Yu Wenwen, Wang Meng, He Jiande, Lu Liyan, Cai Ming, Sun Hongxia, Lu Xiaofeng
*Department of Oral and Craniomaxillofacial Sciences, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine †Department of Oral and Maxillofacial Surgery, Shanghai Stomatological Disease Center ‡Department of Stomatology, Tenth People's Hospital, Tong Ji University School of Medicine, Shanghai, China.
J Craniofac Surg. 2017 Mar;28(2):366-371. doi: 10.1097/SCS.0000000000003294.
As the most effective surgical technique maxillomandibular advancement (MMA) has been used to treat severe obstructive sleep apnea (OSA) in adults, particularly for those who are intolerant of continuous positive airway pressure. Yet for large-scale advancement, it is faced with esthetic problems with marked skeletal protrusion especially for people with convex facial profile. In this study, the authors performed counterclockwise MMA combined with quantified uvulopalatopharyngoplasty (UPPP) surgeries on Chinese adult patients with severe OSA, in order to initially explore the efficacy of these procedures on Chinese populations and provide evidence for esthetic advantages. As the primary procedure counterclockwise MMA was applied on 10 patients, achieving a forward distance of the mandible and the maxilla for 10.6 and 6.7 mm, respectively, and the occlusion plane rotated counterclockwise of 6.2°. After a follow-up of beyond 12 months, polysomnography results showed the apnea-hypopnea index (AHI) significantly decreased from 64.3 to 11.0 per hour, achieving surgical success of 90%. Upper airway measurements demonstrated that the retropalatal and retrolingual spaces got enlarged greatly, resulting in significant AHI reduction and oxygen saturation elevation. More importantly, cephalometric analysis revealed that SNA and SNB were enlarged but in well control without visual abnormalities. Follow-up results showed large-scale advancement of the maxilla and mandible were stable in treating severe OSA. Quantified UPPP surgeries guaranteed no functional insufficiency in pronouncing and swallowing and played auxiliary role in enlarging the upper airway. Thus, procedures of counterclockwise MMA combined with quantified UPPP surgeries might find more application especially in patients with severe OSA with convex facial profile in future.
作为最有效的外科技术，上颌下颌前移术（MMA）已被用于治疗成人重度阻塞性睡眠呼吸暂停（OSA），特别是对于那些不耐受持续气道正压通气的患者。然而，对于大规模前移，它面临着明显的骨骼突出导致的美学问题，尤其是对于面部轮廓凸出的人。在本研究中，作者对成年重度OSA中国患者进行了逆时针MMA联合量化悬雍垂腭咽成形术（UPPP）手术，以初步探索这些手术对中国人群的疗效，并为美学优势提供证据。作为主要手术，对10例患者实施了逆时针MMA，下颌骨和上颌骨分别向前移动了10.6和6.7毫米，咬合平面逆时针旋转了6.2°。经过超过12个月的随访，多导睡眠图结果显示呼吸暂停低通气指数（AHI）从每小时64.3显著降至11.0，手术成功率达到90%。上气道测量表明，腭后和舌后间隙显著扩大，导致AHI显著降低和血氧饱和度升高。更重要的是，头影测量分析显示SNA和SNB增大，但在良好控制范围内，无视觉异常。随访结果表明，上颌骨和下颌骨的大规模前移在治疗重度OSA方面是稳定的。量化UPPP手术保证了发音和吞咽功能无不足，并在上气道扩大中起到辅助作用。因此，逆时针MMA联合量化UPPP手术可能在未来有更多应用，特别是对于面部轮廓凸出的重度OSA患者。
