Han Jeong Joon, Hong Dong Hwan, Hwang Soon Jung
*Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Research Institute, BK 21 Plus, Seoul National University, Seoul†Department of Oral and Maxillofacial Surgery, Chonnam National University Hospital, Gwangju, Republic of Korea.
J Craniofac Surg. 2017 May;28(3):723-730. doi: 10.1097/SCS.0000000000003369.
Mandibular prognathism is usually treated with mandibular setback surgery. However, this approach reduces the pharyngeal airway space, and can aggravate obstructive phenomena in patients with obstructive sleep apnea (OSA). While maxillary expansion is known to lead to an increase in the pharyngeal airway volume (PAS), its effect on the PAS in mandibular setback surgery has not yet been reported. The authors report a surgical approach with maxillary expansion in 2 patients with mandibular prognathism that was accompanied by OSA: maxillary midsagittal expansion with minimum maxillary advancement and minor mandibular setback without mandibular anterior segmental osteotomy (ASO) or major mandibular setback with mandibular ASO. Preoperative and postoperative computed tomography and polysomnography indicated that OSA was improved and pharyngeal airway space was increased or sustained, and the prognathic profile could be corrected to an acceptable facial esthetic profile. In summary, maxillary transversal expansion and mandibular setback with or without mandibular ASO can be successfully applied to treat mandibular prognathism with OSA.
下颌前突通常采用下颌后缩手术进行治疗。然而，这种方法会减少咽部气道空间，并可能加重阻塞性睡眠呼吸暂停（OSA）患者的阻塞性现象。虽然上颌扩弓已知会导致咽部气道容积（PAS）增加，但其在下颌后缩手术中对PAS的影响尚未见报道。作者报告了一种对上颌前突伴OSA的2例患者采用上颌扩弓的手术方法：上颌矢状劈开扩弓并尽量减少上颌前徙，同时进行少量下颌后缩且不进行下颌前部节段性截骨术（ASO），或进行上颌矢状劈开扩弓并尽量减少上颌前徙，同时进行大量下颌后缩并进行下颌ASO。术前和术后的计算机断层扫描及多导睡眠监测表明，OSA得到改善，咽部气道空间增加或维持，且前突的面部轮廓可矫正为可接受的面部美学轮廓。总之，上颌横向扩弓联合下颌后缩（伴或不伴下颌ASO）可成功应用于治疗伴有OSA的下颌前突。
