Stellzig-Eisenhauer Angelika, Meyer-Marcotty Philipp
Poliklinik für Kieferorthopädie, Würzburg University Hospital, Würzburg, Germany.
GMS Curr Top Otorhinolaryngol Head Neck Surg. 2010;9:Doc04. doi: 10.3205/cto000068. Epub 2011 Apr 27.
In terms of pathophysiology, an anatomically narrow airway is a predisposing factor for obstruction of the upper respiratory tract. The correlation between the nasopharyngeal airway and the craniofacial structures is discussed in this context. Thus a mutual interaction between the pharynx and the mandibular position was demonstrated, whereby the transverse dimension of the nasopharynx was significantly larger in patients with prognathism than in patients with retrognathism. The influence of chronic obstruction of the nasal airway on craniofacial development was also discussed. The form-and-function interaction, which ought to explain the causal relationship between nasal obstruction and craniofacial growth, appears to be of a multifactorial rather than a one-dimensional, linear nature. It is not disputed, however, that expanding the maxilla improves not only nasal volume and nasal flow, but also the subjective sensation of patients, although it is not possible to make a prognostic statement about the extent of this improvement because of the differing reactions of individuals. Orthodontic appliances for advancing the mandible can also be successfully used in the treatment of mild obstructive sleep apnea syndrome. This treatment method should be considered particularly for patients who are unwilling to undergo or cannot tolerate CPAP (continuous positive airway pressure) treatment.
在病理生理学方面，解剖学上狭窄的气道是上呼吸道阻塞的一个诱发因素。在此背景下讨论了鼻咽气道与颅面结构之间的相关性。因此，证实了咽部与下颌位置之间存在相互作用，即前突患者的鼻咽横向尺寸明显大于后缩患者。还讨论了鼻气道慢性阻塞对颅面发育的影响。形态与功能的相互作用本应解释鼻阻塞与颅面生长之间的因果关系，但其似乎是多因素的，而非一维线性的。然而，扩大上颌不仅能改善鼻腔容积和鼻气流，还能改善患者的主观感受，这一点并无争议，尽管由于个体反应不同，无法对这种改善的程度作出预后判断。用于前移下颌的正畸矫治器也可成功用于治疗轻度阻塞性睡眠呼吸暂停综合征。对于不愿接受或无法耐受持续气道正压通气（CPAP）治疗的患者，应特别考虑这种治疗方法。
