Cozza Paola, Ballanti Fabiana, Castellano Monica, Fanucci Ezio
Department of Orthodontics, University of Rome Tor Vergata.
Prog Orthod. 2008;9(1):6-16.
The aim of this study was to investigate pharyngeal size differences between pre- and posttrials of a Mandibular Advancement Device (MAD), using a computed tomography (CT),in the treatment of Obstructive Sleep Apnea (OSA) adult patients.
Eighteen patients with mild to moderate OSA (mean Apnea/Hypopnea Index, AHI, of 16.7) were treated with a MAD to wear at night only. After 3 months of treatment, three-dimensional changes in pharyngeal dimensions were measured on CT images performed with a sixteen detector-row CT scanner (Light Speed Plus; GE Medical Systems). Two consecutive axial sections from the hard palate to the epiglottis were obtained with and without the appliance. Measurements were made of the following airway areas (mm2) and lengths (mm): RF (nasopharynx); ROF (naso-oropharynx); OF (oropharynx); IPF (hypopharynx); SPL (soft palate length); SPT (soft palate thickness); Rgn (retrognation)-hyoid bone; hyoid bone-C2; Rgn-C2; PhL (oropharynx length); pharynx posterior wall thickness at three level. The angle between the hard and the soft palate (APDM) was also calculated.
AHI improved significantly (from 16.7 to 11.2) when the appliance was used. Measurements from CT scans showed statistically significant expansion in the naso-oropharynx area (RF p<.014; ROF p<.050), in the Rgn-C2 length (p<.005) and in the angle between the hard and the soft palate (APDM p<.001).
Our findings confirm the effectiveness of MAD in the treatment of patients with mild to moderate OSA. The use of MAD significantly expands the areas of the upper airway lumen most involved in the collapse.
本研究旨在使用计算机断层扫描（CT），调查下颌前移装置（MAD）治疗阻塞性睡眠呼吸暂停（OSA）成年患者前后咽部大小的差异。
18例轻度至中度OSA患者（平均呼吸暂停/低通气指数，AHI，为16.7）接受仅在夜间佩戴的MAD治疗。治疗3个月后，使用16排CT扫描仪（Light Speed Plus；GE医疗系统）对CT图像上咽部尺寸的三维变化进行测量。在佩戴和不佩戴矫治器的情况下，从硬腭到会厌获取两个连续的轴向截面。测量以下气道面积（mm²）和长度（mm）：RF（鼻咽）；ROF（鼻-口咽）；OF（口咽）；IPF（下咽）；SPL（软腭长度）；SPT（软腭厚度）；Rgn（后缩）-舌骨；舌骨-C2；Rgn-C2；PhL（口咽长度）；咽部后壁三个水平的厚度。还计算了硬腭和软腭之间的角度（APDM）。
使用矫治器时，AHI显著改善（从16.7降至11.2）。CT扫描测量显示，鼻-口咽区域（RF p<0.014；ROF p<0.050）、Rgn-C2长度（p<0.005）以及硬腭和软腭之间的角度（APDM p<0.001）有统计学意义的扩大。
我们的研究结果证实了MAD治疗轻度至中度OSA患者的有效性。使用MAD可显著扩大上气道腔最易塌陷的区域。
