Foltán R, Hoffmannová J, Donev F, Vlk M, Sedý J, Kufa R, Bulik O
Department of Oral and Maxillofacial Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic.
Int J Oral Maxillofac Surg. 2009 Oct;38(10):1036-40. doi: 10.1016/j.ijom.2009.06.001. Epub 2009 Jun 27.
The impact of orthognathic surgery for class III malocclusion on ventilation during sleep was examined using a comparison of pre- and post-surgical respiratory parameters. 21 patients with both maxillary hypoplasia and mandibular excess underwent Le Fort I osteotomy and advancement together with bilateral sagittal split osteotomy (BSSO) setback. Respiratory parameters, ECG and position of the body were monitored before surgery and postoperatively after the fixation removal (mean 8.5 months). Average Le Fort I advancement was 4.44 mm, BSSO setback was 4.96 mm. Generally, the orthognathic procedure worsened breathing function during sleep, as reflected in significant increase of index of flow limitations and decrease in oxygen saturation. The posterior airways space decreased to 75% of its original volume, the distance between mandibular plane and hyoid bone increased to 133%. The results indicate that bimaxillary surgery for class III malocclusion increased upper airway resistance. A young person would probably be able to balance such a decline in respiratory function using different adaptive mechanisms, but the potential impact of orthognathic surgery on the upper airways should be incorporated in a treatment plan.
通过比较正颌手术前后的呼吸参数，研究了正颌手术对III类错牙合畸形患者睡眠期间通气的影响。21例上颌发育不足和下颌前突患者接受了Le Fort I截骨术和前徙术，同时进行双侧矢状劈开截骨术（BSSO）后退术。在手术前以及去除固定装置后（平均8.5个月）对呼吸参数、心电图和身体位置进行监测。Le Fort I平均前徙4.44 mm，BSSO平均后退4.96 mm。一般来说，正颌手术会使睡眠期间的呼吸功能恶化，表现为气流受限指数显著增加和血氧饱和度降低。后气道间隙减小至其原始体积的75%，下颌平面与舌骨之间的距离增加至133%。结果表明，III类错牙合畸形的双颌手术增加了上气道阻力。年轻人可能能够通过不同的适应机制来平衡这种呼吸功能的下降，但正颌手术对上气道的潜在影响应纳入治疗方案中。
