Lee Kevin C, Chuang Sung-Kiang, Mehra Pushkar
Resident, Division of Oral and Maxillofacial Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY.
Clinical Professor, Department of Oral and Maxillofacial Surgery, University of Pennsylvania, Philadelphia, PA; Private Practice, Brockton Oral and Maxillofacial Surgery Inc. Attending, Department of Oral and Maxillofacial Surgery, Good Samaritan Medical Center, Brockton, MA.
J Oral Maxillofac Surg. 2020 Dec;78(12):2282-2288. doi: 10.1016/j.joms.2020.08.005. Epub 2020 Aug 12.
The purpose of this study was to evaluate the efficacy of multilevel phase I surgery for the treatment of moderate obstructive sleep apnea (OSA) in retrognathic patients with oropharyngeal and hypopharyngeal obstruction.
This was a 10-year retrospective cohort study of patients treated by a single surgeon at the Boston University Medical Center. From 2000 to 2010, retrognathic patients with moderate OSA and verified palatal and tongue base obstruction were treated with multilevel phase I surgery that included uvulopalatopharyngoplasty, hyoid suspension, and genioglossus advancement. All patients were evaluated clinically and received polysomnographic studies at three time points: preoperatively (T1), between 6 and 12 months postoperatively (T2), and a minimum of 24 months postoperatively (T3).
Twenty-five subjects composed the final study sample. At T2, 11 patients (44.0%) experienced a complete response, 13 (52.0%) experienced a partial response, and 1 (4.0%) experienced no response. Although phase I surgery was associated with significant changes in AHI (F(2,48) = 119.3; P < .01) throughout the follow-up period, only one patient at T3 (4.0%) met the criteria for a complete response. The remaining patients were divided evenly between partial response (48.0%) and treatment failure (48.0%), of whom 4 (16.0%) patients had worsening of their obstruction. Thirteen of these patients subsequently elected to undergo maxillomandibular advancement, while 11 elected to continue using continuous positive airway pressure.
Although phase I surgery was associated with AHI changes, this reduction was not sufficient to produce a long-term treatment response in over half of our patients. Treatment response was worse after 2 years than at 6 to 12 months. Patients with moderate OSA should understand that multilevel phase I surgery has a greater chance of failure than success and that transient improvements may not be durable.
本研究旨在评估多阶段一期手术治疗下颌后缩伴口咽和下咽梗阻的中度阻塞性睡眠呼吸暂停（OSA）患者的疗效。
这是一项对波士顿大学医学中心由单一外科医生治疗的患者进行的为期10年的回顾性队列研究。2000年至2010年期间，对下颌后缩伴中度OSA且经证实存在腭部和舌根梗阻的患者进行了多阶段一期手术，包括悬雍垂腭咽成形术、舌骨悬吊术和颏舌肌前移术。所有患者均接受临床评估，并在三个时间点接受多导睡眠图检查：术前（T1）、术后6至12个月（T2）以及术后至少24个月（T3）。
最终研究样本包括25名受试者。在T2时，11名患者（44.0%）完全缓解，13名（52.0%）部分缓解，1名（4.0%）无缓解。尽管在整个随访期间一期手术与呼吸暂停低通气指数（AHI）的显著变化相关（F(2,48)=119.3；P<.01），但在T3时只有1名患者（4.0%）达到完全缓解标准。其余患者在部分缓解（48.0%）和治疗失败（48.0%）之间平均分配，其中4名（16.0%）患者梗阻加重。这些患者中有13名随后选择接受上颌下颌前移术，而11名选择继续使用持续气道正压通气。
尽管一期手术与AHI变化相关，但这种降低不足以使我们超过一半的患者产生长期治疗反应。2年后的治疗反应比6至12个月时更差。中度OSA患者应明白，多阶段一期手术失败的可能性大于成功，且短暂改善可能不持久。
