Cohen-Levy Julia, Petelle Boris, Vieille Estelle, Dumitrache Marius, Fleury Bernard
Int Orthod. 2013 Mar;11(1):71-92. doi: 10.1016/j.ortho.2012.12.009. Epub 2013 Feb 9.
The aim of this study was to assess changes in the profile of adult male patients treated for obstructive sleep apnea syndrome (OSAS) with maxillomandibular advancement (MMA) surgery and to measure patient perception of changes compared with that of different panels.
Fifteen consecutive apneic patients displaying a wide variety of morphological types, mean age 42 years (20-59), a BMI of 26.60 kg/m(2) (22-29), a mean initial Apnea Hypopnea Index (AHI) of 50.9 (19-85), underwent MMA. Assessment was done by facial photography, lateral cephalographs (Tweed analysis modified by Riley and Delaire architectural analysis), polysomnographic records and a validated self-assessment questionnaire. Patients' pre- and postoperative profiles were taken from photographs using Photoshop 7™ software. Their darkened outlines were shown randomly in positions A or B (pre- and postoperative) to panels composed of orthodontists (n=40), fine arts students (n=50) and lay persons (n=50) who were requested to choose the most attractive profiles.
The MMA success rate for OSAS was 80% (12/15) for an AHI less than 15, with no surgical complications. All patients reported a reduction of their symptoms and 14 out of 15 were satisfied with the esthetic outcome. Mean advancement was 8.4mm (3.0-10.0) for the maxilla and 10.8mm (10.0-13.0) for the mandible. Following MMA, 12 out of 15 exhibited maxillary protrusion and six out of 15 mandibular protrusion. The mean change in the nasolabial angle was -5.7° (-27°; 14°). The postoperative profiles were preferred by 85% of the combined panels (P=<0.001), showing no significant difference from one panel to another. No skeletal characteristic could be correlated with the esthetic preference. Upper lip retrusion, open nasolabial angle and dolichofacial type emerged as positive preoperative predictors of esthetic preference.
The profile changes following MMA were favorably perceived in the majority of cases. However, specific orthodontic preparation could be offered to patients with pronounced preoperative protrusion.
本研究的目的是评估接受上颌下颌前移（MMA）手术治疗阻塞性睡眠呼吸暂停综合征（OSAS）的成年男性患者面部轮廓的变化，并衡量患者与不同评判小组相比对这些变化的感知。
连续15例呼吸暂停患者，呈现多种形态类型，平均年龄42岁（20 - 59岁），体重指数（BMI）为26.60kg/m²（22 - 29），初始平均呼吸暂停低通气指数（AHI）为50.9（19 - 85），接受了MMA手术。通过面部摄影、侧位头影测量（经莱利和德莱尔结构分析修改的特威德分析法）、多导睡眠图记录以及一份经过验证的自我评估问卷进行评估。使用Photoshop 7™软件从照片中获取患者术前和术后的面部轮廓。将他们面部轮廓的深色轮廓随机以A或B位置（术前和术后）展示给由正畸医生（n = 40）、美术专业学生（n = 50）和普通民众（n = 50）组成的评判小组，要求他们选择最具吸引力的面部轮廓。
对于AHI小于15的患者，MMA治疗OSAS的成功率为80%（12/15），且无手术并发症。所有患者均报告症状减轻，15例中有14例对美学效果满意。上颌平均前移8.4mm（3.（此处原文有误，推测应为3.0） - 10.0），下颌平均前移10.8mm（10.0 - 13.0）。MMA术后，15例中有12例出现上颌前突，15例中有6例出现下颌前突。鼻唇角平均变化为 - 5.7°（ - 27°；14°）。85%的综合评判小组更喜欢术后的面部轮廓（P < 0.001），各评判小组之间无显著差异。没有骨骼特征与美学偏好相关。术前上唇后缩、鼻唇角开放和长面型是美学偏好的积极预测因素。
在大多数情况下，MMA术后的面部轮廓变化得到了积极的评价。然而，对于术前有明显前突的患者，可以提供特定的正畸准备。
