Sedaghat Ahmad R, Anderson Iee Ching W, McGinley Brian M, Rossberg Mark I, Redett Richard J, Ishman Stacey L
Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, 601 North Caroline Street, Room 6231, Baltimore, MD 21287, USA.
Cleft Palate Craniofac J. 2012 Jan;49(1):21-6. doi: 10.1597/10-240. Epub 2011 Apr 16.
To characterize airway obstruction before and after tongue-lip adhesion in children with micrognathia using polysomnography.
Retrospective pilot case series.
Evaluation of all children with micrognathia who underwent tongue-lip adhesion and polysomnography before and after surgery from 2002 to 2007 (N = 8).
Eight children met inclusion criteria; six were girls. The mean interval between polysomnography and tongue-lip adhesion was 6 days (range, 2 to 13 days) preoperatively and 17 days (range, 5 to 32 days) postoperatively. Severe obstructive sleep apnea was identified in seven of eight (88%) children, with a mean preoperative obstructive apnea hypopnea index of 52.6 events per hour (range, 7.1 to 85.7 events per hour). None had significant central sleep apneas (>5 per hour). Tongue-lip adhesion resulted in a mean decrease of 34.5 events per hour (range, -65.8 to 71.6 events per hour). After tongue-lip adhesion, seven of eight (87.5%) patients had an improved obstructive apnea hypopnea index, with resolution of obstructive sleep apnea in one child and improvement to mild (two) and moderate (two) obstructive sleep apnea in four others. Only one child had an obstructive apnea hypopnea index that increased after tongue-lip adhesion. Peak end-tidal pCO(2) measurements were elevated in all eight children before surgery at a mean of 60 mm Hg (range, 52 to 76 mm Hg) that improved to 51 mm Hg (range, 45 to 59 mm Hg), with normal peak levels in four children. Oxygen saturation nadir improved from 73% (range, 58% to 81%) to 82% (range, 65% to 94%).
Tongue-lip adhesion may be performed in micrognathic infants to alleviate airway obstruction. Polysomnographic evaluation in this pilot study before and after surgery suggests that tongue-lip adhesion usually improves obstructive sleep apnea, but only 38% had complete resolution. Future studies of tongue-lip adhesion efficacy should include polysomnographic evaluation.
使用多导睡眠图来描述小颌畸形患儿舌唇粘连术前后的气道阻塞情况。
回顾性试验病例系列。
对2002年至2007年间所有接受舌唇粘连术及术前术后多导睡眠图检查的小颌畸形患儿进行评估（N = 8）。
8名儿童符合纳入标准；6名是女孩。术前多导睡眠图检查与舌唇粘连术之间的平均间隔时间为6天（范围2至13天），术后为17天（范围5至32天）。8名儿童中有7名（88%）被诊断为重度阻塞性睡眠呼吸暂停，术前平均阻塞性呼吸暂停低通气指数为每小时52.6次事件（范围7.1至85.7次事件/小时）。无人有明显的中枢性睡眠呼吸暂停（>5次/小时）。舌唇粘连术使每小时事件平均减少34.5次（范围-65.8至71.6次事件/小时）。舌唇粘连术后，8名患者中有7名（87.5%）的阻塞性呼吸暂停低通气指数有所改善，其中1名儿童的阻塞性睡眠呼吸暂停得到缓解，另外4名儿童改善为轻度（2名）和中度（2名）阻塞性睡眠呼吸暂停。只有1名儿童在舌唇粘连术后阻塞性呼吸暂停低通气指数升高。术前所有8名儿童的呼气末二氧化碳分压峰值测量值均升高，平均为60 mmHg（范围52至76 mmHg），术后改善至51 mmHg（范围45至59 mmHg），4名儿童达到正常峰值水平。最低氧饱和度从73%（范围58%至81%）改善至82%（范围65%至94%）。
舌唇粘连术可用于小颌畸形婴儿以缓解气道阻塞。本试验性研究中手术前后的多导睡眠图评估表明，舌唇粘连术通常可改善阻塞性睡眠呼吸暂停，但只有38%的患儿完全缓解。未来关于舌唇粘连术疗效的研究应包括多导睡眠图评估。
