Hsieh Yuh-Jia, Chen Yi-Chieh, Chen Yin-An, Liao Yu-Fang, Chen Yu-Ray
Taoyuan and Linkou, Taiwan From the Craniofacial Center and Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital; the Craniofacial Research Center and Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital; and the College of Medicine, Chang Gung University.
Plast Reconstr Surg. 2015 Feb;135(2):361e-369e. doi: 10.1097/PRS.0000000000000913.
Upper airway narrowing has been a concern of mandibular setback. The aims of this study were (1) to evaluate the effect of bimaxillary rotational setback surgery on upper airway structure in patients with skeletal class III deformities, and (2) to compare the preoperative and postoperative upper airways of class III patients with age- and sex-matched class I control subjects.
The upper airways of 36 adults who consecutively underwent bimaxillary rotational setback surgery for skeletal class III deformities were assessed by means of cone-beam computed tomography before and at least 6 months after surgery. Results were compared with those of age- and sex-matched control subjects with skeletal class I structure.
Before surgery, the class III patients had significantly larger velopharyngeal, oropharyngeal, and hypopharyngeal volumes than did the control subjects (all p < 0.01). The velopharyngeal, oropharyngeal, and hypopharynx volumes decreased significantly after surgery (all p < 0.01). The postoperative airways of class III patients were similar with regard to velopharyngeal, oropharyngeal, and hypopharyngeal volume (all p > 0.01) compared to control subjects. The postoperative velopharyngeal and oropharyngeal airway volumes were associated with the baseline airway volume (p < 0.001) and horizontal movement of the soft palate (p < 0.01).
These results suggest that upper airway volume is decreased after bimaxillary rotational setback surgery for skeletal class III deformities, but is not smaller than in normal controls, and the postoperative upper airway volume is related to airway volume at baseline and changes in the surrounding structures.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
上气道狭窄一直是下颌后缩所关注的问题。本研究的目的是：（1）评估双颌旋转后缩手术对骨骼Ⅲ类畸形患者上气道结构的影响；（2）比较骨骼Ⅲ类患者术前和术后与年龄及性别匹配的Ⅰ类对照受试者的上气道情况。
对36例因骨骼Ⅲ类畸形连续接受双颌旋转后缩手术的成年患者，在术前及术后至少6个月通过锥形束计算机断层扫描评估其上气道。将结果与具有骨骼Ⅰ类结构、年龄及性别匹配的对照受试者的结果进行比较。
术前，Ⅲ类患者的腭咽、口咽和下咽容积显著大于对照受试者（均p<0.01）。术后腭咽、口咽和下咽容积显著减小（均p<0.01）。与对照受试者相比，Ⅲ类患者术后的腭咽、口咽和下咽容积相似（均p>0.01）。术后腭咽和口咽气道容积与基线气道容积（p<0.001）及软腭水平移动（p<0.01）相关。
这些结果表明，对于骨骼Ⅲ类畸形患者，双颌旋转后缩手术后上气道容积减小，但不小于正常对照，且术后上气道容积与基线气道容积及周围结构变化有关。
临床问题/证据水平：治疗性，Ⅲ级。
