Butterfield Kevin J, Marks Patricia L G, McLean Laurie, Newton Jack
Chief, Division of Dentistry/Oral and Maxillofacial Surgery, Ottawa Hospital, and Assistant Professor, Department of Otolaryngology, University of Ottawa School of Medicine, Ottawa, Ontario, Canada.
Research Assistant, Queen's University, Kingston, Ontario, Canada.
J Oral Maxillofac Surg. 2015 Jun;73(6):1133-42. doi: 10.1016/j.joms.2014.11.020. Epub 2014 Dec 13.
Maxillomandibular advancement (MMA) surgery is a well-established treatment of obstructive sleep apnea (OSA). Although many studies have assessed the efficacy of MMA in treating OSA, very few studies have quantified the magnitude of its changes to airway morphology. Therefore, the present study investigated the linear and volumetric morphologic changes that occur in the pharyngeal airway after treatment of OSA using MMA.
A retrospective cohort study of patients with OSA treated from May 2010 to February 2014 was performed. Each patient underwent preoperative clinical and fiberoptic nasopharyngoscopic examinations. Pre- and postoperative polysomnograms, lateral cephalograms, and cone-beam computed tomography scans were acquired. The radiographic images were used to determine the linear and volumetric airway measurements. The time and magnitude of skeletal movement were used as the independent variables. The dependent variables included assessment of success or cure, apnea hypopnea index (AHI), cephalometric changes, Epworth score, rapid eye movement sleep, body mass index, and various airway morphologic parameters.
A total of 15 patients (13 men and 2 women) participated in the present study. The surgical success and cure rate was 73.33% and 40.00%, respectively. Statistically significant improvements were found in the airway total volume, minimal cross-sectional area, anteroposterior and lateral dimensions, airway index, airway length, posterior airway space morphology, AHI, and Epworth sleepiness score.
MMA is a highly successful surgical treatment of OSA that improves airway morphology and sleep quality. MMA results in a shorter and broader airway and associated improvements in the AHI.
上颌下颌前移（MMA）手术是治疗阻塞性睡眠呼吸暂停（OSA）的一种成熟疗法。尽管许多研究评估了MMA治疗OSA的疗效，但很少有研究对其气道形态变化的程度进行量化。因此，本研究调查了使用MMA治疗OSA后咽气道发生的线性和容积形态变化。
对2010年5月至2014年2月接受治疗的OSA患者进行回顾性队列研究。每位患者均接受术前临床和纤维鼻咽镜检查。采集术前和术后的多导睡眠图、头颅侧位片和锥形束计算机断层扫描。利用放射图像确定气道的线性和容积测量值。骨骼移动的时间和幅度用作自变量。因变量包括成功或治愈评估、呼吸暂停低通气指数（AHI）、头影测量变化、爱泼华嗜睡量表评分、快速眼动睡眠、体重指数以及各种气道形态学参数。
共有15例患者（13例男性和2例女性）参与本研究。手术成功率和治愈率分别为73.33%和40.00%。气道总体积、最小横截面积、前后径和左右径、气道指数、气道长度、后气道空间形态、AHI和爱泼华嗜睡量表评分均有统计学意义的改善。
MMA是一种治疗OSA非常成功的手术方法，可改善气道形态和睡眠质量。MMA可使气道变短变宽，并使AHI相应改善。
