孤立Le Fort Ⅰ型截骨术矫治垂直性上颌骨过长后咽气道三维变化的评估：一项前瞻性研究
Evaluation of Three-Dimensional Changes in Pharyngeal Airway Following Isolated Lefort One Osteotomy for the Correction of Vertical Maxillary Excess: A Prospective Study.
作者信息
Vijayakumar Jain S, Muthusekhar M R, Baig M F, Senthilnathan P, Loganathan S, Abdul Wahab P U, Madhulakshmi M, Vohra Yogaen
机构信息
1Present Address: Department of Oral and Maxillofacial Surgery, Sri Hasanamba Dental College and Hospital, Hassan, Karnataka 573202 India.
2Department of Oral and Maxillofacial Surgery, Saveetha University, 162, Poonamallee High Road, Velappanchavadi, Chennai, Tamil Nadu 600077 India.
出版信息
J Maxillofac Oral Surg. 2019 Mar;18(1):139-146. doi: 10.1007/s12663-018-1113-4. Epub 2018 May 8.
BACKGROUND
Orthognathic surgery involves movement of jaws in all three planes, and this being a part of airway complex, displacement of jaws can influence the dimension of airway at all levels. Lefort one osteotomy surgery with superior repositioning is a common procedure done for patients with vertical maxillary excess.
PURPOSE
The purpose of this study was to evaluate the three-dimensional volumetric changes in airway after lefort one impaction surgery using three-dimensional cone beam computed tomography (3D-CBCT) in patients with vertical maxillary excess (VME).
METHODS
A prospective analysis of 15 patients who underwent isolated lefort one impaction surgery was done with pre-operative (T0) and 3-months (T1) post-operative 3D-CBCT scans. Airway was divided into three segments, nasopharyngeal, velopharyngeal and oropharyngeal. Volumetric analysis of all these segments was done before and after surgery. Paired 't test' was used to assess the mean difference in airway volume and area between T0 and T1. One-way ANOVA was used to check the mean percentage difference in airway volume and area among the three segments.
RESULTS
The mean percentage of nasopharyngeal volume difference was - 0.6299 ± 0.9146%, velopharyngeal volume difference was - 0.5205 ± 1.107%, oropharyngeal volume difference was - 1.492 ± 2.745%. Though volume and area of pharyngeal airway were decreased after maxillary impaction surgery in all three segments of airway studied, they were not statistically significant.
CONCLUSION
Among the three segments of airway studied, oropharyngeal airway volume has shown the highest post-surgical reduction though statistically insignificant. ESS scores were within normal limits. Hence, we are of the opinion that there is lack of evidence to conclude that the patients undergoing lefort one superior repositioning for the treatment of VME might develop significant narrowing of PAS that may predispose the patient to breathing disorders.
背景
正颌外科手术涉及颌骨在三个平面上的移动，而颌骨作为气道复合体的一部分，其移位会影响各级气道的尺寸。上颌骨垂直过长患者常采用上颌骨Le Fort Ⅰ型截骨术并向上重新定位。
目的
本研究旨在使用三维锥形束计算机断层扫描（3D-CBCT）评估上颌骨垂直过长（VME）患者行Le Fort Ⅰ型骨块截骨术（lefort one impaction surgery）后气道的三维容积变化。
方法
对15例行单纯Le Fort Ⅰ型骨块截骨术的患者进行前瞻性分析，术前行三维锥形束CT扫描（T0），术后3个月行三维锥形束CT扫描（T1）。气道分为鼻咽部、腭咽部和口咽部三个节段。对所有这些节段在手术前后进行容积分析。采用配对t检验评估T0和T1之间气道容积和面积的平均差异。采用单因素方差分析检查三个节段之间气道容积和面积的平均百分比差异。
结果
鼻咽部容积平均百分比差异为-0.6299±0.9146%，腭咽部容积差异为-0.5205±1.107%，口咽部容积差异为-1.492±2.745%。尽管在所研究的气道所有三个节段中，上颌骨截骨术后咽气道的容积和面积均减小，但差异无统计学意义。
结论
在所研究的气道三个节段中，口咽气道容积术后减小幅度最大，尽管差异无统计学意义。ESS评分在正常范围内。因此，我们认为，没有证据可以得出结论，即接受Le Fort Ⅰ型向上重新定位治疗VME的患者可能会出现明显的PAS狭窄，从而使患者易患呼吸障碍。
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