Posnick Jeffrey C, Choi Elbert, Adachie Anayo, Troost Thomas
Director, Posnick Center for Facial Plastic Surgery, Chevy Chase, MD; Clinical Professor of Surgery and Pediatrics, Georgetown University, Washington, DC; Clinical Professor of Orthodontics, University of Maryland, School of Dentistry, Baltimore, MD; Adjunct Professor, Department of Oral and Maxillofacial Surgery, Howard University College of Dentistry, Washington, DC.
Chief Resident, Department of Oral and Maxillofacial Surgery, Howard University Hospital, Washington, DC.
J Oral Maxillofac Surg. 2016 Mar;74(3):620.e1-11. doi: 10.1016/j.joms.2015.10.021. Epub 2015 Nov 5.
The purpose of this study was to assess the safety and efficacy of intranasal procedures carried out simultaneously with bimaxillary orthognathic surgery.
The authors executed a retrospective cohort study derived from patients treated by a single surgeon at 1 institution from 2004 through 2013 with a minimum follow-up of 1 year (range, 1 to 10 yr). An index study group consisting of a consecutive series of patients with symptomatic chronic obstructive nasal breathing (CONB) and a bimaxillary developmental dentofacial deformity (DFD) also involving the chin were identified. They underwent a minimum of: Le Fort I osteotomy, bilateral sagittal ramus osteotomies, septoplasty, inferior turbinate reduction (ITR), and osseous genioplasty. Study variables included age at operation, gender, pattern of presenting DFD, presence of obstructive sleep apnea, segmentation of the maxilla, and airway management. The primary outcome variable studied was residual CONB.
During the study period, 262 patients met the inclusion criteria. Their age at operation averaged 25 years (range, 13 to 63 yr) and 134 were female (51%). The major patterns of presenting DFD included long face (29%) and maxillary deficiency (25%). No patients required nasal packing, reintubation, tracheostomy, or blood transfusion. In 6 of the 262 patients (2%), the intranasal procedures did not resolve nasal breathing difficulties. In these patients, procedures recommended included synechiae release (n = 3), revision septoplasty (n = 3), and further ITR (n = 4). An association between age at time of surgery and non-segmental Le Fort I osteotomy with the occurrence of residual nasal obstruction was confirmed.
When completing septoplasty and ITR through a Le Fort I, airway management need not be altered from standard protocol. The management of CONB in conjunction with orthognathic surgery is highly effective, with few complications. Non-segmental Le Fort I in patients at least 40 years of age is more likely to be associated with residual CONB, but the incidence remains low.
本研究旨在评估与双颌正颌手术同时进行的鼻内手术的安全性和有效性。
作者进行了一项回顾性队列研究，研究对象为2004年至2013年在一家机构由单一外科医生治疗且随访时间至少1年（范围为1至10年）的患者。确定了一个索引研究组，该组由一系列有症状的慢性阻塞性鼻呼吸（CONB）且伴有双颌发育性牙颌面畸形（DFD）（也涉及下巴）的患者组成。他们至少接受了以下手术：Le Fort I截骨术、双侧矢状劈开下颌支截骨术、鼻中隔成形术、下鼻甲缩小术（ITR）和骨性颏成形术。研究变量包括手术年龄、性别、呈现的DFD模式、阻塞性睡眠呼吸暂停的存在、上颌骨的分段以及气道管理。研究的主要结局变量是残余CONB。
在研究期间，262例患者符合纳入标准。他们的手术平均年龄为25岁（范围为13至63岁），其中134例为女性（51%）。呈现的DFD主要模式包括长脸（29%）和上颌骨发育不足（25%）。没有患者需要鼻腔填塞、重新插管、气管切开或输血。在262例患者中有6例（2%），鼻内手术未能解决鼻呼吸困难。在这些患者中，推荐的手术包括粘连松解术（n = 3）、鼻中隔成形术翻修（n = 3）和进一步的ITR（n = 4）。证实了手术时的年龄和非分段Le Fort I截骨术与残余鼻阻塞的发生之间存在关联。
通过Le Fort I完成鼻中隔成形术和ITR时，气道管理无需偏离标准方案。CONB与正颌手术联合治疗非常有效，并发症很少。40岁及以上患者的非分段Le Fort I更有可能与残余CONB相关，但发生率仍然较低。
