基于双颌正颌手术后经过验证的上气道分析的两年术后上气道锥形束计算机断层扫描结果
Two-Year Postoperative Upper Airway Cone-Beam Computed Tomographic Outcomes Based on a Verified Upper Airway Analysis Following Bimaxillary Orthognathic Surgery.
作者信息
Gurani Sirwan Fernandez, Di Carlo Gabriele, Thorn Jens Jørgen, Ingerslev Janne, Cattaneo Paolo Maria, Pinholt Else Marie
机构信息
PhD Fellow, Department of Oral and Maxillofacial Surgery, Hospital of South West Denmark, Esbjerg; University of Southern Denmark, Faculty of Health Sciences, Institute of Regional Health Services Sciences, Esbjerg, Denmark.
Consultant, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy; Section of Orthodontics, Department of Dentistry and Oral Health, Faculty of Health Science, Aarhus University, Aarhus, Denmark.
出版信息
J Oral Maxillofac Surg. 2019 Jul;77(7):1435-1445. doi: 10.1016/j.joms.2019.02.038. Epub 2019 Mar 5.
PURPOSE
Upper airway (UA) assessment after orthognathic surgery should rely on a verified method of UA analysis. Therefore, the authors applied a new validated UA evaluation method to determine the effect of bimaxillary surgery (BMS) on UA parameters and hyoid bone and epiglottis displacement evaluated immediately and 2 years after surgery.
MATERIALS AND METHODS
A retrospective cohort study was implemented of patients without obstructive sleep apnea who had undergone BMS for maxillomandibular deficiencies. A new validated UA cone-beam computed tomographic (CBCT) analysis, based on stable anatomic landmarks, was applied to CBCT scans acquired before initiation of treatment (T0), immediately after surgery (T1), and 2 years postoperatively (T2). A quality assessment was performed before analysis. The primary predictor variable consisted of time points during treatment (T0, T1 and T2), and UA volumes, cross-sectional area (CSA), and hyoid bone and epiglottis displacement were the outcome variables. Descriptive statistics and t test were performed and the P value was set at .05.
RESULTS
Fifty patients (16 men and 34 women) with a mean age of 25.7 ± 8.2 years at time of surgery were included. CBCT scans were acquired at T0 (20 ± 9 months before surgery), T1 (14 ± 2 days after surgery), and T2 (30 ± 6 months after surgery). Immediately after surgery (T1 vs T0), BMS resulted in a statistically relevant UA volume increase of 26%. At 2-year follow-up (T2 vs T0), UA volume showed a statistically relevant increase by 20%. CSA increased by approximately 26 and 19% (P < .001) at T1 versus T0 and T2 versus T0, respectively. Two years after surgery, epiglottis displacement was 2 mm (P < .001) and hyoid bone displacement was 3 mm (P < .001) in a cranial direction and hyoid bone anterior displacement measured 3 mm (P < .001).
CONCLUSIONS
Based on an objective, standardized, and validated CBCT UA analysis, BMS was associated with increased UA volume and CSA measures evaluated immediately and 2 years after surgery.
目的
正颌外科手术后的上气道（UA）评估应依赖于经过验证的UA分析方法。因此，作者应用一种新的经过验证的UA评估方法，以确定双颌手术（BMS）对UA参数以及舌骨和会厌移位的影响，这些影响在术后即刻及术后2年进行评估。
材料与方法
对因颌骨发育不全接受BMS且无阻塞性睡眠呼吸暂停的患者进行一项回顾性队列研究。一种基于稳定解剖标志点、经过验证的新的UA锥形束计算机断层扫描（CBCT）分析方法，应用于治疗开始前（T0）、术后即刻（T1）和术后2年（T2）获取的CBCT扫描图像。在分析前进行质量评估。主要预测变量包括治疗期间的时间点（T0、T1和T2），UA容积、横截面积（CSA）以及舌骨和会厌移位为结果变量。进行描述性统计和t检验，P值设定为0.05。
结果
纳入50例患者（16例男性和34例女性），手术时平均年龄为25.7±8.2岁。在T0（术前20±9个月）、T1（术后14±2天）和T2（术后30±6个月）获取CBCT扫描图像。术后即刻（T1对比T0），BMS导致UA容积在统计学上有显著增加，增幅为26%。在2年随访时（T2对比T0），UA容积在统计学上有显著增加，增幅为20%。CSA在T1对比T0以及T2对比T0时分别增加了约26%和19%（P<0.001）。术后2年，会厌移位为2mm（P<0.00），舌骨向上移位3mm（P<0.001），舌骨向前移位3mm（P<0.001）。
结论
基于客观、标准化且经过验证的CBCT UA分析，BMS与术后即刻及术后2年评估的UA容积增加和CSA测量值增加相关。
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