Kim Su-Jung, Kim Young-Suk, Park Jeong-Ho, Kim Sung-Wan
Department of Orthodontics, Oral Biology Research Institute, Kyung Hee University School of Dentistry, Seoul, Korea.
J Oral Maxillofac Surg. 2012 Jun;70(6):1404-12. doi: 10.1016/j.joms.2011.03.016. Epub 2011 Jul 16.
The present study investigated whether cephalometric measurements can predict the therapeutic efficacy of multilevel phase I surgery for patients with obstructive sleep apnea (OSA).
Among 210 patients with OSA who underwent multilevel phase I surgery, 85 were recruited on the basis of the baseline polysomnography, body mass index, and lateral cephalogram recordings. The patients were divided into 2 groups according to the degree of change in the apnea-hypopnea index before and 6 months after multilevel surgery: good responders (>50% decrease in apnea-hypopnea index) and poor responders (0% to 50% decrease or increase in apnea-hypopnea index). Cephalometric analysis was performed to identify the relevant variables, with division into 5 compartments: craniofacial, soft palate, tongue, hyoid bone, and upper airway variables.
In the craniofacial compartment, poor responders represented skeletal Class II with a more retrognathic mandible, and a hyperdivergent vertical pattern with a larger mandibular plane angle, longer lower facial height, and steeper occlusal plane than good responders. In the upper airway compartment, poor responders had narrower middle and inferior airway spaces and a longer upper airway length than good responders. No significant differences were found in the soft palate, tongue, and hyoid measurements between the 2 groups.
Some preoperative cephalometric measurements were verified retrospectively to predict the therapeutic response to the multilevel surgery in patients with OSA. This study would contribute not only to establishing selective criteria for the surgical approach to patients with OSA in ear-nose-throat practice but also in deciding on the referral to orthodontists or maxillofacial surgeons.
本研究调查了头影测量能否预测阻塞性睡眠呼吸暂停（OSA）患者一期多级手术的治疗效果。
在210例行一期多级手术的OSA患者中，根据基线多导睡眠图、体重指数和头颅侧位片记录选取了85例患者。根据多级手术后6个月与术前呼吸暂停低通气指数的变化程度，将患者分为2组：反应良好组（呼吸暂停低通气指数下降>50%）和反应不佳组（呼吸暂停低通气指数下降0%至50%或上升）。进行头影测量分析以确定相关变量，分为5个部分：颅面、软腭、舌、舌骨和上气道变量。
在颅面部分，反应不佳组表现为骨骼Ⅱ类错合，下颌后缩更明显，垂直型更为散开，下颌平面角更大，面下高更长，咬合平面更陡，优于反应良好组。在上气道部分，反应不佳组的中、下气道间隙比反应良好组窄，上气道长度更长。两组在软腭、舌和舌骨测量方面未发现显著差异。
回顾性验证了一些术前头影测量可预测OSA患者对多级手术的治疗反应。本研究不仅有助于在耳鼻喉科实践中为OSA患者建立手术方法的选择标准，也有助于决定是否转诊至正畸医生或颌面外科医生。
