Cillo Joseph E, Dattilo David J
Associate Professor and Program Director, Division of Oral and Maxillofacial Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA.
Associate Professor and Division Director, Division of Oral and Maxillofacial Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA.
J Oral Maxillofac Surg. 2019 Dec;77(12):2524-2528. doi: 10.1016/j.joms.2019.06.176. Epub 2019 Jul 2.
Because limited data have been reported, the purpose of the present study was to evaluate the long-term craniofacial cephalometric skeletal changes associated with maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA).
We performed a retrospective cephalometric cohort study of craniofacial skeletal changes in patients who had undergone MMA for OSA. The primary predictor and outcome variables were time and the change in SNB over time, respectively. Digitized cephalometric radiographs were analyzed by an independent third-party cloud-based tracing software for 6 skeletal landmarks at 3 points-preoperatively, within 1 month postoperatively, and at the last follow-up evaluation. Post hoc stratification bidimensional analyses by gender and preoperative age and body mass index (BMI) were performed. Clinically significant results were determined as a greater than 2% change from baseline. Univariate and bivariate statistics were computed, and the statistical significance level was set at P < .05.
Thirty consecutive subjects with an even gender distribution were included in the present study. The average preoperative age, apnea hypopnea index, and BMI were 43.7 years, 59.8, and 39.3 kg/m. The average follow-up duration was 10.7 years (range, 5.6 to 18.8). Statistically and clinically significant long-term postoperative changes were found only for SNA (+4.9° or +6.0%; P < .001) and SNB (+3.8° or +4.9%; P < .001). Stratification by gender and median preoperative age and BMI did not find any statistically or clinically significant results.
Within the limitations of the present study, MMA for OSA produced statistically and clinically significant long-term cephalometric skeletal horizontal angular advancement of the maxilla and mandible of 6 and 4.9%, respectively, independently of gender, age, or BMI.
由于已报道的数据有限，本研究的目的是评估与阻塞性睡眠呼吸暂停（OSA）的上颌下颌前徙术（MMA）相关的长期颅面骨骼测量变化。
我们对接受MMA治疗OSA的患者的颅面骨骼变化进行了一项回顾性头影测量队列研究。主要预测变量和结果变量分别是时间和随时间变化的SNB。数字化头影测量X线片由独立的第三方基于云的追踪软件在术前、术后1个月内和最后一次随访评估的3个时间点对6个骨骼标志点进行分析。按性别、术前年龄和体重指数（BMI）进行事后分层二维分析。具有临床意义的结果被确定为与基线相比变化大于2%。计算单变量和双变量统计量，统计显著性水平设定为P < 0.05。
本研究纳入了30例性别分布均匀的连续受试者。术前平均年龄、呼吸暂停低通气指数和BMI分别为43.7岁、59.8和39.3kg/m²。平均随访时间为10.7年（范围5.6至18.8年）。仅发现SNA（+4.9°或+6.0%；P < 0.001）和SNB（+3.8°或+4.9%；P < 0.001）有统计学和临床意义的长期术后变化。按性别、术前年龄中位数和BMI分层未发现任何统计学或临床意义的结果。
在本研究的局限性内，用于OSA的MMA在统计学和临床上产生了上颌和下颌分别为6%和4.9%的显著长期头影测量骨骼水平角度前徙，与性别、年龄或BMI无关。
