Aragon S B
University of Colorado School of Dentistry, University of Colorado School of Medicine, Department of Otolaryngology, Head and Neck Surgery, 125 Inverness Drive East, Suite 100, Englewood, CO 80112, USA.
Dent Clin North Am. 2001 Oct;45(4):867-79.
Obstructive sleep apnea is a serious medical problem producing both physical and behavioral derangement. It is essential to provide a thorough workup and evaluation of all patients seeking care for snoring or OSA. Polysomnography is the standard for evaluation and assessment of the severity of OSA in every patient. The evaluation and workup for surgical intervention should include a thorough history, complete head and neck evaluation, nasopharyngeal laryngoscopy with a flexible fiberoptic endoscope, and appropriate imaging (e.g., cephalometrics). This workup allows pathologic entities of the upper airway (e.g., neoplasia, cysts) to be ruled out and regions of disproportionate anatomy (e.g., large soft palate, uvula, base of tongue, and a hypoplastic mandible) to be documented. Treatment of site-specific based on the finding of the evaluation. Treatment of snoring is often addressed by more conservative palatal procedures such as LAUP, RVTR, or electrocautery of the soft palate. The more aggressive palatal procedures such as UPPP are generally reserved for OSA. Nasal airway reconstruction may aid in the treatment of OSA, because increased nasal resistance and obstruction may significantly increase the negative pressure of the upper airway, leading to collapse of the velopharyngeal, base-of-tongue, and hypopharyngeal regions. Children with OSA usually respond well to adenotonsillectomy. Occasionally, uvulopalatopharyngeal procedures may be necessary. Craniofacial anomalies and significant skeletal anomalies such as severe mandibular hypoplasia have historically been problematic. Tracheostomies were at one time the only way to secure the airway in these patients. New developments in distraction osteogenesis have enabled mandibular lengthening and airway improvement, leading to earlier decannulation of these patients. The combined phase I and phase II treatment has a success rate of greater than 90%. Phase I treatment may include nasal reconstruction, uvulopalatopharyngeal, base-of-tongue, and hypopharyngeal surgery. Phase I surgery has a documented success rate of about 70% to 80%. Phase II surgery (MMA) has a success rate approaching 100%. In certain cases, MMA may be used as the primary treatment of OSA.
阻塞性睡眠呼吸暂停是一个严重的医学问题，会导致身体和行为紊乱。对所有因打鼾或阻塞性睡眠呼吸暂停前来就医的患者进行全面的检查和评估至关重要。多导睡眠图是评估每位患者阻塞性睡眠呼吸暂停严重程度的标准。手术干预的评估和检查应包括详尽的病史、完整的头颈部评估、使用可弯曲纤维光学内窥镜进行鼻咽喉镜检查以及适当的影像学检查（如头影测量）。这种检查可排除上气道的病理情况（如肿瘤、囊肿），并记录解剖结构不成比例的区域（如大的软腭、悬雍垂、舌根和发育不全的下颌骨）。根据评估结果进行针对特定部位的治疗。打鼾的治疗通常采用更保守的腭部手术，如激光辅助悬雍垂腭成形术、射频组织体积缩小术或软腭电灼术。更激进的腭部手术，如悬雍垂腭咽成形术，一般用于阻塞性睡眠呼吸暂停的治疗。鼻气道重建可能有助于阻塞性睡眠呼吸暂停的治疗，因为鼻阻力增加和阻塞可能会显著增加上气道的负压，导致腭咽、舌根和下咽区域塌陷。患有阻塞性睡眠呼吸暂停的儿童通常对腺样体扁桃体切除术反应良好。偶尔，可能需要进行悬雍垂腭咽手术。颅面畸形和严重的骨骼畸形，如严重的下颌发育不全，历来都是难题。气管切开术曾一度是确保这些患者气道通畅的唯一方法。牵张成骨术的新进展已能够实现下颌延长和气道改善，从而使这些患者更早地拔除气管套管。一期和二期联合治疗的成功率超过90%。一期治疗可能包括鼻重建、悬雍垂腭咽、舌根和下咽手术。一期手术的记录成功率约为70%至80%。二期手术（下颌骨前移术）的成功率接近100%。在某些情况下，下颌骨前移术可作为阻塞性睡眠呼吸暂停的主要治疗方法。
