Department of Orthodontics, West Virginia University, Morgantown, WVa.
Department of Family Medicine, West Virginia University, Morgantown, WVa.
Am J Orthod Dentofacial Orthop. 2020 Oct;158(4):527-534. doi: 10.1016/j.ajodo.2019.09.016. Epub 2020 Aug 14.
This study aimed to evaluate the follow-up observation of patients with obstructive sleep apnea treated with maxillomandibular advancement (MMA) procedure with or without genial tubercle advancement (GTA).
A total of 25 patients (mean age 37.1 ± 17.3 years) were included in the study. Cone-beam computed tomography scans were taken before treatment; after presurgical orthodontic treatment; immediately after MMA procedure; and follow-up visit. All Digital Imaging and Communications in Medicine files were analyzed using the Dolphin 3D Imaging software program (Dolphin Imaging and Management Solutions, Chatsworth, Calif) to determine the total airway volume (TAV), airway area (AA), and minimal cross-sectional area (MCA). Dolphin 3D voxel-based superimposition was used to determine the amount of skeletal advancement with MMA and changes after surgery.
Significant increase in TAV, AA, and MCA was found with MMA treatment (40.6%, 28.8%, and 56.4%, respectively, P <0.0001). Smaller but significant decrease in TAV, AA, and MCA was found during a follow-up visit (20.0%, 9.7%, and 26.8%, respectively, P <0.0001) giving a net increase of TAV, AA and MCA (35.8%, 27.1%, and 45.9%, respectively). No significant differences were found in any of the airway measurements with or without the GTA procedure. The average forward movements of the maxilla, mandible, and chin were 6.6 mm, 8.2 mm, and 11.4 mm, respectively. A relapse of less than 1 mm was found in each of the variables during the follow-up period. No correlation was found between the magnitudes of skeletal advancement and the change in oropharyngeal airway space (OPAS).
Significant increase in OPAS can be expected with MMA surgery with or without GTA procedure in patients diagnosed with obstructive sleep apnea. A partial loss in OPAS was found during the follow-up visit. The surgical movements were found to be stable, with less than 1 mm of relapse during the follow-up period, which was not clinically significant.
本研究旨在评估接受上颌骨前移（MMA）手术联合或不联合颏舌肌前徙（GTA）治疗的阻塞性睡眠呼吸暂停患者的随访观察结果。
本研究共纳入 25 例患者（平均年龄 37.1±17.3 岁）。所有患者在治疗前、术前正畸治疗后、MMA 手术后即刻和随访时均进行锥形束 CT 扫描。使用 Dolphin 3D 成像软件（Dolphin Imaging and Management Solutions，加利福尼亚州查茨沃斯）对所有的医学数字成像和通信（DICOM）文件进行分析，以确定总气道容积（TAV）、气道面积（AA）和最小横截面积（MCA）。使用 Dolphin 3D 体素叠加来确定 MMA 治疗时的骨骼前移量以及术后的变化。
MMA 治疗后 TAV、AA 和 MCA 均显著增加（分别为 40.6%、28.8%和 56.4%，P<0.0001）。随访时 TAV、AA 和 MCA 均有较小但显著的下降（分别为 20.0%、9.7%和 26.8%，P<0.0001），导致 TAV、AA 和 MCA 的净增加（分别为 35.8%、27.1%和 45.9%）。无论是否进行 GTA 手术，气道测量值均无显著差异。上颌骨、下颌骨和颏骨的平均向前移动距离分别为 6.6mm、8.2mm 和 11.4mm。在随访期间，每个变量都有不到 1mm 的复发。在骨骼前移量与口咽气道空间（OPAS）变化之间未发现相关性。
患有阻塞性睡眠呼吸暂停的患者接受 MMA 手术联合或不联合 GTA 手术治疗后，OPAS 显著增加。在随访期间发现 OPAS 部分丧失。手术移动稳定，随访期间复发小于 1mm，无临床意义。
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