Craniomaxillofacial deformities/cosmetic surgery
Improvement in Respiration and Craniofacial Changes Associated With Weight Loss After Bariatric Surgery

https://doi.org/10.1016/j.joms.2010.07.079Get rights and content

Purpose

To study weight loss, craniofacial changes, and respiratory quality among obese patients before and after bariatric surgery.

Material and Methods

The obese group comprised 17 male and female patients aged between 18 and 60 years with body mass index (BMI) ≥40 kg/m2 who were scheduled to undergo bariatric surgery. All patients were evaluated in the preoperative period and at least 4 months following surgery by means of clinical, physical, anthropometric, facial, nasal, oral, and oropharyngeal examinations as well as radiographic examinations of the facial profile with individual cephalometric analysis. Patients also completed the Nasal Obstruction Symptom Evaluation scale. The control group underwent the same examinations and included 10 male and female volunteers with BMI between 18 and 30 kg/m2, good dental occlusion, harmonious facial features, and no history of respiratory or sleep disorders.

Results

There were significant reductions in weight, BMI, and neck circumference as well as an improvement in Nasal Obstruction Symptom Evaluation scores in the obese group after bariatric surgery (P < .05). There was a reduction in craniocervical length, increase in velopharyngeal air space, and reduction in the distance between the hyoid bone and mentum following weight loss. The Mallampati Scale revealed a significant inversion of palate position categories between evaluations.

Conclusions

There was improvement in respiratory quality and craniofacial changes caused by weight loss, especially in soft tissues around the upper air space, as well as craniocervical length and position of the hyoid bone.

Section snippets

Materials and Methods

This study was carried out at the outpatient clinic of the Division of General Surgery and Obesity Surgery of the University Hospital of the Federal University of Pernambuco in association with the Department of Oral and Maxillofacial Surgery of the University of Pernambuco (Brazil). In 2008 and 2009, 2 groups were studied and evaluated with regard to craniofacial characteristics, as well as quality of sleep and nasal respiration.

The obese group (OG) was made up of 17 patients with severe

Results

None of the subjects exhibited important facial asymmetries. There was a predominance of a type I facial profile and brachycephalic characteristic (Table 1).

Table 2 shows significant differences between groups and evaluation times with regard to weight, BMI, neck circumference, and excess weight. There was a significant increase in both interlabial distance and height of the right nostril between the 2 evaluations (T1 and T2). There were no differences in the mean measurements of open bite or

Discussion

It is well known that obesity and various morphological facial characteristics influence respiratory quality and contribute toward both the emergence and aggravation of respiratory diseases, such as OSAHS.5, 6 Little is known regarding morphological craniofacial alterations caused by rapid, substantial weight loss after bariatric surgery. To establish a parameter of significant weight loss for the purpose of studying such outcomes, a single standard of percentage of excess weight loss (EWL%)

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