Li H H, Liu H Z, Li Q L, Bi R Y, Zhu S S
Department of Orthognathic and Temporomandibular Joint Surgery, West China Hospital of Stomatology, Sichuan University & State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Chengdu 610041, China.
Zhonghua Kou Qiang Yi Xue Za Zhi. 2022 Jul 2;57(7):708-715. doi: 10.3760/cma.j.cn112144-20220401-00150.
To evaluate the 2-dimension and 3-dimension changes of upper airway of patients who were diagnosed with idiopathic condylar resorption (ICR) and anterior open bite as well as received bilateral temporomandibular joint (TMJ) prostheses replacement or bimaxillary orthognathic surgery. This study is a retrospective study. Seventeen patients diagnosed as ICR and anterior open bite in Department of Orthognathic and TMJ surgery, West China Hospital of Sichuan University were selected (January 2018 to December 2021) and divided into bilateral TMJ protheses replacement group (group R, =8) and orthognathic group (group O, =9), according to which surgery they have performed. In order to compare variation of upper airway before and after surgery in different dimensions and sections within the same group or between groups, Spiral computed tomography data were obtained before (1 month) and after operation (10 to 12 months) to measure the total volume of airway (VT), the maximum sagittal area (MSA), the maximum cross-sectional area (MACA), the minimum cross-sectional area (MICA), the area of the most posterior plane(PPA), the area of soft-palate plane (SPA), the area of the most posterior point of tongue base plane (PTA), the area of the root of epiglottis plane (EA), the oropharyngeal airway volume (VO), the glossopharyngeal airway volume (VG) and the laryngeal airway volume (VL). Wilcoxon signed-rank test were used to complete statistical analyses for VO (T2),SPA (T2),ΔMSA,ΔMACA in group R as well as PTA (T1),EA (T2) in group O. Statistical analyses of other items were performed with student's test. VT, VO, VG, VL, MSA, MACA, MIC, PPA, PTA and EA of group R (T2) were significantly increased after TMJ prosthesis with Lefort I osteotomy (<0.05). Meanwhile the VT, VO, VG, MSA, MACA, MICA, PPA and SPA of group O (T2) were significantly increased (<0.05). There were significant difference in ΔVT and ΔVL between group R [(6 854.80±3 197.82) mm, (2 252.85±1 527.96) mm] and group O [(3 367.91±3 124.62) mm, (413.21±1 244.44) mm](=2.27, =0.038; =2.74, =0.015). Bilateral temporomandibular joint (TMJ) prostheses replacement and bimaxillary orthognathic surgery can both enlarge the areas and volumes of upper airway in patients who suffer from ICR and anterior open bite. Compared with bimaxillary orthognathic surgery, bilateral temporomandibular joint prostheses replacement plays a more pronounced role in enlargement and reconstruction of middle-inferior section of upper airway.
评估诊断为特发性髁突吸收（ICR）和前牙开（牙合）并接受双侧颞下颌关节（TMJ）假体置换或双颌正颌手术患者的上气道二维和三维变化。本研究为回顾性研究。选取四川大学华西医院正颌与颞下颌关节外科诊断为ICR和前牙开（牙合）的17例患者（2018年1月至2021年12月），根据其所接受的手术方式分为双侧TMJ假体置换组（R组，n = 8）和正颌组（O组，n = 9）。为比较同一组内或组间不同维度和节段手术前后上气道的变化，在术前（1个月）和术后（10至12个月）获取螺旋计算机断层扫描数据，以测量气道总体积（VT）、最大矢状面积（MSA）、最大横截面积（MACA）、最小横截面积（MICA）、最后平面面积（PPA）、软腭平面面积（SPA）、舌根平面最后点面积（PTA）、会厌根部平面面积（EA）、口咽气道体积（VO）、舌咽气道体积（VG）和喉气道体积（VL）。采用Wilcoxon符号秩检验对R组的VO（T2）、SPA（T2）、ΔMSA、ΔMACA以及O组的PTA（T1）、EA（T2）进行统计分析。其他项目的统计分析采用学生t检验。R组（T2）行TMJ假体联合Le Fort I截骨术后VT、VO、VG、VL、MSA、MACA、MIC、PPA、PTA和EA均显著增加（P < 0.05）。同时，O组（T2）的VT、VO、VG、MSA、MACA、MICA、PPA和SPA也显著增加（P < 0.05）。R组[（6 854.80±3 197.82）mm³，（2 252.85±1 527.96）mm³]与O组[（3 367.91±3 124.62）mm³，（413.21±1 244.44）mm³]的ΔVT和ΔVL存在显著差异（t = 2.27，P = 0.038；t = 2.74，P = 0.015）。双侧颞下颌关节（TMJ）假体置换和双颌正颌手术均可扩大ICR和前牙开（牙合）患者的上气道面积和体积。与双颌正颌手术相比，双侧颞下颌关节假体置换在上气道中下节段的扩大和重建中发挥更显著的作用。
