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改良鼻至口腔气管导管转换的评估——用于上颌正颌手术后改良鼻翼基底收紧术

Evaluation of modified nasal to oral endotracheal tube switch-For modified alar base cinching after maxillary orthognathic surgery.

作者信息

Shaik Taj Nizam Shakeel, Meka Sridhar, Ch Pavan Kumar, Kolli Naga Neelima Devi, Chakravarthi P Srinivas, Kattimani Vivekanand S, L Krishna Prasad

机构信息

Department of Oral and Maxillofacial Surgery, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, 522509, India.

出版信息

J Oral Biol Craniofac Res. 2017 May-Aug;7(2):75-80. doi: 10.1016/j.jobcr.2017.03.008. Epub 2017 Mar 23.

Abstract

BACKGROUND

Soft tissue changes secondary to Maxillary orthognathic surgery are many fold. The alar flare is one among them, which affects the appearance of the patient. Cinch suture has been used to prevent alar flare; but the presence of anaesthetic tube hinders cinching. So, the study was aimed to assess an efficacy of modified nasal to oral tube switch technique for modified alar cinching to prevent alar flare after orthognathic and nasal corrective surgeries.

MATERIALS AND METHODS

Patients were randomly allocated in each group, who underwent modified alar base cinching with and without nasal to oral tube switch. Changes in alar base width, upper lip length was measured with Digital Vernier Caliper and nasolabial angle (Cotg-Sn-Ls) on lateral cephalogram at 1st, 3rd, 6th, and 12th months after surgery. The time taken and ease of tube switch were noted. The data obtained were tabulated and interpreted using a test of significance.

RESULTS

Study results showed no statistical significant difference in perinasal soft changes among both groups. But tube switch appears to be beneficial to prevent alar flare.

CONCLUSION

Modified alar base cinching was performed effectively in patients with a modified tube switch technique. It increased positive results in comparison with non-shift. The technique of tube switch used is effective in prevention of alar flare. Because of small sample size and limited period of follow up, our study suggests multi centre, randomized studies to know the technical difficulties of tube switch for cinching and aesthetic results with varying anaesthetist and the surgeon's experience.

摘要

背景

上颌正颌手术后继发的软组织变化是多方面的。鼻翼外扩就是其中之一,它会影响患者的外观。收紧缝合已被用于预防鼻翼外扩;但麻醉管的存在会妨碍收紧操作。因此,本研究旨在评估改良鼻至口插管转换技术用于改良鼻翼收紧以预防正颌和鼻整形手术后鼻翼外扩的疗效。

材料与方法

将患者随机分为两组,一组进行改良鼻翼基底收紧并采用鼻至口插管转换,另一组不采用。在术后第1、3、6和12个月,使用数字游标卡尺测量鼻翼基底宽度、上唇长度,并在侧位头影测量片上测量鼻唇角(Cotg-Sn-Ls)。记录插管转换所需时间和难易程度。将获得的数据制成表格,并使用显著性检验进行解释。

结果

研究结果显示两组鼻周软组织变化无统计学显著差异。但插管转换似乎有利于预防鼻翼外扩。

结论

采用改良插管转换技术对患者进行改良鼻翼基底收紧操作有效。与未转换相比,其阳性结果有所增加。所采用的插管转换技术对预防鼻翼外扩有效。由于样本量小且随访期有限,我们的研究建议进行多中心随机研究,以了解不同麻醉师和外科医生经验下插管转换收紧操作的技术难点及美学效果。

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本文引用的文献

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Simplified Technique to Change the Endotracheal Tube from Nasal to Oral Cavity.将气管内导管从鼻腔更换至口腔的简化技术。
J Maxillofac Oral Surg. 2017 Sep;16(3):392-394. doi: 10.1007/s12663-016-0908-4. Epub 2016 Apr 28.
3
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Comparison of two techniques of cinch suturing to avoid widening of the base of the nose after Le Fort I osteotomy.
Br J Oral Maxillofac Surg. 2010 Jul;48(5):356-9. doi: 10.1016/j.bjoms.2009.08.007. Epub 2009 Sep 8.
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Nasal vs oral intubation.经鼻插管与经口插管
Minerva Anestesiol. 2003 May;69(5):348-52.
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Changes in facial movement after maxillary osteotomies.上颌骨截骨术后面部运动的变化。
J Oral Maxillofac Surg. 1997 Oct;55(10):1044-8; discussion 1048-9. doi: 10.1016/s0278-2391(97)90275-5.

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