Ahn Hyo-Won, Lee Baek-Soo, Kim Sung-Wan, Kim Su-Jung
Assistant Professor, Department of Orthodontics, Kyung Hee University School of Dentistry, Seoul, Korea.
Professor, Department of Oral and Maxillofacial Surgery, Kyung Hee University School of Dentistry, Seoul, Korea.
J Oral Maxillofac Surg. 2015 Sep;73(9):1827-41. doi: 10.1016/j.joms.2015.02.028. Epub 2015 Mar 18.
Maxillomandibular advancement (MMA) surgery can be considered a primary single-stage treatment for improving the quality of life in patients with preadolescent refractory obstructive sleep apnea (OSA). The aim of the present report was to evaluate the treatment efficacy and stability of modified MMA surgery in a growing patient with morbidly severe symptoms and medical complications. Using the follow-up results from the questionnaire, polysomnography, 2-dimensional cephalometry, and 3-dimensional cone-beam computed tomography measurements, the success of modified MMA surgery was assessed in terms of the postoperative improvements of functions and esthetics and postretentive stability of the improvements throughout the growth period. The present report provides some clinical recommendations when considering skeletal surgery in preadolescent patients with OSA: 1) the decision criteria of MMA surgery as definite treatment; 2) the proper surgical design for both maximum enlargement of the airway and esthetic improvement; and 3) the postoperative facial growth for long-term stability of airway function and skeletal improvement. With a systematic multidisciplinary approach, early surgical intervention can be used to treat OSA in children successfully and permanently.
上颌下颌前移（MMA）手术可被视为改善青春期前难治性阻塞性睡眠呼吸暂停（OSA）患者生活质量的主要单阶段治疗方法。本报告的目的是评估改良MMA手术对一名患有严重症状和医学并发症的生长发育期患者的治疗效果和稳定性。利用问卷调查、多导睡眠图、二维头影测量和三维锥形束计算机断层扫描测量的随访结果，从术后功能和美学改善以及整个生长发育期改善后的保持稳定性方面评估改良MMA手术的成功率。本报告在考虑对青春期前OSA患者进行骨骼手术时提供了一些临床建议：1）MMA手术作为确定性治疗的决策标准；2）为最大程度扩大气道和改善美学而进行的适当手术设计；3）术后面部生长以实现气道功能和骨骼改善的长期稳定性。通过系统的多学科方法，早期手术干预可成功且永久地治疗儿童OSA。
