Liang Yingxiang, Cheng Wenjie, Shu Kaiyi, Ma Lunkun, Ke Cheng, Xu Xi, Zhao Shanbaga, Li Lei, Zhang Zhiyong, Liu Wei
Chinese Academy of Medical Sciences & Peking Union Medical College.
J Clin Sleep Med. 2025 Aug 1. doi: 10.5664/jcsm.11826.
Mandibular distraction osteogenesis (MDO) is recommended for children with craniofacial microsomia (CFM) and obstructive sleep apnea (OSA). However, its efficacy remains limited, with success rates of 36.4%-60%. The role of adenoid hypertrophy (AH) in persistent OSA post-MDO has not been been fully investigated. This study aimed to evaluate the role of AH in influencing MDO outcomes and to explore its contribution to the pathophysiology and treatment of OSA in patients with CFM.
A retrospective analysis was conducted on 72 patients with CFM undergoing MDO. Preoperative adenoid size was assessed using adenoid/nasopharyngeal (A/N) ratios from cranial CT scans. Polysomnographic data, including pre- and postoperative obstructive apnea-hypopnea index (OAHI), were analyzed. Patients were classified into effective and ineffective groups based on postoperative OSA improvement. Statistical correlations between A/N ratios, OSA severity, Pruzansky-Kaban classification and treatment outcomes were examined.
AH prevalence among patients with CFM with OSA was 61.1%. A/N ratios correlated with postoperative OAHI (r = 0.261, p = 0.027), but not with preoperative OAHI. The ineffective group had higher A/N ratios than the effective group (0.69 ± 0.13 vs. 0.64 ± 0.12). Overall MDO effectiveness rate was 47.22%, with greater improvement observed in patients with severe OSA. No significant association was found between the Pruzansky-Kaban classification and either OSA severity or MDO treatment outcomes.
Adenoid hypertrophy plays a significant role in persistent OSA post-MDO, particularly in mild to moderate cases. Routine preoperative assessment of AH, combined with targeted interventions such as adenoidectomy when indicated, may improve treatment outcomes. These findings underscore the importance of addressing both skeletal and soft tissue factors in the comprehensive management of OSA in patients with CFM.
对于患有颅面短小畸形（CFM）和阻塞性睡眠呼吸暂停（OSA）的儿童，推荐采用下颌骨牵张成骨术（MDO）。然而，其疗效仍然有限，成功率为36.4%-60%。腺样体肥大（AH）在MDO术后持续性OSA中的作用尚未得到充分研究。本研究旨在评估AH在影响MDO结果中的作用，并探讨其对CFM患者OSA病理生理学和治疗的贡献。
对72例接受MDO的CFM患者进行回顾性分析。术前腺样体大小通过头颅CT扫描的腺样体/鼻咽（A/N）比值进行评估。分析多导睡眠图数据，包括术前和术后阻塞性呼吸暂停低通气指数（OAHI）。根据术后OSA改善情况将患者分为有效组和无效组。检查A/N比值、OSA严重程度、普鲁赞斯基-卡班分类与治疗结果之间的统计相关性。
患有OSA的CFM患者中AH的患病率为61.1%。A/N比值与术后OAHI相关（r = 0.261，p = 0.027），但与术前OAHI无关。无效组的A/N比值高于有效组（0.69±0.13 vs. 0.64±0.12）。总体MDO有效率为47.22%，重度OSA患者改善更明显。未发现普鲁赞斯基-卡班分类与OSA严重程度或MDO治疗结果之间存在显著关联。
腺样体肥大在MDO术后持续性OSA中起重要作用，尤其是在轻至中度病例中。常规术前评估AH，并在必要时结合如腺样体切除术等有针对性的干预措施，可能会改善治疗结果。这些发现强调了在CFM患者OSA综合管理中解决骨骼和软组织因素的重要性。
