School of Medicine of Ribeirao Preto, University of Sao Paulo, Brazil.
Samaritano Hospital- São Paulo, Brazil.
J Craniomaxillofac Surg. 2020 Apr;48(4):339-348. doi: 10.1016/j.jcms.2020.02.007. Epub 2020 Feb 29.
To investigate the changes induced by surgically assisted rapid maxillary expansion (SARME) on palate and pharynx morphology as well as the correlation of these changes with the improvement of obstructive sleep apnea (OSA).
The study was conducted in 16 patients, seven women and nine men, aged on average 40.23 ± 10.23 years, all of them with OSA confirmed by polysomnography (PSG) and with posterior crossbite. All participants underwent computed tomography (CT) and PSG before and after SARME. The CT scans were used to determine the dimensions of the palate and pharynx before and after surgery. Data were analyzed statistically by the paired t-test, Wilcoxon test and Pearson correlation, with the level of significance set at P < 0.05.
A 56.24% reduction in apnea and hypopnea index was detected (from 33.23 ± 39.54 to 14.54 ± 19.48: P = 0.001). The total airway area increased on average by 23.99% (P = 0.016), although in a more expressive manner in its lower half (28.63%, P = 0.008). A 24% transverse bone increase was observed in the palate in the region of the first premolars and an 18% increase in the region of the first molars (from 2.42 ± 0.31 to 2.99 ± 0.26. P < 0.001, and from 3.11 ± 0.32 to 3.70 ± 0.41, P < 0.001, respectively), and a mean 15% reduction of its depth (from 1.07 ± 0.33 to 0.89 ± 0.18, P = 0.014). A moderate correlation was detected between palate depth and width and OSA severity, as well as a correlation of the reduction of palate depth and its transverse increase with the improvement of OSA, especially among patients with severe OSA.
It appears that narrowing of the palate, especially in the premolar region, and its greater depth may be related to the severity of OSA. SARME promotes transverse maxillary widening and lowering of palate depth, thus reducing OSA among adults and expanding the airway, especially in its lower half.
研究手术辅助上颌快速扩弓（SARME）对上颚和咽部形态的影响，以及这些变化与阻塞性睡眠呼吸暂停（OSA）改善的相关性。
该研究纳入了 16 名患者，7 名女性和 9 名男性，平均年龄为 40.23±10.23 岁，所有人均经多导睡眠图（PSG）证实存在 OSA 且伴有后牙反合。所有参与者在 SARME 前后均接受了计算机断层扫描（CT）和 PSG。CT 扫描用于确定手术前后上颚和咽部的尺寸。通过配对 t 检验、Wilcoxon 检验和 Pearson 相关性分析对数据进行统计学分析，显著性水平设为 P<0.05。
检测到呼吸暂停和低通气指数降低了 56.24%（从 33.23±39.54 降至 14.54±19.48：P=0.001）。总气道面积平均增加了 23.99%（P=0.016），尽管在下半部分更为明显（28.63%，P=0.008）。在上颚第一前磨牙区域观察到 24%的横向骨增加，第一磨牙区域增加 18%（从 2.42±0.31 增加到 2.99±0.26，P<0.001，从 3.11±0.32 增加到 3.70±0.41，P<0.001），其深度平均减少 15%（从 1.07±0.33 减少到 0.89±0.18，P=0.014）。在上颚深度和宽度与 OSA 严重程度之间检测到中度相关性，在上颚深度减小及其横向增加与 OSA 改善之间存在相关性，尤其是在严重 OSA 的患者中。
上颚狭窄，尤其是前磨牙区域，以及较大的深度可能与 OSA 的严重程度有关。SARME 促进上颌横向扩宽和上颚深度降低，从而减轻成人 OSA，并扩大气道，尤其是在下半部分。
