Goncalves Joao Roberto, Buschang Peter H, Goncalves Daniela Godoi, Wolford Larry M
Orthodontics, UNESP-Paulista State University, Sao Paulo, Brazil.
J Oral Maxillofac Surg. 2006 May;64(5):755-62. doi: 10.1016/j.joms.2005.11.046.
This study evaluated oropharyngeal airway changes and stability following surgical counter-clockwise rotation and advancement of the maxillo-mandibular complex.
Fifty-six adults (48 females, 8 males), between 15 and 51 years of age, were treated with Le Fort I osteotomies and bilateral mandibular ramus sagittal split osteotomies to advance the maxillo-mandibular complex with a counter-clockwise rotation. The average postsurgical follow-up was 34 months. Each patient's lateral cephalograms were traced, digitized twice, and averaged to estimate surgical changes (T2-T1) and postsurgical changes (T3-T2).
During surgery, the occlusal plane angle decreased significantly (8.6 +/- 5.8 degrees ) and the maxillo-mandibular complex advanced and rotated counter-clockwise. The maxilla moved forward (2.4 +/- 2.7 mm) at ANS and the mandible was advanced 13.1 +/- 5.1 mm at menton, 10 +/- 4.4 mm at point B, and 6.9 +/- 3.7 mm at lower incisor edge. Postsurgical hard tissue changes were not statistically significant. While the upper oropharyngeal airway decreased significantly (4.2 +/- 3.4 mm) immediately after surgery, the narrowest retropalatal, lowest retropalatal airway, and the narrowest retroglossal airway measurements increased 2.9 +/- 2.7, 3.7 +/- 3.2, and 4.4 +/- 4.4 mm, respectively. Over the average 34 months postsurgical period, upper retropalatal airway increased 3.9 +/- 3.7 mm, while narrowest retropalatal, lowest retropalatal airway, and narrowest retroglossal airway remained stable. Head posture showed flexure immediately after surgery (4.8 +/- 5.9 degrees ) and extension postsurgically (1.6 +/- 5.6 degrees ).
Maxillo-mandibular advancement with counter-clockwise rotation produces immediate increases in middle and lower oropharyngeal airway dimensions, which were constrained by changes in head posture but remain stable over the postsurgical period. The upper oropharyngeal airway space increased only on the longest follow-up.
本研究评估了上颌-下颌复合体手术逆时针旋转和前移后口咽气道的变化及稳定性。
56名年龄在15至51岁之间的成年人（48名女性，8名男性）接受了Le Fort I截骨术和双侧下颌升支矢状劈开截骨术，以使上颌-下颌复合体逆时针旋转并前移。术后平均随访34个月。对每位患者的头颅侧位片进行描图、数字化处理两次并求平均值，以评估手术变化（T2-T1）和术后变化（T3-T2）。
手术过程中，咬合平面角显著减小（8.6±5.8度），上颌-下颌复合体前移并逆时针旋转。上颌在鼻前棘处向前移动（2.4±2.7毫米），下颌在颏部前移13.1±5.1毫米，在B点前移10±4.4毫米，在下切牙边缘前移6.9±3.7毫米。术后硬组织变化无统计学意义。虽然术后即刻上咽气道显著减小（4.2±3.4毫米），但软腭后最窄处、软腭后最低处气道以及舌后最窄处气道测量值分别增加了2.9±2.7毫米、3.7±3.2毫米和4.
