Doff Michiel H J, Jansma Johan, Schepers Rutger H, Hoekema Aarnoud
Dept. of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
Cranio. 2013 Oct;31(4):246-51. doi: 10.1179/crn.2013.31.4.001.
Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder, characterized by disrupted snoring and repetitive upper airway obstructions. Oral appliance therapy is an effective alternative to continuous positive airway pressure (CPAP) and is especially effective in mild and moderate OSAS cases. Successful oral appliance therapy has been suggested as a predictor for successful maxillomandibular advancement (MMA) surgery in OSAS patients. MMA surgery has gained increasing popularity in this field since this procedure is associated with an enlargement of the entire velo-oro-hypopharyngeal airway. The authors present an unusual case of a CPAP-intolerant morbidly obese female (body mass index (BMI) = 40) with morbidly severe OSAS (apnea-hypopnea index (AHI) = 139, lowest oxyhemoglobin saturation level = 73%), who underwent a successful combination of MMA surgery, a modified genioplasty and cervicomental liposuction after oral appliance therapy. The post-surgical AHI was 6, and the lowest oxyhemoglobin saturation level increased to 86%. The authors suggest that this surgical combination should be seriously considered in obese patients with severe OSAS and CPAP intolerance.
阻塞性睡眠呼吸暂停综合征（OSAS）是一种与睡眠相关的呼吸障碍，其特征为打鼾中断和上气道反复阻塞。口腔矫治器疗法是持续气道正压通气（CPAP）的一种有效替代方法，在轻度和中度OSAS病例中尤其有效。成功的口腔矫治器疗法已被认为是OSAS患者上颌下颌前徙术（MMA）成功的预测指标。由于该手术与整个腭咽气道扩大相关，MMA手术在该领域越来越受欢迎。作者报告了一例特殊病例，一名对CPAP不耐受的病态肥胖女性（体重指数（BMI）=40），患有极其严重的OSAS（呼吸暂停低通气指数（AHI）=139，最低氧合血红蛋白饱和度水平=73%），在接受口腔矫治器治疗后，成功接受了MMA手术、改良颏成形术和颈颏部吸脂术联合治疗。术后AHI为6，最低氧合血红蛋白饱和度水平升至86%。作者建议，对于患有严重OSAS且不耐受CPAP的肥胖患者，应认真考虑这种手术组合。
