Saleh Eli, Saleh Joseph, Beauchemin Gabriel, El-Jalbout Ramy, Borsuk Daniel E
Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Quebec, Canada.
Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
Plast Reconstr Surg Glob Open. 2020 Nov 30;8(11):e3232. doi: 10.1097/GOX.0000000000003232. eCollection 2020 Nov.
The effects of maxillary advancement on velopharyngeal anatomy have primarily been studied using lateral cephalometric radiographs. However, with recent advances in orthognathic surgery, there is an increased need for more detailed and precise imaging such as computerized tomographic (CT) scan reconstructions, to help in surgical planning and to measure outcomes. The purpose of this study was to compare the pre- and post-operative velopharyngeal anatomic configuration modifications as measured on CT scans.
This is a retrospective cohort study of 44 patients with and without cleft palate who were treated with maxillary advancement. The pre- and post-operative CT scans were compared with respect to pre-established landmarks. Linear distances, cross-sectional areas, and volumes were measured using 3-dimensional CT scan reconstructions.
For the linear distances measured, a statistically significant difference was found when comparing the pre- and post-operative measures of the narrowest part of the nasopharynx and the narrowest part of the retropalatal airway space ( = 0.001 and 0.026, respectively). Retropalatal cross-sectional areas, nasopharyngeal cross-sectional areas, and the volumetric assessment of the nasopharyngeal space showed no statistically significant differences when comparing pre- and post-operative scans ( < 0.05). Mean changes in the measures did not differ over time (pre- and post-operative) depending on whether there was a prior history of cleft palate repair.
Although structural modifications of the pharyngeal space are inherent to maxillary advancement, its surface area and volume do not significantly change. The use of 3-dimensional reconstruction using CT scans should be the first choice for evaluation of the upper airway.
上颌前徙对腭咽解剖结构的影响主要通过头颅侧位X线片进行研究。然而，随着正颌外科手术的最新进展，对更详细、精确成像（如计算机断层扫描（CT）扫描重建）的需求日益增加，以辅助手术规划并评估手术效果。本研究的目的是比较CT扫描测量的上颌前徙手术前后腭咽解剖结构的改变。
这是一项回顾性队列研究，纳入了44例接受上颌前徙治疗的腭裂患者和非腭裂患者。将术前和术后的CT扫描与预先确定的标志点进行比较。使用三维CT扫描重建测量线性距离、横截面积和体积。
对于测量的线性距离，比较鼻咽最窄处和腭后气道间隙最窄处的术前和术后测量值时，发现有统计学显著差异（分别为 = 0.001和0.026）。比较术前和术后扫描时，腭后横截面积、鼻咽横截面积以及鼻咽空间的容积评估均无统计学显著差异（ < 0.05）。测量值的平均变化在术前和术后并未随时间不同，且与是否有腭裂修复史无关。
尽管上颌前徙必然会导致咽腔结构改变，但其表面积和体积并无显著变化。使用CT扫描进行三维重建应作为评估上气道的首选方法。
