD: 0.6, p &lt; 0.01; BMI: 23.8 SD: 1.2, p &lt; 0.05). Sample size was calculated to detect an effect size of 0.9, with statistical power set at 0.8 and the significance level set at 0.05. Results: No statistically significant correlation was found between the extent of mandibular setback, PAS and BMI change. Conclusion: This study confirms the effects of mandibular setback surgery on the upper airways, reporting a statistically significant PAS reduction in the medium- and long-term follow-up. On the other hand, no direct correlation was identified with OSAS risk, at least for the small mandibular setback (&lt;8 mm), despite the statistically significant increase in BMI.<\/jats:p>","DOI":"10.3390\/jpm13071105","type":"journal-article","created":{"date-parts":[[2023,7,7]],"date-time":"2023-07-07T01:41:36Z","timestamp":1688694096000},"page":"1105","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Upper Airway Changes and OSAS Risk in Patients after Mandibular Setback Surgery to Treat III Class Skeletal Malocclusion"],"prefix":"10.3390","volume":"13","author":[{"given":"Paolo","family":"Ronchi","sequence":"first","affiliation":[{"name":"Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabina","family":"Saccomanno","sequence":"additional","affiliation":[{"name":"Orthodontic Residency, Department of Life, Health and Environmental Sciences, University of L\u2019Aquila, 67100 L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Disconzi","sequence":"additional","affiliation":[{"name":"Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0151-1764","authenticated-orcid":false,"given":"Stefano","family":"Saran","sequence":"additional","affiliation":[{"name":"Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3729-7923","authenticated-orcid":false,"given":"Andrea","family":"Carganico","sequence":"additional","affiliation":[{"name":"Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9521-1174","authenticated-orcid":false,"given":"Salvatore","family":"Bocchieri","sequence":"additional","affiliation":[{"name":"Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodolfo Francesco","family":"Mastrapasqua","sequence":"additional","affiliation":[{"name":"ENT Department, Rivoli Hospital, ASL TO 3, 10098 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0335-4165","authenticated-orcid":false,"given":"Luca","family":"Fiorillo","sequence":"additional","affiliation":[{"name":"Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune 411018, India"},{"name":"Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98100 Messina, Italy"},{"name":"Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania \u201cLuigi Vanvitelli\u201d, 80121 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0633-7582","authenticated-orcid":false,"given":"Sergio","family":"Sambataro","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98100 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7058-4126","authenticated-orcid":false,"given":"Marco","family":"Cicci\u00f9","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Surgical Sciences, University of Catania, 95124 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2412-7765","authenticated-orcid":false,"given":"Luca","family":"Levrini","sequence":"additional","affiliation":[{"name":"Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s40510-018-0218-0","article-title":"Treatment decision in adult patients with class III malocclusion: Surgery versus orthodontics","volume":"19","author":"Eslami","year":"2018","journal-title":"Prog. Orthod."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.jcms.2014.11.017","article-title":"Effects of mandibular setback surgery on upper airway dimensions and their influence on obstructive sleep apnoea\u2014A systematic review","volume":"43","author":"Pinho","year":"2015","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1016\/j.ijom.2012.01.003","article-title":"Changes in posterior airway space, pulmonary function and sleep quality, following bimaxillary orthognathic surgery","volume":"41","author":"Gokce","year":"2012","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.ijom.2011.09.008","article-title":"Cone-beam computed tomography evaluation of short- and long-term airway change and stability after orthognathic surgery in patients with Class III skeletal deformities: Bimaxillary surgery and mandibular setback surgery","volume":"41","author":"Park","year":"2012","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"677","DOI":"10.47102\/annals-acadmedsg.V37N8p677","article-title":"Effect of Orthognathic Surgery on the Posterior Airway Space (PAS)","volume":"37","author":"Lye","year":"2008","journal-title":"Ann. Acad. Med. Singap."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1016\/j.ijom.2010.03.006","article-title":"Effectiveness of maxillo-mandibular advancement in obstructive sleep apnea patients with and without skeletal anomalies","volume":"39","author":"Ronchi","year":"2010","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s40902-017-0120-6","article-title":"The structural changes of pharyngeal airway contributing to snoring after orthognathic surgery in skeletal class III patients","volume":"39","author":"Park","year":"2017","journal-title":"Maxillofac. Plast. Reconstr. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/s11325-015-1274-z","article-title":"Sleep-disordered breathing following mandibular setback: A systematic review of the literature","volume":"20","author":"Canellas","year":"2016","journal-title":"Sleep Breath."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1016\/0278-2391(87)90016-4","article-title":"Obstructive sleep apnea syndrome following surgery for mandibular prognathism","volume":"45","author":"Riley","year":"1987","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/j.ijom.2009.01.010","article-title":"The effect of mandibular setback or two-jaws surgery on pharyngeal airway among different genders","volume":"38","author":"Degerliyurt","year":"2009","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.joms.2005.09.009","article-title":"Combined Push-Pull Distraction for Correction of Syndromic Midfacial Hypoplasia","volume":"64","author":"Schulten","year":"2006","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"195","DOI":"10.5604\/00114553.1092262","article-title":"Cephalometric changes after maxillomandibular advancement in obstructive sleep apnea patients","volume":"67","author":"Caprioglio","year":"2014","journal-title":"J. Stomatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1007\/s11325-018-1725-4","article-title":"Association between obstructive sleep apnea syndrome and waist-to-height ratio","volume":"23","author":"Unal","year":"2019","journal-title":"Sleep Breath."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"129","DOI":"10.4041\/kjod.2020.50.2.129","article-title":"Immediate effects of mandibular posterior displacement on the pharyngeal airway space: A preliminary study","volume":"50","author":"Choi","year":"2020","journal-title":"Korean J. Orthod."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1007\/s12663-013-0524-5","article-title":"Computerized Cephalometric Study of the Pharyngeal Airway Space in Patients Submitted to Orthognathic Surgery","volume":"13","author":"Rocha","year":"2014","journal-title":"J. Maxillofac. Oral Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1111\/joor.12666","article-title":"Cephalometric, muscular and swallowing changes in patients with OSAS","volume":"45","author":"Valarelli","year":"2018","journal-title":"J. Oral Rehabil."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1016\/j.ijom.2014.06.010","article-title":"Effects of orthognathic surgery on pharyngeal airway and respiratory function during sleep in patients with mandibular prognathism","volume":"43","author":"Uesugi","year":"2014","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/j.bjoms.2012.07.004","article-title":"Changes in overnight arterial oxygen saturation after mandibular setback","volume":"51","author":"Kobayashi","year":"2013","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1016\/j.ijom.2011.01.011","article-title":"Changes in oropharyngeal airway and respiratory function during sleep after orthognathic surgery in patients with mandibular prognathism","volume":"40","author":"Hasebe","year":"2011","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/j.ijom.2007.12.005","article-title":"Effects of mandibular setback surgery on oropharyngeal airway and arterial oxygen saturation","volume":"37","author":"Kitagawara","year":"2008","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/S0915-6992(08)80002-7","article-title":"Respiratory status during sleep following orthognathic mandibular setback surgery","volume":"20","author":"Yamada","year":"2008","journal-title":"Asian J. Oral Maxillofac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/S0901-5027(06)80024-X","article-title":"Mandibular setback for surgical correction of mandibular hyperplasia\u2014Does it provoke sleep-related breathing disorders?","volume":"25","author":"Hochban","year":"1996","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.ijom.2007.06.020","article-title":"A cephalometric evaluation of the pharyngeal airway space in patients with mandibular retrognathia and prognathia, and normal subjects","volume":"37","author":"Muto","year":"2008","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_24","first-page":"274","article-title":"Heart rate during obstructive sleep apnea depends on individual hypoxic chemosensitivity of the carotid body","volume":"96","author":"Sato","year":"1997","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2301","DOI":"10.1016\/j.joms.2007.06.644","article-title":"Soft tissue profile changes following mandibular advancement and setback surgery an average of 12 years postoperatively","volume":"65","author":"Eggensperger","year":"2007","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"59","DOI":"10.2186\/jjps.52.59","article-title":"Influence of oral appliances for obstructive sleep apnea syndrome on stomatognathic system part 1. Occlusion","volume":"52","author":"Shioda","year":"2008","journal-title":"Nihon Hotetsu Shika Gakkai Zasshi"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/S0278-2391(00)90053-3","article-title":"Assessment of the pharyngeal airway space after mandibular setback surgery","volume":"58","author":"Tselnik","year":"2000","journal-title":"J. Oral Maxillofac. Surg."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/7\/1105\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:07:45Z","timestamp":1760126865000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/7\/1105"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,7]]},"references-count":27,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["jpm13071105"],"URL":"https:\/\/doi.org\/10.3390\/jpm13071105","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,7]]}}}