College of Stomatology, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China.
College of Stomatology, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China.
Int J Surg. 2017 Feb;38:31-40. doi: 10.1016/j.ijsu.2016.12.033. Epub 2016 Dec 24.
This study is aimed at assembling, through a systematic review and meta-analysis, scientific evidence related to the effects of mandibular setback (MdS) surgery and bimaxillary surgery for the correction of Class III malocclusion on the cross-sectional area (CSA) and volume of the upper airway as assessed using CT.
An electronic search was conducted on Cochrane Library, EMBASE, PubMed, Scopus and Web of Science up to June 20, 2016. The inclusion criteria were prospective or retrospective studies, with the aim of comparing the impact on the upper airway space of orthognathic surgery for the treatment of the skeletal class III malocclusion. The methodological index for non-randomized studies (MINORS) was chosen as the evaluation instrument and Revman5.3 was used for the meta-analysis.
A total of 1213 studies were retrieved, of which only 18 met the eligibility criteria. The results of meta-analysis showed that the mean decrease in the upper airway volume after MdS surgery was 3.24 cm [95%CI (-5.25,-1.23), p = 0.85]; the mean decrease in minimum CSA after a combined surgery of maxillary advancement with mandibular setback (MdS + MxA) was 27.66 mm [95%CI (-52.81,-2.51), p = 0.51], but there was no significant decrease in upper airway volume (mean 0.86 cm); comparison between MdS + MxA and isolated MdS showed significant differences in the CSA of the posterior nasal spine plane (PNS) and epiglottis plane (EP); statistically significant differences in nasopharynx volume (P < 0.0001) and upper airway total volume (P = 0.002) were observed, but no statistically meaningful variations existed in oropharynx volume (P = 0.08) and hypopharynx volume (P = 0.64).
The results of this study suggest that bimaxillary surgery promotes less decrease on the upper airway than mandibular setback surgery alone for the correction of the skeletal class III malocclusion.
通过系统评价和荟萃分析，收集与下颌后退（MdS）手术和双颌手术矫正 III 类错畸形对上气道横截面积（CSA）和体积的影响相关的科学证据，这些证据是使用 CT 评估得出的。
对 Cochrane 图书馆、EMBASE、PubMed、Scopus 和 Web of Science 进行电子检索，检索时间截至 2016 年 6 月 20 日。纳入标准为前瞻性或回顾性研究，旨在比较正颌手术治疗骨性 III 类错畸形对上气道空间的影响。采用非随机研究方法学指数（MINORS）作为评价工具，Revman5.3 进行荟萃分析。
共检索到 1213 篇研究，其中仅有 18 项符合纳入标准。荟萃分析结果显示，MdS 手术后上气道容积平均减少 3.24cm[95%CI（-5.25，-1.23），p=0.85]；上颌骨前徙与下颌骨后退（MdS+MxA）联合手术后最小 CSA 平均减少 27.66mm[95%CI（-52.81，-2.51），p=0.51]，但上气道容积无明显减少（平均 0.86cm）；MdS+MxA 与单纯 MdS 比较，后鼻孔平面（PNS）和会厌平面（EP）CSA 差异有统计学意义；鼻咽腔容积（P<0.0001）和上气道总容积（P=0.002）差异有统计学意义，但口咽腔容积（P=0.08）和下咽腔容积（P=0.64）差异无统计学意义。
本研究结果表明，与单纯下颌后退手术相比，双颌手术矫正骨性 III 类错畸形对上气道的影响较小。
