不同正颌手术术后上气道变化的锥形束 CT 评估：系统评价和荟萃分析。

Upper Airway Changes Following Different Orthognathic Surgeries, Evaluated by Cone Beam Computed Tomography: A Systematic Review and Meta-analysis.

机构信息

Dental Implant Research Center, Department of Oral and Maxillofacial Radiology.

Oral and Maxillofacial Radiology Department.

出版信息

J Craniofac Surg. 2021;32(2):e147-e152. doi: 10.1097/SCS.0000000000006940.

DOI:10.1097/SCS.0000000000006940

PMID:33705056

Abstract

PURPOSE

This study sought to assess the upper airway changes following different orthognathic surgeries using cone-beam computed tomography.

METHODS

An electronic search of the literature was conducted in major electronic databases including Medline (PubMed), Web of Science, Scopus, and Open Grey for articles published up to January 20, 2018. Human studies that evaluated the changes in the volume and minimum cross-sectional area of the upper airway or its subdivisions in patients who had undergone orthognathic surgery by use of cone-beam computed tomography were included. Manual search of the bibliographies of the included articles was also conducted. The included studies underwent risk of bias assessment.

RESULTS

A total of 1330 articles were retrieved. After excluding the duplicates and irrelevant articles, 41 studies fulfilled the eligibility criteria for this systematic review; out of which, 30 entered the meta-analysis. The majority of studies had a medium risk of bias. Mandibular setback, and maxillary advancement + mandibular setback decreased the volume of the upper airway (-6042.87 mm3 and -1498.78 mm3, respectively) and all its subdivisions in long-term (>3 months), except for the nasopharynx, the volume of which increased following maxillary advancement + mandibular setback. Mandibular advancement and maxillomandibular advancement both increased the upper airway volume in long-term (7559.38 mm3 and 7967.06 mm3, respectively); however, only the changes after the former procedure were significant. The minimum cross-sectional area increased after maxillomandibular advancement (161.43 mm2), and decreased following maxillary advancement + mandibular setback (-23.79 mm2) in long-term.

CONCLUSION

There is moderate evidence to suggest that mandibular advancement is the only orthognathic movement that provides a statistically significant change in long-term upper airway volume.

摘要

目的

本研究旨在通过锥形束 CT 评估不同正颌手术后的上气道变化。

方法

在 Medline（PubMed）、Web of Science、Scopus 和 Open Grey 等主要电子数据库中进行电子文献检索，检索截至 2018 年 1 月 20 日的文献。纳入使用锥形束 CT 评估正颌手术后上气道及其亚单位容积和最小横截面积变化的人体研究。还对纳入文章的参考文献进行了手工检索。纳入的研究进行了偏倚风险评估。

结果

共检索到 1330 篇文章。在排除重复和不相关的文章后，41 项研究符合本系统评价的纳入标准；其中 30 项研究纳入了荟萃分析。大多数研究存在中度偏倚风险。下颌骨后退和上颌骨前徙+下颌骨后退分别减少了上气道的容积（-6042.87 mm3 和-1498.78 mm3）及其所有亚单位（长期 >3 个月），除了鼻咽部，上颌骨前徙+下颌骨后退后鼻咽部容积增加。上颌骨前徙和上颌骨前徙+下颌骨后退均可增加上气道容积（分别为 7559.38 mm3 和 7967.06 mm3）；然而，只有前者的变化具有统计学意义。长期随访时，上颌骨前徙+下颌骨后退后最小横截面积减小（-23.79 mm2）。